Diphtheria rhinitis

Diphtheritic runny nose or diphtheria of the nose most often occurs in newborns a few days after birth or 3-8 months later, most often in the cold season. In the initial period, the clinical picture corresponds to acute banal rhinitis: nasal congestion, difficulty in nasal breathing (which disrupts the feeding of the infant), nasal discharge is muco-purulent, sometimes with a gray or bloody tinge, with an unpleasant odor. Soon after the appearance of discharge from the nose, the skin around the nostrils is macerated. Films and surface erosion appear on the mucous membrane of the nose. This form of diphtheritic cold is usually not accompanied by severe intoxication, but has a tendency to prolonged flow. In the foreign literature, numerous clinical forms of diphtheritic cold are described.

Clinical forms:

• "Simple" diphtheria of the nose is limited only to the defeat of the nasal mucosa without any pathognomonic signs of diphtheritic inflammation.
• The pseudomembranous form of the diphtheria of the nose is characterized by the appearance of pseudomembranous raids that can cover the entire surface of the mucous membrane of the nasal cavity and spread to the mucous membrane of the nasopharynx. This form is often combined with a fibrinous form caused by a Leffler's stick, combined with pneumococcus and staphylococcus.
• The erosive form of diphtheria of the nose is characterized by the appearance in the nose of numerous erosions and ulcers, located under pseudomembranous films. Sometimes this form develops against the background of the primary "dry" rhinitis in the absence of the symptoms described above.
• The latent or "occult" form of nasal diphtheria is characterized by the fact that in the nasal cavity it is not possible to detect any morphological changes characteristic of the diphtheria process, however, a diphtheria bacillus is found in the nasal mucus. From simple bacteriocarrier this form differs in that in the general clinical picture reveal choleric forms of the gastrointestinal tract or syndrome of severe bronchopneumonia.
• The extensive form of diphtheria of the nose is characterized by the spread of infection to neighboring areas both in close proximity (conjunctivitis, sinusitis, otomastoid, tubo-otitis), and at some distance (laryngitis, meningitis, etc.). A characteristic feature of this form of diphtheria of the nose is that the primary focus of infection is the nasal mucosa.
• The paralytic (polyneuritic) form of the diphtheria of the nose, like in the diphtheria of other localizations, is characterized by initial or delayed paralysis of certain cranial nerves and vertebral nerves. Thus, the lesion of the glossopharyngeal nerve (IX pair) is manifested by a loss of taste sensitivity on the same posterior third of the tongue, unilateral paralysis of the soft palate, nasal congestion, swallowing disorder, and sometimes Sicar syndrome (neuralgia of the IX nerve); defeat of the vagus nerve (X pair) leads to disruption of numerous motor functions of the pharynx and larynx as paresis and paralysis, secretory functions and functions of vital organs. Bilateral total defeat of the vagus nerve or its nuclei leads to the so-called vagal death due to the cessation of respiratory and vasomotor functions.
• Recurrent and chronic forms of diphtheria of the nose are observed mainly in bacterial carriers. Their general condition slowly but progressively worsens, reaching a state of total exhaustion, culminating in death, or before any complication with the same outcome.

Complications of nasal diphtheria are basically the same as those with a measles runny nose. The late complications include cicatricial stenoses of the nasal passages and the vestibule of the nose. Diphtheria of the nose can be complicated by bronchopneumonia, diphtheria laryngitis and croup, as well as internal organs and diphtheritic polyneuritis. The late complications include cicatricial stenosis of the nasal passages and the vestibule of the nose, atrophic processes in the nasal mucosa. Some authors associate the origin of the lake with the past diphtheria of the nose.

The diagnosis of nasal diphtheria is established on the basis of the symptoms described above and the results of a bacteriological study in which the material from the nose or throat (in the presence of lesions of its mucous membrane) is taken with a sterile swab on the border between the affected area and a healthy mucous membrane on an empty stomach or 2 hours after eating. When the diphtheritic bacillus is isolated, its toxigenicity is determined.

Differential diagnosis is carried out with banal acute rhinitis, as well as with rhinogenetic manifestations of congenital syphilis, in which there are also numerous syphilitic manifestations (pemphigus on the palmar and foot surfaces of the skin, skin syphilis, splenomegaly, etc.). In this case, conventional serological and bacteriological studies are carried out. An effective means of differential diagnosis is the early conduct of diagnostic serotherapy with antidiphtheria serum.

The prognosis is defined as being cautious due to the possibility of spreading the infection to the larynx, the possibility of diphtheritic polyneuritis, the defeat of vital organs.

Treatment of diphtheria of the nose involves a number of general and local activities. The general measures include, first of all, the use of antidiphtheria serum, detoxification products and treatment for maintaining or restoring the functions of vital organs.

Local treatment is aimed at restoring the respiratory function of the nose and preventing the development of pyogenic infection. Apply instillations fibrinolytic enzymes, the introduction of vasoconstrictor ointments and drops, aspiration of the contents of the nasal cavity. After the toilet, disinfect the nasal cavity with a 1% solution of silver nitrate, protargol, collargol, washings with antibiotic solutions and antidiphtheria serum on isotonic sodium chloride solution.