Symptoms of diphtheria in children

The oropharynx is most often affected by diphtheria, less often - the respiratory tract, nose, larynx, trachea. Diphtheria lesions of the eye, ear, genitals, skin are rarely observed. When two or more organs are affected simultaneously, a combined form of diphtheria is diagnosed.

Diphtheria of the oropharynx. Depending on the prevalence and severity of the local process and general intoxication, localized (mild), widespread (moderate) and toxic (severe) forms of diphtheria of the oropharynx are distinguished.

• Localized form of diphtheria of the oropharynx occurs more often in vaccinated children. The plaque is located on the palatine tonsils and does not extend beyond them. The general condition is moderately disturbed, sore throat when swallowing is insignificant. Plaques form on the tonsils, in the first 1-2 days they are tender, thin, and later they look like films with a smooth, shiny surface and clearly defined edges of a whitish-yellowish or whitish-grayish color. Depending on the size of the plaque, an insular form is distinguished, in which the plaque is located in the form of islands between the lacunae, and a membranous form of localized diphtheria, when the plaque completely or almost completely covers the tonsils, but does not extend beyond them. The plaque is dense, fused with the underlying tissue, when trying to remove it, the mucous membrane bleeds. New plaques form in place of the removed plaques. The tonsillar lymph nodes are not enlarged, painless, and mobile.
• A common form of oropharyngeal diphtheria is accompanied by moderate general intoxication. Body temperature is 39 °C and above. Complaints of sore throat when swallowing. The plaque is massive, completely covering both tonsils and spreading to the arches, the back wall of the pharynx or the uvula. The tonsillar lymph nodes are moderately enlarged, slightly painful. There is no edema in the oropharynx or neck.
• The toxic form of diphtheria of the oropharynx is immediately accompanied by severe toxicosis, usually in unvaccinated children. Parents can name the hour when the child fell ill. The body temperature rises to 39-40 °C, the patient feels general weakness, complains of headache, chills, sore throat when swallowing. On the 1st day of the disease, the tonsillar lymph nodes noticeably enlarge, their palpation is painful. Diffuse hyperemia and edema of the oropharynx appear, and then the cervical tissue. A coating in the form of a jelly-like translucent film begins to form on the enlarged tonsils.

Depending on the severity and prevalence of edema, toxic diphtheria of the oropharynx is classified according to severity:

• I degree - swelling of the cervical tissue reaches the middle of the neck;
• II degree - swelling of the cervical tissue up to the collarbones;
• Grade III - swelling below the collarbones, extending to the anterior surface of the chest, sometimes reaching the nipple or xiphoid process.

At the height of the disease, the oropharynx is sharply swollen, the tonsils are enlarged, touching along the midline, pushing the swollen uvula back, the back wall of the pharynx is not visible. Thick whitish-gray or dirty-gray plaque completely covers both tonsils and spreads to the palatine arches, uvula, soft and hard palate, lateral and back walls of the pharynx, sometimes to the root of the tongue to the mucous membrane of the cheek up to the molars. The plaque is tightly fused with the underlying tissues, is difficult to remove, at the site of the removed plaque the mucous membrane bleeds and a fibrinous film quickly forms again.

• Subtoxic form of diphtheria of the oropharynx: swelling is less pronounced, plaque slightly spreads to the palatine arches or uvula, and can also be localized on the tonsils, swelling or pastosity of the cervical tissue in the area of the regional lymph nodes is weak, sometimes on one side, intoxication is moderately pronounced.

In diphtheria, the process is bilateral, but in some cases, with the subtoxic form of diphtheria of the oropharynx, plaque may be located only on one tonsil, and swelling of the cervical tissue occurs on the corresponding side of the neck (Marfan form).

The most severe forms of diphtheria of the oropharynx are hypertoxic and hemorrhagic with a malignant course.

Diphtheria of the respiratory tract (diphtheritic croup). Diphtheritic croup can be isolated (only the respiratory tract is affected) or occur as part of a combined form of diphtheria (combined damage to the respiratory tract and the oropharynx or nose). Most patients have isolated croup.

Depending on the distribution of the process, a distinction is made between:

• diphtheritic croup localized (laryngeal diphtheria);
• diphtheritic croup is common: diphtheritic laryngotracheitis and diphtheritic laryngotracheobronchitis.

The disease begins with a moderate increase in body temperature (up to 38 °C), malaise, loss of appetite, dry cough, hoarseness. Later, all these symptoms increase, the cough becomes paroxysmal, rough, barking, the voice is hoarse, husky. These symptoms correspond to the first stage of diphtheria croup - the stage of croupous cough (or dysphonic stage).

Gradually, there is a steady progression of symptoms with a gradual transition to the second stage - stenotic, when difficult, noisy, stenotic breathing appears and becomes the leading symptom in the clinical picture of the disease with a transition to the third stage.

Diphtheria of the nose. Manifested by difficulty breathing through the nose, bloody discharge from one half of the nose, and filmy deposits on the nasal septum.

Rare localizations of diphtheria include diphtheria of the eye, ear, genitals, skin, umbilical wound, lips, cheeks, etc.

Complications of diphtheria

With toxic diphtheria, complications naturally arise in the cardiovascular system (myocarditis), peripheral nervous system (neuritis and polyneuritis) and kidneys (nephrotic syndrome).

• Nephrotic syndrome occurs in the acute period of the disease at the height of intoxication.
• Myocarditis occurs on the 5th-20th day of the disease, usually at the end of the acute period. The child's condition, which had improved by this time, worsens again, the skin becomes paler, adynamia and anorexia develop. The child becomes capricious and irritable. The boundaries of relative cardiac dullness increase, more to the left, the heart sounds are muffled.
• Early paralysis occurs in the 2nd week of the disease and is most often manifested by paralysis of the soft palate.
• Late paralysis occurs on the 4th, 5th, 6th, 7th week of the disease, and proceeds as polyradiculoneuritis with all the signs of flaccid peripheral paralysis (atony, areflexia, atrophy).

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