Symptoms of diphtheria in children

Most often in diphtheria, the oropharynx is affected, more rarely - the airways, nose, larynx, trachea. Rarely observed diphtheria lesions of the eye, ear, genitals, skin. With simultaneous lesion of two organs and more diagnosed combined diphtheria form.

Diphtheria of the oropharynx. Depending on the prevalence and severity of the local process and general intoxication, there is a localized (light), widespread (moderate) and toxic (severe) form of the oropharyngeal diphtheria.

• The localized form of diphtheria of the oropharynx is more common in vaccinated children. The raids are located on the palatine tonsils and do not extend beyond their limits. The general condition is moderately disturbed, sore throat when swallowed insignificant. Tonsils form plaques, the first 1-2 days are tender, thin, and later they look like a film with a smooth, shiny surface and clearly outlined edges whitish-yellowish or whitish-gray in color. Depending on the size of the plaque, an island shape is distinguished, in which the raids are arranged in the form of islets between the lacunae, and the film form of localized diphtheria, when the rafts completely or almost completely cover the tonsils, but do not go beyond them. The raids are dense, soldered to the underlying tissue, while attempting to remove their mucous membrane is bleeding. On the site of remote raids, new ones are formed. Tonsillar lymph nodes are not enlarged, painless, mobile.
• The common form of diphtheria of the oropharynx is accompanied by a moderately pronounced general intoxication. Body temperature is 39 ° C and above. Complaints of sore throat when swallowing. The raids are massive, completely cover both tonsils and extend to the arches, the posterior wall of the pharynx or the tongue. Tonsillar lymph nodes are moderately enlarged, slightly painful. There is no edema in the oropharynx, or on the neck.
• Toxic form of diphtheria of the oropharynx is immediately accompanied by severe toxicosis, usually in unvaccinated children. Parents can call the hour when the child is sick. The body temperature rises to 39-40 ° C, the patient feels a general weakness, complains of a headache, chills, sore throats when swallowing. On the first day of illness, tonsillar lymph nodes noticeably increase, their palpation is painful. There are diffuse hyperemia and edema of the oropharynx, and then of the neck tissue. On enlarged tonsils begins to form a plaque in the form of a jelly-like translucent film.

Depending on the severity and prevalence of edema, the toxic diphtheria of the oropharynx is distinguished in degrees of severity:

• I degree - edema of the neck tissue reaches the middle of the neck;
• II degree - edema of the cervical tissue to the clavicles;
• III degree - edema below the clavicles, extends to the anterior surface of the thorax, sometimes reaching the nipple or the xiphoid process.

The oropharynx is swollen at the height of the disease, the tonsils are enlarged, touch along the middle line, pushing back the edema of the tongue, the posterior wall of the pharynx is not visible. Thick, whitish-gray or dirty gray deposits completely cover both tonsils and spread to the palatine arch, tongue, soft and hard palate, lateral and posterior pharyngeal walls, sometimes to the root of the tongue on the mucous membrane of the cheek up to the molars. The raids are tightly welded to the underlying tissues, they are removed with difficulty, the mucous membrane bleeds on the site of the removed plaque and fibrinous film is quickly formed again.

• Sub-toxic form of diphtheria of the oropharynx: edema less expressed, plaque slightly spreads on the palatine arch or tongue, can be localized on tonsils, edematous or pastose cervical tissue in the region of regional lymph nodes weak, sometimes on the one hand, intoxication moderately expressed.

In diphtheria, the process is two-sided, but in some cases with the subtitic form of diphtheria, the oropharynx can be located on only one tonsil, the edema of the cervical tissue then arises on the corresponding side of the neck (Marfanov's form).

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

Diphtheria of the respiratory tract (diphtheria croup). Diphtheria croup may be isolated (only respiratory tracts are affected) or occur as part of a combined form of diphtheria (combined defeat of the respiratory tract and oropharynx or nose). In most patients, isolated cereals are observed.

Depending on the distribution of the process, they distinguish:

• diphtheria croup localized (diphtheria of the larynx);
• Diphtheria croup is common: diphtheria laryngotracheitis and diphtheria laryngotraheobronchitis.

The disease begins with a moderate increase in body temperature (up to 38 ° C), malaise, decreased appetite, dry cough, hoarseness. In the future, all these signs increase, cough becomes paroxysmal, rough, barking, voice - hoarse, hoarse. 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 a difficult, noisy, stenotic breathing appears and becomes the leading symptom in the clinical picture of the disease with the transition to the third stage.

Diphtheria of the nose. It is manifested by the difficulty of nasal breathing, sukrovichnymi secretions from one half of the nose, filmy raids on the septum of the nose.

To rare localizations, diphtheria is the diphtheria of the eye, ear, genital organs, skin, umbilical wound, lip, cheek, etc.

Complications of diphtheria

When toxic diphtheria, complications arise from 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 5-20th day of the disease, usually at the end of an acute period. Improved by this time, the child's condition worsens again, the pallor of the skin becomes worse, adynamia, anorexia develop. The child becomes capricious, irritable. The boundaries of relative cardiac dullness increase, more to the left, the heart sounds are muffled.
• Early paralysis occurs on the 2nd week of illness and manifests itself most often as a paralysis of the soft palate.
• Late paralysis occurs on the 4th, 5th, 6th, 7th weeks of the disease, proceed as a polyradiculoneuritis with all the signs of flaccid peripheral paralysis (atony, areflexia, atrophy).

[1], [2], [3], [4], [5]