Symptoms of diphtheria

The symptoms of diphtheria vary depending on the form of the disease, but the general characteristic sign of diphtheria is inflammation, which provokes the appearance of a specific fibrinous membrane, film and severe edema in the area of the inflammatory process.

Diphtheria, the symptoms of which were known as early as the first century BC, was not accidentally called "the strangled man's disease" since ancient times, and was considered a deadly disease for a long time, since the number of fatal outcomes was more than 80% of the total number of patients with this infection. Two centuries ago, the disease was given a name that characterizes the main symptom of diphtheria - from the Greek word diphtheri, that is, "film". Mass vaccinations began only in the second half of the last century, and only then did the mortality rate from diphtheria decrease significantly. The causative agent of the disease is a specific toxin, the Klebs-Leffler bacillus, which affects various organs and systems of the human body, most often children. Diphtheria can be in the area of the nose, skin, throat, eyes, it can even affect the heart, nervous system and kidneys. The incubation period for this disease, as a rule, does not exceed seven days. Diphtheria, the symptoms of which depend on the area of localization of the process, is a very severe disease of bacterial etiology, divided into the following types and forms:

• Oropharyngeal infection – localized, moderate or widespread, subtoxic, toxic in two stages and hypertoxic – life-threatening.
• Croup is an infection of the larynx, diphtheria of the trachea and larynx (widespread croup), infection of the larynx, trachea with spread to the bronchi (descending diphtheria).
• Diphtheria of the nasopharynx, nose.
• Diphtheria infection of the genitals.
• Ophthalmic diphtheria (eyes).
• Diphtheria of the skin.
• Simultaneous infection of organs - combined diphtheria infection.

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Diphtheria, the symptoms of which indicate infection of the mouth (pharynx) - oropharynx

This is the most common type of disease, which is divided into the following forms:

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Localized form (typical, atypical)

This is the mildest variant of the disease, characterized by a catarrhal course (atypical) and accompanied by headache, painful sensations when swallowing food and liquid, a slight increase in temperature. The diphtheritic membrane covers only the tonsils, is difficult to separate from them, and is capable of growing again, which is the main clinical manifestation of the disease. Both tonsils become inflamed at once, which are clearly hyperemic, and quickly swell. Diagnostically, the film is differentiated at the first stage using simple manipulations - rubbing and immersion in water. The film is not subject to rubbing and quickly sinks to the bottom of a container with water. During bacterial studies, a specific exotoxin bacillus is isolated from the film. Upon palpation, the area of the lymph nodes is enlarged, causing painful sensations on the part of the patient. As a rule, this type of diphtheria is diagnosed only during a preventive examination and with the help of serological, bacterial analysis, since localized diphtheria in a mild form rarely manifests itself with noticeable clinical symptoms. If localized diphtheria, the symptoms of which are hidden, is not treated, then it quickly transforms into a widespread (or toxic) form.

Toxic form (typical, atypical)

This is one of the most severe variants of the disease, which can develop independently, but can be a consequence of untreated localized diphtheria. The toxic form of the disease spreads rapidly, causing an increase in body temperature to 40 degrees. Pain is present in the throat and neck as a whole. Often this form is accompanied by delirious states, delirium, vomiting. Toxic diphtheria, the symptoms of which appear very quickly, requires immediate medical care, since delay in the literal sense of the word is like death from suffocation. Rapidly developing edema of the larynx, hyperemia can completely block the lumen of the pharynx. The fibrinous film grows in a matter of hours, closing the pharynx, the lymph nodes increase significantly in size, are very painful when palpated. Often the swelling spreads to the entire neck, reaching the collarbones, affecting the face, upper back. In addition to swelling and the risk of suffocation, diphtheria of this form is characterized by severe intoxication of the entire body and a sharp decrease in blood pressure. The prognosis for treatment and the possibility of recovery depend on the time of contacting a doctor and the beginning of emergency medical care. If toxic diphtheria is not controlled by resuscitation measures, it quickly passes into the hypertoxic stage, when encephalopathy rapidly develops, pressure drops to the lowest possible values, disseminated intravascular coagulation syndrome develops - DIC, resulting in toxic shock and death.

Diphtheria, the symptoms of which indicate a widespread form, is considered a moderately severe variant of the disease. The film affects not only the tonsils, but also the palate and the mucous membrane of the pharynx. Edema develops quickly, but not to the same extent as in the toxic form. Pain in the oropharynx is moderate, the temperature rarely rises above 38 degrees. Plaques and film can be neutralized and treated within 10 days. Also, the widespread form of diphtheria does not have pathologically dangerous complications.

Croup. Diphtheria, the symptoms of which indicate a croupous nature

The disease can be localized in the larynx, or in a widespread form, when the mouth, nose, trachea, and bronchi are affected simultaneously. Signs of croup are changes in the timbre of the voice (hoarse voice), a typical "barking" cough, which gradually becomes silent. Breathing is difficult, noises are heard when inhaling and exhaling, the face becomes pale, signs of cyanosis (blueness) are often visible. Cardiological signs - severe tachycardia, arrhythmia, shortness of breath can develop rapidly and often leads to asphyxia. With suffocation, blood pressure drops sharply, the pulse weakens, the person loses consciousness and may die without emergency care. The croupous form of diphtheria is especially dangerous in children, since their chest is anatomically less developed than in adults, and suffocation occurs faster.

Diphtheria infection of the nose is characterized by purulent discharge (catarrhal form), when breathing is impaired due to nasal congestion with diphtheria film. The mucous membrane is edematous, often covered with small ulcers, fibrinous films. Diphtheria, the symptoms of which indicate this form of the disease, is rarely independent, most often it is combined with infection of the pharynx, larynx and eyes.

Diphtheria symptoms may be localized in the eye area. Diphtheria eye lesions also occur in a catarrhal form, may be accompanied by intoxication or be in a membranous form. Most often, with diphtheria of the eyes, the clinical signs of the disease are conjunctivitis, accompanied by periodic discharge in the form of mucus. The temperature rarely rises above 37 degrees, the lymph nodes are not enlarged or inflamed. If the eyes are affected by diphtheria in a membranous form, the eyes swell and become covered with a loose fibrinous film. As a rule, one eye is affected first, after two or three days the process affects the other. The toxic version of diphtheria of the eyes develops more rapidly, the swelling increases within 24 hours, and purulent secretions are abundantly released from the eyes. The swelling spreads to the entire face, often affecting the neck.

Anal-genital diphtheria, the symptoms of which are often accompanied by signs of diphtheria of the pharynx and nose, is characterized by inflammation of the inguinal lymph nodes and general edema. The genitals are hyperemic, covered with a fibrinous film. In men, the foreskin is most often affected, in women - the vagina or anus. All patients with this form of diphtheria without exception have difficulty urinating, there are serous, purulent discharges. Often, diphtheria of this form is combined with mycoses, which lead to erosions, cracks and purulent ulcers.

Diphtheria symptoms may vary, but there are also common signs that allow the disease to be diagnosed fairly quickly. These signs include the following manifestations:

• A sore throat that cannot be explained by an acute respiratory viral infection or viral infection.
• Difficulty breathing, shortness of breath, desire to throw your head back.
• An increase in temperature from subfebrile to very high.
• Weakness, nausea and vomiting.
• Hyperemia of the oropharynx, turning into swelling.
• Enlarged tonsils
• Change in voice timbre, hoarseness.
• The characteristic smell is clearly noticeable - sweetish-sour.
• Painfully enlarged lymph nodes.
• Swelling in the neck area.
• Drop in blood pressure, weakening of pulse.
• Tachycardia, arrhythmia.

Diphtheria symptoms may also be hidden, especially in the localized form of the disease of the oropharynx, but this variant of the disease quite quickly develops into more severe, sometimes deadly forms of diphtheria. Therefore, the only effective method of prevention and reduction of the risk of infection with the diphtheria bacillus today is early vaccination, which is subsequently carried out every ten years until reaching the age of 56.

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