Diphtheria larynx

Laryngeal diphtheria croup, or laryngeal diphtheria is observed in severe forms of diphtheria, manifesting signs of a common infectious disease.

And although diphtheria sore throat and laryngitis in our time, due to vaccination with diphtheria toxoid, are rare, there are still cases of acute primary diphtheria laryngitis, limited only by laryngeal disease.

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

Causes of laryngeal diphtheria

Laryngeal diphtheria occurs as a result of a descending infection nesting in the nasal cavity and nasopharynx in bacteria carriers. Less commonly, laryngeal diphtheria occurs after suffering a banal tonsillitis. Diphtheria croup occurs much more often in children under 5 years of age, especially those weakened by childhood infections, vitamin deficiency, nutritional deficiency, etc.

[6], [7], [8]

Pathological anatomy

In the debut stage of the disease, the infection causes an inflammatory reaction that is no different from banal catarrhal inflammation. However, soon ulcers form on the mucosa, on the surface of which pseudomembranous films of yellowish-green color are formed, formed from fibrin and containing a large number of causative agents of diphtheria. These films are tightly soldered to the mucous membrane of the larynx, especially on its back surface and vocal folds. Later, they are rejected, forming, as it were, casts of the inner surface of the larynx. In some cases, diphtheria toxin causes ulceration and necrotic lesions of the mucous membrane and underlying tissues.

[9], [10], [11], [12],

Symptoms of diphtheria larynx

The onset of the disease is cunning, it is often mistaken for a common cold or catarrhal pharyngitis: a small subfebrile condition, pallor of the face, weakness, redness of the pharynx and a mild rhinitis - symptoms that can not indicate the occurrence of a disease that is very serious in its consequences. However, soon with the advent of diphtheria films, the patient's general condition deteriorates dramatically, body temperature rises to 38-39 ° C, the voice changes, which becomes dull, inexpressive, almost hissing, a cough appears, breathing becomes noisy, and when the stenosis of the larynx grows, which indicates the occurrence of croup of the larynx.

In the clinical course of diphtheria of the larynx, three stages can be distinguished:

• stage of dysphonia, characterized by hoarseness, dry barking cough at first; after 1-2 days dysphonia ends with complete aphonia;
• dyspnoetic stage, signs of which occur already in the middle of the dysphonia stage and already dominate the clinical course of the disease already on the 3-4th day - noisy stridoric breathing appears, attacks of laryngeal spasm with asphyxiation symptoms of inspiratory character increase; the latter is manifested by inhalation of inspiration over the piles and other and supraclavicular fossae, intercostal space; signs of hypoxia prevail in the general condition of the patient, the face acquires an earthy hue, lips and nasolabial triangle are cyanotic, breathing is frequent, superficial, pulse is frequent and filiform, heart sounds are weak and deaf, which may indicate the occurrence of toxic myocarditis; the child lies in bed with his head thrown back (phenomena of meningism), shows motor restlessness, his eyes are extinct, wandering; the extremities are cold, the body is covered with cold sweat;
• the terminal stage is characterized by a pronounced hypoxic toxic syndrome, manifested by a lesion of the vasomotor and respiratory centers; if the disease has reached this stage, then any drug and oxygen treatment does not bring any improvement in the condition of the patient, who eventually dies from paralysis of the bulbar centers.

When laryngoscopy in the debut stage of the disease, diffuse hyperemia and edema of the mucous membrane are detected, which is covered with a slight whitish bloom, later transformed into dirty gray or green films, as already noted above, tightly welded to the underlying tissues. When you try to remove them, ulcers and punctate hemorrhages (a symptom of "blood dew") are detected under them. These pseudomembranous raids can spread downward into the sub-storage space and then to the tracheal mucosa. In some cases, revealed swelling of the vestibule of the larynx, which hides a picture of diphtheria of the sub-storage space and the trachea.

Complications of diphtheria of the larynx: bronchitis, abscess and perichondritis of the larynx, post-diphtheria polyneuritis (paralysis of the soft palate, extraocular muscles, disturbance of accommodation, paralysis of the extremities).

[13], [14], [15],

Diagnosis of diphtheria larynx

If, together with diphtheria croup, established pharyngeal diphtheria is established bacteriologically, or if signs of acute laryngitis develop after the latter, the diagnosis does not cause any particular difficulties. If the larynx diphtheria develops initially, then it is possible to assume the presence of diphtheria infection, especially at the initial stage, only on the basis of the epidemiological history, that is, if the child was in contact with a diphtheria patient or in an environment where diphtheria was observed and there are carriers of the diphtheria pathogen.

Laryngeal diphtheria is differentiated from pseudo- corpus, influenza laryngobronchitis and other acute infectious diseases of the larynx. Larynx diphtheria is also differentiated from the laryngeal stridor, laryngospasm, foreign laryngeal bodies, the pharyngeal abscess, allergic edema, and laryngeal papillomatosis, etc.

The final diagnosis is established only after receiving a positive bacteriological response. But even if his results are doubtful or have not yet been obtained, and the clinical picture indicates the possible presence of laryngeal diphtheria, specific serotherapy is immediately begun.

[16], [17], [18], [19], [20], [21],

Treatment of diphtheria larynx

Treatment for suspected diphtheria of the larynx is urgent and complex, is carried out in a specialized hospital for infectious patients. It includes the following activities:

• large doses of anti-diphtheria antitoxic serum (3000 AU / kg) are administered both intramuscularly and subcutaneously according to a modified method A.M. Frequently, antihistamines are used simultaneously (suprastin, diazolin, etc.);
• antibiotics are prescribed in combination with hydrocortisone for the prevention of pneumonia, toxic pulmonary edema, and secondary complications;
• cardiac and respiratory analeptics, vitamin B12 and cocarboxylase are also prescribed to prevent toxic damage to vital centers and diphtheria polyneuritis;
• conduct intensive detoxification therapy;
• to prevent reflex spasms of the larynx, barbiturates (phenobarbital) are prescribed in small doses, often;
• carry out inhalation and instillation of proteolytic enzymes, hydrocortisone, alkaline oil solutions, antibiotics, adrenaline, ephedrine into the larynx;
• young children are placed in an oxygen chamber; older children are prescribed masked oxygen or carbogen therapy;
• in the event of obstructive asphyxia, direct laryngoscopy is performed with aspiration of false membranes, thickened mucus;
• when asphyxia occurs, one should not hope to improve breathing and postpone the production of a tracheotomy, since the respiratory obstruction of the larynx may occur instantaneously, and then all interventions for the rehabilitation of respiration may be delayed.

Prevention of laryngeal diphtheria

Prevention of laryngeal diphtheria consists in carrying out the following activities:

• compulsory vaccination of all children with diphtheria vaccine;
• registration of carriers of diphtheria pathogen and preventing them from working in institutions;
• bacteriological examination of all persons entering the workforce in children's groups, children's and adult psycho-neurological hospitals for diphtheria pathogen;
• carrying out final disinfection in the diphtheria lesion, etc.

[22]

Prognosis for diphtheria larynx

The prognosis of diphtheria in the larynx is serious, especially in children younger than 2 years old, in whom the infection often spreads to the trachea and bronchi, causing severe forms of diphtheria bronchopneumonia. In hypertoxic forms, even in older children and adults, the prognosis remains cautious.

[23], [24],