What is Diphtheria?

Diphtheria is an acute respiratory infectious disease caused by diphtheria. It is characterized by fever, discouragement, hoarseness, bark-like cough, and white pseudomembrane in the pharynx, tonsils and surrounding tissues. In severe cases, symptoms of systemic poisoning are obvious, and myocarditis and peripheral nerve paralysis may be complicated.

Basic Information

English name

diphtheria

Visiting department

Infectious Diseases

Multiple groups

Diphtheria is most common in adults and older children

Common causes

Diphtheria infection

Common symptoms

Fever, discouragement, hoarseness, bark-like cough, white pseudomembrane in throat, tonsils and surrounding tissue

Contagious

Have

way for spreading

Respiratory infection

Clinical manifestations of diphtheria

Diphtheria can be divided into four types, and the incidence rate is from pharyngeal diphtheria, larynx diphtheria, nasal diphtheria, and diphtheria in other parts. Diphtheria is most common in adults and older children, and other types of diphtheria are more common in young children.

Diphtheria

(1) Mild fever and systemic symptoms are slight, tonsils are slightly red and swollen, and a little or a small piece of pseudomembrane on it, the symptoms can disappear naturally after a few days.

(2) General onset gradually with symptoms such as fatigue, poor appetite, nausea, vomiting, headache, mild to moderate fever, and sore throat. The tonsils are moderately red and swollen, with milky or off-white large false membranes visible, but the scope does not extend beyond the tonsils. The fake film starts to be thin and is not easy to peel off. If it is wiped off with force, it can cause a small amount of bleeding and form a new fake film within 24 hours.

(3) Swelling and congestion of severe tonsils and pharynx are obvious. The fake film spread into large pieces within 12 to 24 hours. In addition to the tonsils, it also affects the zygomatic arch, epicondyle, uvula, posterior pharynx and nasopharynx, and even extends to the oral mucosa. The mouth has a rancid odor, the cervical lymph nodes are swollen, and the neck is swollen like a "bull neck". Severe symptoms of systemic poisoning may include severe fever such as high fever or hypothermia, irritability, shortness of breath, pale complexion, vomiting, rapid pulse, decreased blood pressure, or enlarged heart, arrhythmia, and bleeding.

2. Laryngeal and tracheobronchial diphtheria

Mostly caused by pharyngeal diphtheria spreading to the larynx, but also primary. More common in children 1 to 5 years old. The onset was slow, accompanied by fever, and the cough was "empty", hoarse, and even lost sound. At the same time, due to false membranes, edema, and spasms in the throat causing respiratory tract obstruction symptoms, cicadas can be heard when inhaling, and "three concave signs" can be seen when inhaling. Laryngoscopy showed redness and swelling of the larynx and false membranes. The pseudomembrane can sometimes reach the trachea and bronchi, bronchioles.

3. Nasal diphtheria

Rare. In terms of diphtheria of the front nose. Nasal diphtheria may exist alone, or coexist with laryngo-diphtheria and pharyngeal diphtheria. More common in infants and young children. The range of lesions is small and systemic symptoms are mild. The main manifestation is serous bloody snot, which later becomes thick purulent snot, which can sometimes be associated with epistaxis and is often unilateral. The skin around the nostrils was red, eroded, and crusted, and a white pseudomembrane was visible on the vestibule or septum of the nose.

4. Diphtheria in other parts

(1) Diphtheria of the skin or wound Rarely, it is caused by direct or indirect infection of the skin or mucous membranes. Although this type of symptoms are not serious and easy to spread.

(2) Other occasional diphtheria may occur in the vulva, umbilicus, esophagus, middle ear, and conjunctiva. Local inflammation and pseudomembrane, often accompanied by secondary infection. Systemic symptoms are mild.

Diphtheria check

Blood image

The white blood cell count increased slightly and the percentage of neutrophils increased (around 0.80).

2. Bacteriological examination

(1) Pharyngeal and nasal mucosal swab smears. Neisser or Ponzi staining microscopy to find coryneform bacteria with metachromatic particles.

(2) Positive for fluorescent antibody staining .

(3) Bacterial culture A nasopharyngeal swab or a sample of the affected area was used to grow diphtheria bacilli, and the virulence test was positive.

Diphtheria diagnosis

Epidemiology

Autumn or winter or early spring season, the local epidemic or spread of the disease; or the patient had a history of contact with diphtheria patients within 1 week before the disease.

Diphtheria

(1) Limited type Mild to moderate fever, accompanied by fatigue, lack of energy, and anorexia. Sore throat, drooling, mild to moderate congestion in the pharynx. Red and swollen tonsils. A bit or flaky off-white pseudomembrane on the surface of the tonsils or pharyngeal isthmus, which is not easy to peel off, and the surface of the basement oozes when forcibly removed. Submandibular lymph nodes are enlarged and slightly painful.

(2) The symptoms of disseminated systemic poisoning are severe, the pseudomembranes are extensive, the cervical lymph nodes are swollen, and the surrounding soft tissues are edema, which is prone to myocardial damage.

(3) The poisoning type is more acute and the symptoms of systemic poisoning are serious; the pseudomembranes are extensive and often black and red due to bleeding; swelling and necrosis of pharyngeal tissue; cervical lymphadenopathy and surrounding soft tissue edema; bleeding tendency and circulatory failure .

3. Nasal diphtheria

Serous bloody nose, nasal mucosa with false membranes, and superficial ulcers often appear on the periphery of the nostril and upper lip.

4. Diphtheria diphtheria

Fever, dry cough, hoarseness, inspiratory dyspnea and laryngeal obstruction.

Diphtheria treatment

General treatment

Patients should rest in bed and reduce activity, usually no less than 3 weeks. Pay attention to oral and nasal hygiene.

2. Antibiotic treatment

Penicillin is often used, and it takes 7 to 10 days until the symptoms disappear and the diphtheria culture is negative. Those who are allergic to penicillin or those who are still positive after 1 week of application of penicillin can switch to erythromycin and take it orally or intravenously in four divided doses. The course of treatment is the same as above.

3. Antitoxin treatment

Antitoxins can neutralize free toxins, but cannot neutralize bound toxins. The effect was better in the first 3 days of the course of treatment, and the effect was significantly reduced in the future. The dose depends on the scope and location of the pseudomembrane and the time of treatment.

4. Treatment of myocarditis

Patients should rest in bed, and those who are irritated should be given sedatives. Prednisone can be used orally, and gradually reduced after symptoms improve. Severe patients can be treated with adenosine triphosphate (ATP) and coenzyme A50U.

5. Treatment of nerve paralysis

Nasal feeding for those with difficulty swallowing.

6. Treatment of Laryngeal Obstruction

For patients with mild laryngeal obstruction, the development of the condition needs to be closely monitored, and tracheotomy is prepared at any time. Breathing is more severe. When a tri-concavity occurs, a tracheotomy should be performed immediately, and the false membrane should be clamped at the incision, or trypsin or chymotrypsin will be added to dissolve the false membrane.

7. Treatment of diphtheria carriers

Do a diphtheria virulence test first. Positives are isolated and treated with penicillin or erythromycin, without the need for antitoxins. Isolation was released after 3 consecutive negative cultures. For those who are stubborn, consider tonsillectomy. If diphtheria recovery period carriers need to do tonsillectomy, 3 months after recovery, and the heart is completely normal.