How does diphtheria appear in children - symptoms and treatment methods. Ways of penetration of the pathogen into the child's body. Diphtheria Patient Care

Diphtheria in children is an acute infectious disease serious danger for the child's body. The disease is characterized by extensive inflammation of the airways, skin, genitals, or eyes. It is important to consult a doctor at the first signs of the disease. If left untreated, it can be fatal. To determine the disease, a swab is taken from the throat.

A timely vaccination can save the baby from hospitalization and other unpleasant consequences.

The causative agent of diphtheria is corynebacterium. Another name is diphtheria bacillus. It can withstand drying for a long time and low temperatures. On household items, the microbe will remain for a long time. Boiling kills it in less than a minute. Disinfection - with the help of hydrogen peroxide, chloramine and other means, it is detrimental to corynebacteria when exposed to more than 10 minutes. A throat swab helps to identify the bacterium.

The source of infection is the patient or the carrier of the disease. The incubation period for the disease is usually 3 days.. The child is contagious to others from the moment the first signs appear and until complete recovery.

The main route of infection transmission is airborne. Rarely, the infection is transmitted through household items. Corynebacterium penetrates into the child's body most often through the mucous membrane of the nose or larynx.

Kinds

Depending on the place of occurrence of inflammation, infection of the larynx, nose, ear, eyes and genital organs is distinguished.

Diphtheria of the larynx

Young children suffer from this type of disease most often. Diphtheria in children develops both in isolation and as a result of a disease of another localization.. In this case, the film gradually reaches the larynx, spreads to the glottis, blocking it and making breathing difficult. A throat swab is taken for diagnosis.

In the first days, as with diphtheria of the nose, the temperature rises (up to 38), a cough occurs, the baby's voice becomes hoarse. In the future, coughing attacks become barking. After 2-3 days, wheezing appears, with difficulty breathing.

If the disease is not treated, the temperature drops, but this is a sign of the progression of the disease. The child's breathing becomes irregular. In the future, involuntary defecation and urination are possible. The child may lose consciousness, convulsions occur throughout the body. Absence medical assistance at this stage leads to death from lack of oxygen.

Nasal diphtheria

Nasal diphtheria is often recorded at an early age. Nasal diphtheria is manifested as follows:

• Temperature rise;
• Difficulty breathing, inflammation of the nose, the mucous membrane of which swells noticeably;
• One nostril exudes a fluid that looks like ichor.

Symptoms

Symptoms of diphtheria of the larynx and nose in children are similar to common signs infectious diseases. The child notices an increase in temperature, weakness occurs throughout the body, appetite disappears. A characteristic symptom is pain in the throat.

fibrous film

During the inspection oral cavity noticeably severe inflammation tonsils. A gray film appears on them, which is difficult to remove - this is diagnostic sign diphtheria.

There are 2 main forms of the disease: islet and film. In the first case, the film covers only small areas of the tonsils, in the second case it completely captures them.

At different types disease, it appears on the tongue, posterior pharyngeal wall and palate. First, a transparent film is formed, then it acquires a whitish tint, becomes more dense.

Other symptoms

Common and easily recognizable signs include:

• Enlarged lymph nodes;
• Heat;
• Swelling of the neck;
• Apathy, immobility of the child;
• Headache.

Swelling of the soft tissues of the neck extends to the clavicles. The lower the edema spreads, the more severe the patient's condition. At the same time, the child's lips dry, the skin begins to turn pale, noisy and rapid breathing, leakage of fluid from the nose. One of the most serious signs danger - the appearance of seizures.

vaccinated and unvaccinated child

In an unvaccinated child diphtheria is very difficult from the first days of the manifestation of the disease. Symptoms of the disease develop rapidly. In most cases, there are serious complications.

In a vaccinated child the bacterium may not provoke the disease - it becomes a carrier. If he becomes ill, the symptoms are limited. The incubation period for diphtheria lasts from 2 to 10 days.

How to distinguish diphtheria from tonsillitis

A characteristic sign of diphtheria is the covering of the tonsils with a white film. With angina, the tonsils are very inflamed and have a reddish tint. Sometimes pus is visible on them - a yellowish coating. In addition, there is a plaque on the tongue and redness of the pharynx, the tongue swells.

Main differences:

• In diphtheria, inflammation extends to the palate, and is not limited to the tonsils, as is the case with angina;
• Pain in the throat when swallowing during a sore throat is quite strong - because of them, the patient refuses food. With diphtheria, there is no pain, only discomfort appears.

Such clear signs help distinguish angina from diphtheria, and pre-determine the condition of the child.

Self-medication is dangerous for the life of even a vaccinated baby, so at the first sign you need to go to the doctor. A throat swab for analysis will help determine the nature of the disease.

Complications

Diphtheria belongs to the list of those diseases, the consequences of which are quite serious. Lack of treatment contributes to the penetration of diphtheria bacillus toxin into various organs. This applies more to children who have not been vaccinated. It causes:

• Kidney damage;
• Negative effect on the nervous system;
• Toxic shock - manifests itself in the form sharp increase temperature, dizziness, fainting, vomiting, muscle aches;
• - severe inflammation lungs;
• Myocardial damage (middle muscle layer of the heart).

Each complication from this list is dangerous for the health and life of the child. If the first symptoms appear, contacting a doctor is the only right decision.

Treatment

Each patient with suspected diphtheria is placed in the infectious diseases department. It is worth making forecasts for recovery only after the introduction of antidiphtheria serum.

With the development of a complex and severe form, more concentrated serum . The dosage is prescribed by the doctor. When diagnosing diphtheria, serum is injected at the first appointment, a fluid sample is taken from the pharynx.

When the plaque gradually disappears, the child is soldered with antibiotics that suppress pathogenic microbes.

Prevention

Medicine developed effective methods fight against diphtheria. Immunization (vaccination) is the main and most effective of them. Prevention of diphtheria in children - important aspect maintaining the health of the whole family. The child is vaccinated with attenuated diphtheria toxoid. Vaccination is carried out at a certain age:

• 3rd month old baby- three times, the vaccination is done with an interval of one and a half months;
• 1.5–2 years - the vaccination is repeated;

After vaccination, such signs appear - an increase in body temperature, swelling at the injection site of the solution (as in the photo).

There may be a deterioration in well-being. This occurs as a result of the struggle of the immune system with the weakened microbes that the vaccine contains.

Diphtheria is an extremely contagious infectious disease that affects both children and adults. His trick is that characteristics appear already at the stage when it is much more difficult to cope with the consequences. The waste products of pathogens are extremely toxic. The danger is that they accumulate in the vital important organs leading to severe complications, up to death. It is necessary to know by what signs the disease can be recognized, how it is treated, what is the role of preventive vaccination.

You can get diphtheria from a sick person who is a distributor of the infection until all the pathogens of this disease die in his body. Analyzes show the absence of bacteria in the mucous membranes of the respiratory tract only 2-3 weeks after treatment and the disappearance of symptoms. If a child is found to have diphtheria, the child is immediately isolated and those who have been in contact with the child are tested for the infection.

In some people, diphtheria occurs in a latent form, which is especially dangerous for others. Sometimes bacteria carriers are outwardly completely healthy people, in the body of which the corynebacterium lives without showing itself in any way. The main route of infection with diphtheria is airborne, although household (through objects touched by a sick child) is not excluded.

Most often they get sick in the cold months of the year. The incubation period is from 2 to 10 days.

Infants are immune to diphtheria, as they are protected by maternal immunity. At risk are children aged 3-7 years. In an older child the immune system stronger, therefore, the susceptibility to diphtheria pathogens is lower.

Corynebacteria produce toxic substances poisoning body, and in contact with mucous membranes - necrosis. Toxins are absorbed into the blood and carried throughout the body. They settle in the heart, kidneys, organs nervous system, destroying their tissues, as well as blood vessels, even after the death of diphtheria bacilli. This gives rise to severe complications(myocarditis, nephrosis, polyneuritis).

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Causes of the disease

The causes of diphtheria are usually:

• lack of vaccination (due to the presence of contraindications or due to the deliberate refusal of parents to vaccinate their children);
• non-compliance with the rules of personal hygiene;
• poor sanitary living conditions.

Complications, as a rule, arise due to untimely diagnosis of diphtheria.

Note: It is very difficult to notice the onset of diphtheria, since the child's condition does not cause much concern. There is only a slight malaise, as with a small cold or sore throat. A warning sign should be the appearance of a sore throat in the absence of a runny nose. the true reason only a doctor can establish such a state.

Diphtheria bacteria enter the child's body through the mucous membranes of the nose, pharynx, and larynx. Less often - through the mucous membranes of the eyes, genital organs. If happened contact infection(while touching, for example, the toys that the patient played with), then the bacteria penetrate the skin of the child.

Signs of diphtheria infection

After the end of the incubation period, a child infected with diphtheria develops the first faint signs ailments: slight pain in the throat, temperature rise to subfebrile values ​​(not higher than 38 °). Parents usually associate them with a cold and do not consider it necessary to take the baby to the doctor.

There are no other manifestations by which one could suspect the occurrence of such a serious disease as diphtheria in the first day. The next day, when examining the child's throat, a gray coating on the tonsils is found, which gradually darkens and becomes more dense, acquiring the appearance of films. They appear as a result of necrosis of epithelial cells.

Further development of the disease leads to the spread inflammatory process on the larynx, trachea and bronchi. A condition appears, which is called "diphtheria croup." Unlike the "false" that occurs with some SARS, it develops with a gradual increase in the severity of the condition. The films are able to block the airways, from which the child suffocates, which leads even to death.

A characteristic manifestation of diphtheria is swelling in the chin and neck.

Symptoms of diphtheria in various types of disease

Depending on which part of the child's body development begins pathological process, distinguish diphtheria of the nose, oropharynx, larynx, eyes, ear, umbilical region, skin and genital organs.

Diphtheria of the pharynx and pharynx

This type of disease is the most famous, as it occurs most often. Depending on the place of development of bacteria and the appearance of films, the following forms of pharyngeal diphtheria are distinguished:

• localized (the lightest);
• common ( moderate);
• toxic (the most severe).

Localized form- this is when only the tonsils are covered with plaque in a child. At the same time, they increase in size. The gray coating has a yellow-white tint. If you try to remove it, wounds remain. Throat hurts a little. The temperature rises to 38°-39°. With this form of the disease, the lymph nodes do not increase.

Common form- films cover not only the tonsils, but the entire surface of the oropharynx. The cervical lymph nodes are enlarged. The temperature rises to 39° and above. There is pallor skin. If the disease does not progress, then on the 3rd-4th day the films are rejected, the surface of the mucosa is regenerated.

toxic form. Its onset is acute, the symptoms of intoxication are most pronounced. These include an increase in temperature to 40 °, lips dry, a strong headache and feverish condition. The child may have seizures. The entire surface of the pharynx is edematous, covered with a dense coating. The skin is pale, the tongue is coated.

There is a spasm of the muscles of the larynx, which makes it difficult to open the mouth. The pain in my throat gets worse. Discharge from the nose appears in the form of an ichor, as well as an unusual sweet smell from mouth. Falling down arterial pressure, pulse quickens.

Tonsils and lymph nodes are enlarged. The neck is thickened. The edema spreads, gradually reaches the collarbone area and can go even lower.

Diphtheria of the larynx (diphtheria croup)

As a rule, this form occurs in babies aged 1-5 years. Sometimes it is combined with the occurrence of foci of infection in other parts of the body. serious condition occurs due to the appearance of films in the larynx, making it difficult to breathe.

Localized form diphtheria of this type is characterized by damage to the larynx itself.

Common- associated with damage to deeper located organs (trachea and bronchi).

With diphtheria croup in unvaccinated children, there is a consistent worsening of symptoms. The disease goes through the following stages:

1. Dysphoric, which is characterized by the appearance of a hoarse barking cough in a child, coarsening and hoarseness of voice. This stage can last from 2-3 to 7 days.
2. Stenotic. The cough is much weaker, the voice is barely audible. Breathing is very difficult, as a result of which there is a retraction of the muscles chest, blueing of the skin.
3. Asphyxia. There is suffocation, convulsions, pressure drops, pupils dilate. If you do not provide immediate assistance, death occurs.

In children, manifestations of diphtheria croup are more severe than in adults. At timely treatment the disease does not reach a severe form, after 3-4 days the child gets better, the films disappear after a week.

Nasal diphtheria

Nasal mucosal lesions are sometimes seen in children younger age. The temperature of the child remains normal, rarely rises to 37.2 ° -37.5 °. Only nasal congestion and the appearance of ichor from the nostrils speak of the disease. The child's health practically does not suffer, but the infection can spread to the pharynx and larynx.

skin diphtheria

It usually occurs in infants. With this disease on the skin of the face, neck, armpits, inguinal folds or behind the ears there are red spots and sores that do not heal, swelling appears. Infection occurs if the baby touches the patient or touches his things. Skin lesions can occur at the site of an abrasion or cut.

diphtheria eye

Often occurs together with a disease of the nasopharynx. The infection first affects the mucous membrane of one eye, then spreads to the second. The eyelids turn red and become swollen. Gray films appear on them, slight purulent discharge. The condition is dangerous because the lesion extends to the cornea of ​​the eye, the iris, ophthalmic nerve. Due to defeat eye muscles strabismus develops. Blindness may occur.

ear diphtheria

The disease in this form is taken for otitis media. Appear bloody issues with pus, shooting pains in the ears. Unlike otitis, the disease is protracted, conventional procedures do not help.

Diphtheria of the umbilical wound

A similar form of the disease occurs sometimes in newborns infected at birth. Edema appears in the navel area and crusts of dried blood form. At the same time, the body temperature rises, the baby suffers from a headache, often spitting up. The reason is the poisoning of the body with toxins.

Diphtheria of the genital organs

As an independent form of the disease, it rarely occurs, usually manifests itself against the background of other types. similar illness. Both girls and boys can get sick. There is swelling and redness of the genital organs, gray films appear. Becomes painful urination. There is an increase inguinal nodes. The disease occurs in a localized form, when the genital organs are directly affected, as well as in a common one. With this form, the skin lesion extends to the perineum and anus.

The most severe form is toxic, in which symptoms such as swelling in the groin, pubis and thighs are added.

Possible Complications

The impact of toxins on various organs leads to such serious complications as:

1. Infectious-toxic shock. TSS develops in the first 3 days with severe toxic diphtheria. This causes heart failure, which can lead to death.
2. Myocarditis (damage to the heart muscle). This condition occurs at 2-3 weeks and significantly complicates the course of the disease, reduces the chances of recovery.
3. Nephrosis is a disease of the kidneys, in which the content of protein in the urine increases.
4. Damage to the organs of the central and peripheral nervous system.

The result is paralysis. soft palate, the symptoms of which are the appearance of nasality in the voice, the impossibility of normal swallowing. Liquid food begins to flow out through the nose.

Paralysis of the eye muscles occurs, resulting in drooping of the eyelids and strabismus. At further development disease occurs paralysis of the muscles of the face (paresis) and body.

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Diagnosis of diphtheria

When examining a patient, the doctor first of all finds out how long ago the symptoms appeared, what is their nature. Blood pressure and pulse rate are measured, as well as body temperature. Checking for the presence or absence of external signs diseases (swelling of the throat, the appearance of gray plaque, changes in the timbre of the voice).

In addition to the pediatrician, the throat of a sick child is examined by an ENT doctor who uses an indirect laryngoscopy device for this (a special mirror and a forehead reflector). This is necessary to detect changes in the mucous membrane of the larynx.

A smear is taken from the surface of the tonsils, it is done bacteriological culture to detect the type of bacteria.

Note: The study of the smear is carried out not only in the child himself, but also in those who communicated with him in recent times(relatives, children and kindergarten teachers, housemates). If a diphtheria bacillus is found, they are isolated even if there are no signs of illness. Bacteriocarriers undergo appropriate treatment, which helps prevent further spread of the infection.

General clinical analysis blood, which allows to detect the presence of a characteristic inflammatory process (the content of leukocytes increases, the number of platelets decreases, the ESR increases). Immunological methods of analysis (ELISA and others) are used to clarify the type of infection.

Treatment

If diphtheria is suspected, patients are urgently hospitalized and sent to the infectious diseases hospital. The earlier diphtheria serum is administered, the less likely it is to have severe complications due to exposure to toxins. Therefore, in the hospital, immediately, even before the results of the examination, the child is given antidiphtheria serum.

Warning: The introduction of serum on the 2nd day of the disease is 20 times more effective than on the 5th day, when the toxin has already spread throughout the organs and its destructive effect has begun.

To prevent the development of inflammatory processes (such as pneumonia, myocarditis, conjunctivitis), antibiotic treatment is started at the same time. Solutions are administered intravenously to neutralize the action of toxins (hemodez, glucose, vitamin C, insulin, and others).

Inflammation of the larynx is eliminated with inhaled corticosteroids. Films formed in the larynx and interfering with breathing are removed using a laryngoscope and a suction device for this.

AT severe cases when the child has suffocation, he is transferred to intensive care. This is where tracheal intubation is performed artificial ventilation lungs with the introduction of a special flexible tube into the trachea through the throat or nose). Sometimes, to save the life of a sick child, it is necessary to perform a tracheotomy, during which an incision is made in the trachea, where a tube is inserted to provide air access to the lungs.

For several months, treatment is carried out to restore the functioning of various organs.

Prevention

Vaccination is the only way to avoid contracting diphtheria. Babies begin to be vaccinated from 3 months, then until the age of 14, the vaccine is administered according to a specific schedule.

In children's institutions, after a case of diphtheria is detected, a mandatory sanitization premises, examination of children and staff for bacteriocarrier. Patients with diphtheria, as well as bacteria carriers, undergo mandatory treatment in the hospital. They are considered non-infectious only after they have tested negative for diphtheria.

Parents should remember that if a child develops symptoms such as a sore throat, a change in voice and difficulty in breathing, it is urgent to see a doctor. This will help to avoid complications of diphtheria.

Diphtheria is known as an infectious disease. It is transmitted by airborne droplets. The disease is life-threatening for the patient. Once in the body, the infection disrupts the nervous system and poisons the body. Diphtheria is especially dangerous for a child from three to seven years old. Since in the course of the disease there are complications that lead to inflammation of the respiratory tract. Treatment of diphtheria in children is carried out in a complex manner, only after an accurate diagnosis has been made.

The causative agent of the disease is corynebacterium (diphtheria bacillus), which tolerates temperatures down to -20 degrees and drying well. Can be saved on items for a long time. Dies only from boiling and disinfectants.

The incubation period in children varies from two to seven days. A child can get diphtheria at any age. Diphtheria in young children has a more severe course, as it is accompanied by edema and the development of spasms of the larynx. However, infants are less likely to become infected, as they receive the necessary antibodies that provide immunity with mother's milk.

Diphtheria can occur in the following forms:

• diphtheria of the oropharynx;
• nasal diphtheria;
• diphtheria croup (this type of diphtheria is more common in children than in adults);
• diphtheria of the eyes;
• skin diphtheria;
• diphtheria of the genital organs;
• mixed forms, when different organs are affected by the infection at the same time.

Most often, infection occurs in winter time years, through the oropharynx and nasal sinuses. Less often through the eyes and skin. According to localization, a common form of diphtheria and localized are distinguished.

Symptoms of diphtheria in children:

• temperature rise;
• sore throat when eating;
• swelling of the larynx;
• reddening of the tonsils and the formation of plaque on them (in the first two days the color of the plaque is white, after which it acquires a gray tint);
• enlarged lymph nodes;
• a gray purulent or bloody substance comes out of the sinuses;
• crusts form on the forehead, cheeks and chins;
• plaque is visible inside the nose;
• swelling of the eyelids, discharge of gray purulent matter from the eyes (hard to distinguish from);
• raid gray color or with a dirty tint on the skin;
• in case of skin damage - long healing;
• stomach ache;
• headache.

If the child is vaccinated against diphtheria, then after seven days the disease recedes. In children who have not been vaccinated, it turns into a severe toxic form.

Body temperature can rise to 41 degrees, accompanied by a severe headache. The skin becomes pale. Possible severe vomiting and pain in the abdomen. Edema spreads over the entire surface of the palate, can completely block the access of air.

Diagnosis of the disease

Diagnosis consists in collecting information during the examination of the patient and all tests that may indicate diphtheria in a child.

Causes of possible infection

1. Contact with a patient with diphtheria.
2. Outbreaks of the disease in the area where the child lives.

The disease can be transmitted by airborne droplets from sick children to healthy ones or from carriers. Infection passes through objects very rarely. But to avoid this, you need to disinfect all the toys of the child.

When infected, a fatal outcome is possible, with damage to the heart and difficulty breathing. In the event that you do not consult a doctor in time and do not take steps to eliminate the diphtheria toxin. The toxin is carried along with the blood throughout the body of the child. First of all, the heart muscles, kidneys and nervous system are affected.

Inspection

A plaque (white, gray or dirty shades) is characteristic, which is difficult to remove. After scraping the plaque, the wound begins to bleed and a new film may form.

Analyzes

1. A smear of the affected area.
2. Blood test (general). To detect diphtheria toxin.
3. Examination of a smear under a microscope.
4. Determination of the titer (level) of antitoxic antibodies.

All need to be identified possible signs and the cause of the disease to exclude the diagnosis of false croup.

diphtheria croup

The disease begins to progress gradually: the temperature rises, weakness and malaise are expressed, the voice becomes nasal, a cough appears. Gradually, an increase in symptoms begins, if earlier the cough was like with ARVI, now it is attacks, the voice sits down. The voice change period lasts for two days.

One of the main manifestations is difficulty in breathing. It becomes hoarse and whistling. Cough in the last stage disease becomes completely silent.

Children feel bad. They begin to refuse food, the lips begin to turn blue due to severe respiratory failure. Blood circulation is disturbed, drowsiness appears, the skin becomes bluish, breathing weakens.

If in the first two days a drug against diphtheria bacillus toxin is administered, then the child will be saved.

Treatment

Treatment is carried out in a hospital severe form illnesses in intensive care. It should be comprehensive and begin immediately after the diagnosis is made. Sometimes, without even waiting for the results of the analysis, anti-diphtheria serum is administered to avoid complications of diphtheria.

Serum neutralizes the effect of the toxin on the child's body. Its dosage depends on the complexity of the course of the disease.

The antidote is made on the basis of horse serum, therefore, before administering the drug, the doctor checks the child's body for sensitivity. If a reaction is detected, the serum is administered according to a special method, diluting it. It is administered intravenously, with a severe course of the disease, the drug is administered for several days in a row. With a mild form once.

Standing in front of the doctors not an easy task. Need to deliver quickly accurate diagnosis and inject the serum into the body of the infected child as soon as possible. The dose varies depending on the severity and duration of the disease.

Treatment also includes antibiotics to prevent the spread of the disease and to prevent pneumonia. They cannot prevent the action of diphtheria bacillus toxin, so they are not used instead of serum, but in combination with it.

In the case of a disease in the larynx, anti-inflammatory antibiotics are used. If there is swelling of the neck and lymph nodes, which blocks the flow of air, soothing drugs are used. If there is a threat of suffocation, surgical intervention is required - hardware breathing.

It is possible to use drugs such as antipyretics, vitamins that normalize the heart rhythm. If pneumonia has already formed, then the child, in combination with other drugs, is offered drugs that expand the bronchi.

Strict bed rest is required. With severe swelling and sore throat, nutrition is prescribed using a probe.

Complications

Diphtheria in children is dangerous for its complications. In case of untimely assistance to the child, a fatal outcome is possible. Since in the course of the disease, edema of the larynx and respiratory tract is often noted. The reasons for the development of complications are the action of diphtheria bacillus toxin on the body and too late administration of serum.

Serious complications include heart rate, paralysis of the limbs and respiratory muscles, thrombosis, kidney damage, cerebral edema, deterioration of blood clotting, diphtheria hepatitis. Infrequent complications can be pneumonia and lung abscess.

Manifestations can be:

• leakage of liquid food from the nose;
• nasal voice;
• language deviation;
• manifestation of strabismus;
• choking on food;
• eyelid edema of one eye.

If you find at least one manifestation of a complication of diphtheria in a child, immediately inform your doctor.

Prevention

The most reliable preventive measure against diphtheria is vaccination. Vaccination is carried out using a weakened toxin called DTP (pertussis-diphtheria-tetanus), or DTP (diphtheria-tetanus) vaccine.

Patients with diphtheria are isolated for 7 days for an accurate diagnosis and a negative analysis of a swab from the nose and throat. During all seven days, observation and examination of children is carried out.

Preventive measures

1. Graft.
2. Quarantine for 7 days to examine a sick child.
3. Isolation of the sick.
4. Unvaccinated children in contact with a child with diphtheria are injected with toxoid.
5. Handling all toys disinfectants, boiling.

Diphtheria - dangerous disease with serious complications. If the child shows signs of diphtheria, treatment begins in the very first days after the incubation period. Otherwise, not only the larynx, but also the respiratory tract will be covered with plaque.

Prevention of the disease is carried out with the help of DTP vaccines or ADS for children of any age. After vaccination, the chances of infection will be minimal. The importance of vaccination is great, since even if infected with diphtheria, it will help to avoid serious complications on the body of a small miracle.

Useful video about diphtheria in children

Answer

Diphtheria in children is an acute infectious life-threatening disease that affects not only the mucous membranes of the airways, but also the skin, umbilical wound, and genital organs. The disease is characterized by severe intoxication and the development of severe complications.

The reasons

Diphtheria is called diphtheria bacillus(corynebacterium), able to tolerate drying, low (up to -20 0 C) temperature. Under the action of conventional disinfectants, it dies in 10 minutes, and at 100 0 C in 1 minute.

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The spreader of the infection is a person - a patient or a bacterio-excretor. The incubation period is 2-10 days. On his last day, the patient can already infect others. Infectiousness persists until full recovery.

Ways of infection:

• main - airborne;
• contact-household (possible, although less often noted) - through objects: books, towels, dishes, toys, etc .;
• transfer through third parties is possible.

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Entrance gates for infection can be:

• nasal mucosa, oropharynx, larynx (most often);
• mucous membrane of the eye;
• mucous membrane of the genital organs;
• umbilical wound;
• wounds and burns;
• diaper rash.

Diphtheria affects children of any age, usually unvaccinated. The winter seasonality of the disease is characteristic. Susceptibility to the disease is not high - about 15%. Infants are protected by maternal antibodies obtained with breast milk (passive immunity), so they rarely get sick. During the illness, antimicrobial and antitoxic immunity develops, but it is unstable, it is possible reinfection diphtheria. After vaccination, it is also relatively unstable, which is why revaccination is necessary.

The pathogenicity of a bacterium is related to its ability to produce exotoxin. Therefore, diphtheria bacilli are divided into toxicogenic and non-toxigenic.

After penetration into the body, corynebacteria actively multiply and secrete an exotoxin during life, which has a local and general effect. Local consists in the death of tissue cells in the area of ​​penetration, from which a dense fibrinous film of gray color is formed in the process of local inflammation. The development of complications is associated with the general action of the toxin.

Symptoms

Symptoms of diphtheria depend on the localization of the process and the intensity of antitoxic immunity. In vaccinated children, the disease develops in rare cases in the form of a bacteriocarrier or in an easily flowing localized form with a favorable outcome without complications. The unvaccinated are dominated by combined and toxic forms with the development of complications and a high risk to life.

Oropharyngeal diphtheria

More often (in 95%), diphtheria in children develops in the oropharynx in a localized, widespread or toxic form:

1. Diphtheria in a localized form can be catarrhal, insular and membranous, depending on local changes in the pharynx. The inflammation is limited to the tonsils. The onset is acute with sore throat and fever above 38 0 C. For catarrhal form redness of the tonsils without raids is characteristic.
2. For island shape - slight redness tonsils, with a clear border raids in the form of islands of a shiny grayish or yellowish film. It is difficult to separate with a spatula and the mucous membrane bleeds after removal. cervical lymph nodes painless, slightly enlarged.
3. The membranous form is distinguished by the appearance of a grayish pearlescent film with a sheen, completely covering the tonsil. After the forcible removal of the film, the mucous membrane bleeds.
4. The common form develops less frequently, usually with moderate severe course. The film extends beyond the borders of the tonsils: back wall pharynx, on the temples and tongue. There is no swelling in the neck, and enlarged lymph nodes are painful. Intoxication is manifested by adynamia and lethargy of the child, lack of appetite, headache.
5. Unvaccinated children develop toxic form with a severe course: it begins acutely with a high (up to 40 ° C) fever and signs of intoxication. Possible vomiting. Periodically there is excitation, followed by lethargy. Severe pallor of the skin. Swelling appears in the throat, then a film forms on the tonsils and beyond. By 2-3 days there is swelling of the neck (painless), which can fall to the collarbone and below. Seizures may occur.
6. The hypertoxic form is characterized by rapid development, severe intoxication syndrome from the first hours of illness: high fever, convulsions, loss of consciousness develop earlier than plaque and swelling of the neck form on the tonsils. The severity of the condition grows at lightning speed.

The prevalence of edema determines the severity of toxic diphtheria:

• to the middle of the neck - I step. gravity;
• to the collarbones - II degree;
• below the clavicle - III step.

Increasing cardiovascular insufficiency is the cause of death of the child for 2-3 days of illness.

If against the background of toxic diphtheria II-III step. hemorrhagic syndrome appears, then they diagnose hemorrhagic form diphtheria. Plaques on the tonsils are saturated with blood, there are nasal, intestinal bleeding, bleeding gums, etc. Against this background, myocarditis develops, from which the child dies.

Diphtheria of the larynx

In children, it develops more often from 1 to 5 years. Its complication is life-threatening true croup. Moreover, the larynx can be affected in isolation (more often), or it can be a manifestation of a combined form of diphtheria, when films spreading from the throat reach the larynx and close the glottis, making breathing difficult.

On the background general malaise and fever up to 38 ° C, the stage of croupous cough develops. Hoarseness of voice and dry barking appear and grow. paroxysmal cough. The stage lasts 1-3 days.

Symptoms of the 2nd (stenotic) stage of true croup:

• noisy, wheezing, labored breathing;
• loss of voice
• silent cough;
• retraction of the intercostal muscles during inspiration.

growing respiratory failure, anxiety of the baby, cyanosis of the skin. The stage lasts from 2-3 hours to 2-3 days. The introduced anti-diphtheria serum will interrupt the development of croup and its manifestations will disappear.

If treatment is not carried out, then the stage of asphyxia develops:

• breathing will become less noisy;
• the child is lethargic;
• diffuse cyanosis of the skin;
• temperature is below normal;
• frequent pulse;
• pressure drops;
• pupils are dilated.

If not provided surgical care(tracheotomy), then loss of consciousness, convulsions, irregular breathing and death from suffocation occur.

Nasal diphtheria

This form of diphtheria is more typical for infants and preschool age. The condition of the baby suffers slightly. The temperature is normal or slightly elevated. From the 1st nasal passage appear sanious secretions. Nasal entrances are worn, irritated. nasal breathing difficult.

Diphtheria of other localizations

With diphtheria of the eyes, umbilical wound, ear, genital organs of the skin, the condition remains satisfactory. A grayish, hard-to-remove dense film forms on the affected area. With diphtheria of the eyes, damage to the 1st eye, swelling of the eyelid is characteristic. The film spreads from the conjunctiva to the eyeball.

Bacteriocarrier

It can develop in children vaccinated against diphtheria when meeting with corynebacterium. During the bacteriocarrier, the level of toxoid in the blood rises significantly, which indicates an asymptomatic disease. The tank carrier has no signs of the disease, but it is dangerous to others.

According to the duration, the types of carriage are distinguished:

• transient (up to 7 days);
• short-term (up to 2 weeks);
• medium duration (up to 1 month);
• protracted (from 1 month to several years).

Complications

Complications of diphtheria are life-threatening. Their development is associated with the entry of toxin into the blood and spread through bloodstream, as a result of which severe lesions of the cardiovascular, adrenal glands, nervous system, and kidneys develop.

Myocarditis, which developed at 2-3 weeks, is accompanied by a rhythm disturbance up to cardiac arrest.

Affecting the nervous system, the toxin causes peripheral paralysis and paresis, impaired speech, swallowing, vision, paralysis of the diaphragm and respiratory muscles. They may appear as early as 2 weeks or later. Their manifestation can be a nasal voice, strabismus, choking on food, etc. It is with the toxin that the appearance of swelling of the neck is associated.

Diagnostics

With diphtheria in children, clinical and laboratory diagnostics are carried out. The clinical diagnosis of diphtheria is based on the discovery hallmark: dense, gray color, difficult to remove film.

Methods of laboratory diagnostics:

• bacterioscopic: detection of the pathogen in a smear from the affected area when examined under a microscope;
• bacteriological: isolation of the causative agent of diphtheria when sowing a smear on a nutrient medium;
• serological: detection in the child's blood serum of specific antibodies to the pathogen in the reactions of ELISA, RNGA, RA, etc.;
• detection of diphtheria antitoxin in the blood (taken necessarily before the introduction of anti-diphtheria serum).

The toxigenicity of the isolated corynebacterium is determined in the gel precipitation reaction. Confirmation of the diagnosis is also a pronounced positive dynamics (disappearance or reduction of films, raids) after the administration of serum.

Treatment

With diphtheria in children, treatment is carried out only in a hospital. The child is hospitalized even if this is suspected dangerous infection to the infectious department. In the event of complications, treatment is carried out in the intensive care unit.

The main treatment for diphtheria is intravenous injection. diphtheria antitoxic serum . It is introduced even in case of suspicion of diphtheria before the results of the bacteriological examination are obtained. The serum has a neutralizing effect on the corynebacterium toxin. Timely administration of serum helps to avoid the most severe complications of diphtheria in children, and sometimes save their lives.

Since the basis of the drug is horse serum, before using it, a check is made of the individual sensitivity of the child's body to it. With increased sensitivity, the introduction of serum is carried out according to a special method (diluted).

It is important to introduce it as early as possible. The prognosis and success of treatment depends on the timeliness of serum administration. Dose depends on clinical form diphtheria. If the child has mild form- serum is injected 1 time, a severe form requires repeated injections.

Component complex treatment diphtheria are antibiotics, the purpose of their use is to prevent the development of pneumonia and the further spread of diphtheritic inflammation. They cannot replace diphtheria antiserum, as they do not act on corynebacterium toxin.

Various antibiotics can be used - Erythromycin, Rifampicin, Ciprofloxacin, Ceftriaxone, etc. They are used in age doses orally, injected into a vein or muscle (depending on the severity of the condition) for a 5-7-day course.

Corticosteroid drugs are used for diphtheria of the larynx as drugs with a powerful anti-inflammatory effect. From this group, Prednisolone, Dexamethasone, Ortadexone, Fortecortin, etc. can be prescribed.

True croup requires special attention. Make sure you have access fresh air. Antiallergic and sedative drugs are prescribed. With the development of the stage of stenosis, it is necessary urgent operations - tracheotomy (a special tube is inserted into the trachea to ensure the flow of air into the lungs and prevent the child from suffocating).

Symptomatic therapy includes: detoxification treatment (intravenous injection of solutions of Rheosorbilact, Albumin, glucose 10%, etc.), vitamin therapy, antipyretics. With myocarditis, oxygen therapy, antiarrhythmic drugs, Curantil, Riboxin, etc. are prescribed. In case of pneumonia, in the event of the development of respiratory disorders, apparatus breathing (IVL) is connected.

Of great importance is baby care. Provide bed rest, timely feed or water the child, reassure - the task of the parents. Feeding through a nasogastric tube is used for violation of swallowing. Lubrication of the throat with cranberry juice (freshly squeezed) or gargling with it every half hour will help ease the child’s well-being with severe sore throats.

It is necessary to treat bacteria carriers of diphtheria bacillus with the sanitation of foci of chronic infection and general strengthening therapy: vitamin therapy, good nutrition, daily exposure to fresh air.

A 7-day course of Erythromycin is carried out in combination with Polyoxidonium in the form of drops in the nose, 1-3 drops each. three times a day.

Forecast

The outcome of the disease depends on its form and the period of serum administration. Favorable prognosis have localized forms.

Toxic forms are complicated by the more severe, the later serum treatment was started.

The cause of death can be severe myocarditis, associated pneumonia and paralysis of the respiratory muscles. With hypertoxic diphtheria, a child may die as early as 2-3 days due to severe intoxication.

Prevention

There are specific and non-specific diphtheria prophylaxis. Specific is a routine immunization of the entire population. It is carried out intramuscularly for children from 3 months. age 3 times with an interval of 1.5 months. the introduction of DTP or ADS. Children are revaccinated at 1.5-2 years old, at 7 and 14 years old.

Immunization against diphtheria rarely leads to complications. Of the adverse reactions, there may be malaise, not a high temperature, but redness and induration at the injection site.

There are practically no contraindications to vaccination against diphtheria. If the child had a mild ARVI, then he can be vaccinated immediately after recovery. If the infection was severe, then the vaccine can be administered after 2 months. later. In the presence of chronic pathology internal organs vaccination is carried out in remission by permission and under the supervision of an immunologist.

To preventive measures relate:

• isolation of patients until recovery and negative control bakanaliza;
• observation and examination of contacts;
• identification of corynebacteria carriers and their treatment.

Diphtheria is a dangerous airborne infection. If you suspect it, you should contact a pediatrician, infectious disease specialist or ENT doctor. The result of treatment depends on the timely administration of a special serum.

You can prevent the disease by immunizing your child. Do not rush to refuse vaccination: after all, it is impossible to completely exclude the contact of the child with the bacteria carrier in the store, in transport, and the child may get sick.

Diphtheria in children is an acute infectious disease characterized by inflammation of the mucous membranes of the upper respiratory tract and nasopharynx, and, in rare cases, the skin at the site of injury. This disease can lead to death. The main manifestation is the appearance of grayish fibrinous films on the surface of the tonsils and mucous membranes of the oropharynx.

For diphtheria in children, as for many infectious diseases upper respiratory tract, predominantly winter seasonality is characteristic.

The main route of transmission of the pathogen is airborne. In rare cases, the infection is transmitted by contact-household. The incubation period ranges from 2 to 7 days (average 3 days). Persons not immunized against the infection can become ill at any age.

The causative agent and causes of diphtheria in children

The main causes of diphtheria in children are age absence and infection. The causative agent of the disease is Corynebacterium diphtheria. By producing diphtheria toxin, it causes disease. The entrance gate of infection is most often the mucous membrane of the mouth, nose, and larynx. Corynebacteria spread to tissue cells and begin to produce exotoxin - a substance that causes the death of body cells. Exotoxin has both local and general effects when spreading through the vascular bed. When a diphtheria bacillus enters the pharyngeal tonsils from the affected cells, a specific fluid is released, during the thickening of which a dense fibrinous film of a grayish color is formed.

To the most serious complications Exotoxin effects include: myocarditis (inflammation of the heart muscle) and damage to the nervous system. When myocarditis occurs, the work of the heart is disturbed, various severe arrhythmias occur, up to a complete stop of cardiac activity. With damage to the nervous system, visual impairment may occur according to the type of diplopia (doubling), the act of swallowing, speech, until the complete loss of voice. Diphtheria toxin can penetrate the tissues of the neck, causing very severe swelling (“bull neck”).

Signs and symptoms of diphtheria in children

Symptoms of diphtheria in children are very diverse and depend on the localization of the infectious process.

Signs of diphtheria of the nose. When this form occurs, the nasal passages are damaged. Of these, a bloody discharge is released. Upon detailed examination, areas of a thin crust appear on the wings of the nose. This form of the disease very rarely leads to complications. However, for healthcare organizations, nasal diphtheria is problematic because spreads more quickly than other forms this disease. The first signs of nasal diphtheria appear quickly.

Symptoms of diphtheria oropharynx

Diphtheria of the oropharynx (pharynx) is the most common form of the disease. It is characterized by the appearance of dense fibrinous films on the tonsils, which are very difficult to remove with a spatula. When you try to remove them, they begin to bleed.

The disease of this form is also characterized by such symptoms of diphtheria as the appearance of an inflammatory process of the oropharynx, an increase in body temperature to 38.3-38.9 ° C, tachycardia, general weakness.

Signs of diphtheria of the larynx

Diphtheria of the larynx is one of the most dangerous forms diphtheria for the occurrence of complications. Patients develop the following signs of diphtheria - high body temperature (39.4-40 ° C), general weakness, coughing, hoarseness and loss of voice, respiratory disorders. The appearance of a "bull's neck" indicates a high titer of exotoxin in the bloodstream. In rare cases, acute respiratory failure occurs and, as a result, death.

Skin diphtheria in children

Occurs in approximately 33% of all cases of the disease. It is mainly characteristic of people who do not follow the rules of personal hygiene. Almost any area of ​​the skin can become infected with a diphtheria bacillus. At the site of infection, inflammation of the dermis occurs with the formation of a grayish plaque, ulcers, non-healing wounds.

Must be remembered! At the first suspicion of diphtheria, you should immediately contact a medical institution.

Diagnosis of diphtheria in children

It is necessary to diagnose the disease in urgent order. Usually, the doctor makes a diagnosis based on clinical manifestations, without waiting for confirmation of laboratory data. Diagnosis of diphtheria in children is based on different data.

First, he examines the ears, nose and mouth of the patient to rule out other diseases, causing inflammation oropharynx, high temperature body - streptococcal infection, Infectious mononucleosis etc. The most important sign that characterizes diphtheria is the appearance of dense fibrinous films.

Laboratory diagnosis of diphtheria

The diagnosis of diphtheria can be confirmed by smear microscopy from the infected area. Gram stain is used. Under a microscope, diphtheria bacilli look like numerous beaded, closely spaced colonies.

Treatment of diphtheria

Diphtheria - especially dangerous disease which is being treated in a hospital. With the appearance of severe complications (etc.), treatment is carried out in intensive care unit. Treatment for diphtheria includes A complex approach: how to use drug therapy and meticulous patient care.

Introduction of antitoxin

The main method of treatment for diphtheria is the administration of antitoxic antidiphtheria serum (PDS), without waiting for confirmation of the disease using laboratory tests. PDS is made on the basis of horse serum. Its introduction will almost completely eliminate pernicious influence exotoxin on the human body. Before the introduction, the doctor must do a test for individual sensitivity to serum. Approximately 10% of all patients have hypersensitivity to the PDS. For them, it is necessary to dilute the antitoxin. Since 2004, antitoxic antidiphtheria serum has been the only drug against diphtheria exotoxin.

Dosage: from 20,000 to 100,000 IU, depending on the severity, form and time of the disease. The antitoxin is given intravenously.

Antibacterial therapy for dephtheria

They are used to prevent further prevention of infection, as well as the prevention of severe complications (). They are not used as replacement therapy PDS, and in combination with it. For the treatment of diphtheria are used: penicillin, ampicillin, erythromycin. Of these, erythromycin is more effective for the treatment of the disease, because. has better tissue penetration ability.

Diphtheria Patient Care

Patients suffering from diphtheria need strict bed rest, meticulous care and intensive care - infusion therapy, oxygen therapy, control of cardiovascular and respiratory systems, treatment of pathology of the nervous system. Patients with laryngeal diphtheria may require emergency surgery about insular stenosis.

Recovering patients after an illness should rest at home for about 2-3 weeks. In addition, they are immunized against diphtheria.

Treatment of diphtheria complications and prognosis

If myocarditis occurs in patients with diphtheria, oxygen therapy is prescribed - with the help of it, rhythm disturbances can be avoided. Sometimes, with more severe violations Rhythm needs setting artificial driver rhythm. Patients with impaired swallowing can be fed through a nasogastric tube. , sharp respiratory disorders transferred to artificial lung ventilation.

The prognosis depends on the form, severity, presence of complications, time of administration of antitoxin. The higher these figures, the higher the likelihood of death.

at risk with lethal outcome include: children under 15 years of age, patients with concomitant pneumonia or myocarditis. Diphtheria of the nose and skin is rarely fatal.

Prevention

Prevention of diphtheria includes 4 main aspects: immunization of the population, isolation of infected patients, identification and treatment of contact persons, reporting the outbreak to the health department.

Population immunization

Currently, immunization of the population is the most effective method prevent diphtheria. Immunization is carried out by introducing a vaccine against diphtheria, whooping cough, in 3 stages:

• first vaccination at 3 months;
• second vaccination at 4.5 months;
• third vaccination at 6 months.

• the first - at 18 months;
• the second - at the age of 7;
• the third - at 14 years old.

Thereafter, all adults are revaccinated against diphtheria every 10 years from the last revaccination.

Isolation of infected patients

Patients with diphtheria should be isolated for 1-7 days. Isolation of the patient is terminated after the final disinfection and a single negative result of a bacterial study of mucus from the throat.

Identification and treatment of contact persons

Given that diphtheria has a very short incubation period and highly contagious, the identification and monitoring of persons in contact with the patient is carried out. For the purpose of prevention, they are prescribed a seven-day course of antibiotic therapy.

These activities are necessary to track potential foci of infection, and also contribute to the compilation of more reliable information about the nature of the focus of diphtheria.