Diphtheria in adults has been familiar to mankind for many centuries and the symptoms of the disease are similar to angina. Previously, this disease was in the nature of epidemics, the symptoms appeared instantly, the mortality rate reached 60%.
Now the level of immunization of the population of most countries is so high that diphtheria is rare. But anti-vaccination movements pose some danger in this regard.
Physician-therapist: Azalia Solntseva ✓ Article reviewed by a doctor
Diphtheria - symptoms in adults
Diphtheria is an acute infectious disease. The disease is caused by the penetration of corynebacterium diphtheriae into the human body. Infection occurs most often by airborne droplets or by household contact (toys, furniture) when bacteria get on the mucous membranes of the mouth, nose, and also the upper respiratory tract.
The symptoms of the disease differ depending on where the pathological focus is located. It should be noted that in the early stages the disease is difficult to diagnose; there are also asymptomatic and low-symptom forms.
Symptoms that are observed in all patients include:
- increased body temperature for several days, which then reaches 39-40 ° C;
- malaise, weakness, headaches;
- pallor of the skin, which occurs due to spasm of small vessels;
- lowering blood pressure;
- chills and fever;
- an increase in the size of the lymph nodes;
- discharge from the affected mucous membranes, their swelling and soreness.
This is basically how the process of intoxication of the body, triggered by diphtheria toxin, is expressed.
Treatment of diphtheria in adults
Treatment of diphtheria is mandatory and is carried out in the hospital of the infectious diseases department of the hospital. This helps to avoid the spread of a dangerous disease.
Treatment includes the following methods:
- Etiotropic therapy is the administration of serum against diphtheria, since the main cause of the severity of the disease is diphtheria toxin. In each case, the attending doctor prescribes a specific dosage, which depends on many factors.
- Antibiotics - used as part of complex therapy, which is aimed at combating the pathogen.
- Local treatment of the focus of inflammation.
- Glucocorticosteroids - are prescribed for severe intoxication of the body, often in combination with various saline solutions and vitamin C.
- Prednisolone and plasmapheresis - in some cases.
- Intubation and tracheostomy - with the threat of asphyxia or obstruction of the airways.
The patient is prescribed bed rest, as well as a diet high in calories and vitamins.
Diphtheria prevention and vaccinations
Prevention plays an important role in stopping the spread of a serious disease like diphtheria. Since the infection is transmitted by airborne droplets, contact with sick people should be avoided in the first place.
If a patient is found, the place where he appeared must be treated with a disinfectant. Timely admission to the hospital and isolation of the patient is an important step in prevention.
Vaccination and DTP vaccination - preventing tetanus and diphtheria
The most effective preventive measure remains periodic vaccination of diphtheria in adults. In Russia, this is a vaccine called DPT.
It is placed free of charge in the clinic, starting from 3 months of age. Further, a certain schedule of revaccination should be observed - it is based on diphtheria, tetanus separately.
How often revaccination is needed
Adults are given the vaccine every 10 years. Vaccination will not protect you from accidental infection, but it will ease the course of the disease. The immune system has developed a defense, so the fight against the diphtheria bacillus begins immediately.
Side effects of vaccination for the patient
Side effects are noted on DTP. Among them: an increase in temperature, a change in behavior due to poor health, moodiness, redness and induration may occur at the injection site. Symptoms usually resolve within 3 days.
Stages of development of diphtheria
The disease does not reach its peak in 1 day, but passes in several stages.
The incubation period for the development of infection
After the pathogen enters the human body and before the first symptoms appear, on average, it takes 2 to 10 days - this is the incubation period. By the end of this period, there is a slight fever, general weakness and malaise. In the classic form, sore throat and sore throat occur, and the lymph nodes closest to the site of inflammation increase.
How does the inflammatory period manifest?
It is characterized by pronounced symptoms as the body fights the infection. Signs of intoxication are clearly manifested, high temperature due to diphtheria toxin, which poisons the body. During this period of time, symptoms inherent in a certain type of disease are revealed to varying degrees of severity. Most often, the acute period lasts about 3 days.
Patient recovery and detoxification
Gradually released toxins are removed, due to which the temperature drops. But other signs, such as plaque and discharge, may bother you further, up to 8 days. The edema of the tissues and the size of the lymph nodes gradually decrease.
Characteristic features of the disease
Since the disease manifests itself in an atypical form, it complicates diagnosis, and, accordingly, hospitalization. About 90% of all cases are localized diphtheria.
Due to mass vaccination, serious cases of intoxication usually do not occur, and the disease itself passes with a slight deterioration in well-being.
But this does not mean that treatment is unnecessary. In an advanced stage, such as croup, inflammation can go lower, causing asphyxiation and death.
Given the severity of the condition and the severity of symptoms, the forms of diphtheria are divided as follows:
- Non-toxic - the disease is relatively easy. This happens when a person is vaccinated.
- Subtoxic - all signs of serious intoxication are mild.
- Toxic is the most common. It develops rapidly: all stages of the disease, including acute intoxication, develop literally within 3 days. It is expressed in severe edema that affects the neck and surrounding tissues, and abdominal pains may bother.
- Hypertoxic - symptoms of intoxication are very pronounced. In this case, edema and high fever are accompanied by convulsions, the person loses consciousness, suffers from fever. If treatment is not available, death can result from heart failure.
- Hemorrhagic - diphtheria affects the hematopoietic system. This is a very severe form, in which hemorrhagic rashes occur throughout the body, hemorrhages in the gastrointestinal tract and mucous membranes may occur.
The last 3 forms are very dangerous and require urgent medical attention to prescribe the necessary treatment.
Forms of diphtheria or types of disease
Depending on the location of the bacteria, there are several types of this disease.
How does oropharyngeal diphtheria manifest itself?
This variety is considered classic, since 90% of people who get sick suffer from this form.
When bacteria enters the oropharyngeal mucosa, it becomes inflamed and further necrotic. The process is accompanied by the occurrence of severe edema and jelly-like discharge on the tonsils.
Soon they are replaced by dense, grayish fibrinous films. Mechanically plaque is poorly removed, and if it succeeds, then the tissue bleeds. Within a day, it forms again.
Plaque and swelling can grow so large that breathing problems can occur. This process is able to spread to neighboring tissues.
Diphtheria croup of the larynx, trachea, bronchi
The respiratory system is damaged, which is why a severe cough becomes a problem with this form. The voice is hoarse, breathing is difficult, pallor of the skin appears, a violation of the heart rhythm.
There is confusion, a drop in blood pressure and heart rate. The combination of factors leads to loss of consciousness, suffocation and death.
Diphtheria of the nose - developmental process
It is manifested by pronounced difficulty breathing through the nose, as well as ichor and purulent-serous secretions. In this case, the nasal mucosa is affected and swollen, covered with sores and a fibrinous film, which is separated by flaps.
Crusting and irritation can spread around the nose. This form almost never manifests itself on its own, but goes in combination with damage to the larynx, oropharynx or eyes.
Diphtheria of the eyes - basic provisions
A rare occurrence, and is often expressed only by redness of the eyes.
There are 3 types:
- Catarrhal - the conjunctiva becomes inflamed, while small, bloody discharge may be observed. Intoxication does not occur, and body temperature is within normal limits, or slightly increased.
- Filmy - the eye tissues swell and become covered with a fibrinous film, purulent-serous discharge may be present. The temperature rises slightly, and the intoxication is mild.
- Toxic - occurs rapidly and is manifested by edema of the tissues of the eye and eyelids. In addition to the conjunctiva, inflammation affects other parts of the eye, as well as neighboring tissues. Intoxication manifests itself quite strongly.
Diphtheria of rare localization - types of lesions
Occasionally lesions occur:
- Genital organs: in men it is the foreskin, in women it is the labia. Puffiness and bloody discharge appear, the process of urination is painful. Infection can also affect adjacent tissues.
- Damaged skin: wound, diaper rash, crack, etc. A gray film and purulent-serous discharge form on the wound. Intoxication is mild, but the wound heals slowly - from a month or more.
Diagnostics and research
It is difficult for doctors to diagnose diphtheria, not to mention self-diagnosis. The problem is that symptoms can be easily confused with other diseases - sore throat or stomatitis. Since it manifests itself with dangerous consequences for the body and death, the correct diagnosis saves lives.
For this, laboratory tests are assigned:
- bacteriological smear from the oropharynx - determines the causative agent of the disease;
- serological - helps to determine the severity of the inflammatory process;
- PCR - determines the DNA of the bacteria.
Due to the large number of possible complications, additional examination of other organs and systems is performed.
Treatment with folk methods
Folk remedies are designed to initially relieve local symptoms and support immunity with the help of decoctions for drinking and rinsing, compresses, etc.
Popular remedies include cranberries, lingonberries and lemon. It is recommended to drink plant sap warm and lubricate the plaque in the throat with it. Rinsing is also considered effective. 
Features of the course in pregnant women and the elderly
Infection with diphtheria of a pregnant woman has a number of characteristics and difficulties associated with its treatment. Its position imposes many restrictions on the intake of medications.
In addition to the consequences of the transferred disease, typical for everyone, pregnant women are observed:
- damage to the genitals, which can cause vaginal obstruction;
- infection of the fetus - at birth it will have immunity for some time - vaccination is also effective;
- early miscarriage may occur.
The severity of the disease in older people is due to reduced immunity. It should be borne in mind that the vaccine has a temporary effect. Every 10 years, revaccination is carried out, since often age is not an obstacle to infection.
With a timely appeal to a medical institution, as well as the beginning of treatment, the prognosis for the course of the disease is favorable. This is also facilitated by the mass vaccination of the population, which begins at the age of 3 months. If there is a severe form of toxic poisoning and untimely treatment, a lethal outcome is also possible. At the moment, mortality is no more than 5% of the total number of cases.
Diphtheria is a very dangerous bacterial infection that is often fatal if prevention is insufficient or treatment is delayed. The disease does not make a choice between ages; symptoms of diphtheria in adults can occur in the same way as in children. In Europe, epidemics of the disease flared up over and over again, especially in the late 19th century and during the First and Second World Wars. Since about 1947, vaccinations have been systematically carried out against the infection, and it has been largely suppressed.
The CIS countries still remember the terrible epidemics of the 90s. There were 150 thousand patients, 5 thousand dead. The causes of diphtheria are a large number of people who have not been vaccinated (less than 70% of people were vaccinated between 1986 and 1991), as well as the collapse of the health care system.
In recent years, cases of this disease have been repeatedly observed, especially in adults. This is due to the lack of vaccinations: on average, one in five people are not sufficiently vaccinated against diphtheria. There is also a tendency to refuse vaccination of newborns, the anti-vaccination community is actively promoted, but this is not always justified, as in this case.
Diphtheria is an acute bacterial infection. It usually affects the upper respiratory tract, especially in the throat.
The causes of infection are coughing or sneezing, for example, airborne droplets from person to person. Sometimes by contact with contaminated objects. The carrier of the bacteria can be both a sick and a healthy person.
Once bacteria have settled in the throat, they begin to produce poison. It is responsible for diphtheria symptoms such as sore throat and fever. It can spread through the bloodstream throughout the body, enters the organs farther from the site of inflammation - the heart, nervous system, kidneys and liver. Toxins damage cells of affected organs, destroying the cell membrane, and cause dangerous complications. If there is no treatment for the disease, then the person's life is at risk.
The diphtheria vaccine is a prophylaxis that can prevent or alleviate the disease. When the vaccine was introduced, the number of new cases dropped dramatically.
However, local epidemics still occur due to the cause of insufficient vaccination. In Russia, the doctor must urgently inform the State Sanitary and Epidemiological Supervision about suspicion and actual morbidity or mortality from diphtheria.
Symptoms
The period between infection and the onset of the disease (incubation) is relatively short: the symptoms of diphtheria in children and adults appear as early as two to seven days after infection.
First symptoms
The first manifestations usually start in the throat. The poison produced by the bacteria causes the mucous membranes to swell. This leads to a sore throat, difficulty swallowing, fever, and general malaise. As a rule, a swollen neck (bovine) is visible from the outside. So, the first symptoms:
- malaise;
- fever;
- sore throat;
- shortness of breath and wheezing sounds when breathing;
- abdominal pain.
Often, the first symptoms of diphtheria in an adult and a child can be mistaken for manifestations of laryngitis or tonsillitis. Whitish-yellow deposits form on the tonsils. They are called pseudomembranes and for a doctor this is a sure sign of diphtheria. They can spread to the throat and nose. If someone tries to remove them, the mucous membrane begins to bleed.
During the entire period of the disease, a sweetish odor from the mouth is heard. A child, especially a very small child, often suffers from the nasopharyngeal mucosa. In such cases, there is a bloody or purulent discharge from the nose.
The moment when the disease affects the larynx is very dangerous. Swelling of the mucous membrane leads first to a barking cough and hoarseness. If the disease is not treated, increased swelling can cause shortness of breath and respiratory arrest.
Further manifestation of the disease
After a few days, diphtheria presents with the following, more severe symptoms:
For an actual, definitive diagnosis of diphtheria, the presence of the bacterium must be proven. To do this, the doctor takes a swab with a cotton swab from the throat or nasal mucosa. This smear is examined for the pathogen and its toxin in the laboratory. Results will only be available after twelve hours. Thus, the doctor often starts therapy only if diphtheria is suspected.
Types of defeat
Depending on the place of its manifestation, there are various combinations of these forms of the disease. Their symptoms and course of the disease are somewhat different. Occurs:
- pharyngeal diphtheria;
- widespread diphtheria;
- toxic;
- hypertoxic and hemorrhagic;
- other localization - nose, eyes, skin, genitals;
- combined.
Pharyngeal diphtheria (localized)
The most common, manifests itself in 70-75 cases of the disease out of 100. There are three variants of the course of such diphtheria and its foci are located only in the oropharynx:
- The first one is filmy (the most severe), when plaque in the form of a dense film covers the amygdala with a solid spot. When trying to remove the mucous membrane begins to bleed. Treatment is carried out with serotherapy, after which the plaque disappears after 3-4 days.
- In the second type, the film covers the inner side of the tonsils in the form of foci (usually they are not in the depressions) of the disease, the edges of which are uneven. This form is called insular... If not treated, it becomes common or toxic. Usually, the symptoms of diphtheria in an adult and a child with this form are accompanied by a high temperature (38-39 o C), headache, weakness and pain when swallowing. This is why it is sometimes confused with angina.
- At the third, catarrhal form, the disease can be detected only with a bacterial study, since there are no symptoms of intoxication, and the tonsils do not increase significantly. The temperature is slightly above normal. This is the mildest form of the disease.
Diphtheria common form
In an adult, this form is much less common than in a child - in 5 cases out of 100.
The film covers not only the tonsils, but also the palatine arches with the uvula. Also, a bad sweetish bad breath and moderate swelling of the cervical and submandibular lymph nodes are usually expressed.
Thickening of the pseudo-membrane extends to the entire space of the nasopharynx and leads to severe respiratory failure, which manifests itself in a wheezing noise when breathing.
Toxic diphtheria
Much more dangerous, has three degrees of severity. The poison of Löffler's bacillus (the so-called causative agent of the cause of diphtheria) causes a violent toxic reaction:
- with body temperature up to 40 ° C;
- severe malaise and lethargy;
- headaches;
- sore throat, neck, abdomen.
In just 2-3 days, a spider web of jelly-like plaque covers almost the entire oral cavity, quickly thickens and becomes dirty gray. It is clearly visible on the tonsils of a child or an adult, the soft and hard palate and palatine arch, tongue.
It becomes difficult for the patient to breathe, films on the nasal mucosa are possible, the ichor is flowing. The person begins to nasal, there is a smell from the mouth. The neck swells strongly, but not painfully (up to the collarbones), the lymph nodes are significantly enlarged, the swelling can even reach the cheeks. Skin color does not change.
Hypertoxic and hemorrhagic
The most malignant and fastest forms of the disease. They usually occur if treatment was started late and the antidiphtheria serum was administered late. If the drug is administered, the film is torn off the mucous membrane after 6-8 days.
The hypertoxic form has a pronounced intoxication in the form of hyperthermia, unconsciousness, collapse and seizures. The throat swells strongly, plaque covers most of it. If the treatment is untimely, a person dies on the 2-3rd day due to problems with the cardiovascular system.
The causes of the hemorrhagic form - the bacillus causes multiple bleeding from the nose and mouth, in the gastrointestinal tract. A sure symptom of this form is a hemorrhagic rash.
Typical complications: myocarditis, peripheral paralysis.
Possible other sites - nose, eyes, genitals
Diphtheria occurs not only in the upper respiratory tract, but also in other systems with mucous membranes, since this is an ideal environment for the development of bacilli. The toxin secreted by the bacillus leads to edema and necrosis of these membranes, damage to the myocardium and peripheral nerves, kidneys in both the child and the adult.
Nasal diphtheria
Especially often such a progressive form is found in a child. It is characterized by loss of appetite, fatigue, fever, and purulent nasal discharge. Nasal diphtheria is mild in most cases.
Croup
Inflammatory narrowing of the airways (larynx) with shortness of breath, wheezing, noises on inhalation. Other symptoms include hoarseness, loss of voice, and a barking cough. Due to respiratory failure, acute suffocation occurs.
Therapy
Treatment is aimed at quickly neutralizing the toxin and preventing bacilli from increasing in numbers.
In case of suspicion of diphtheria, antitoxin serum should be injected immediately, without waiting for the results of diagnostic tests.
The treatment itself is carried out in inpatient conditions both for a sick adult or child, and for a carrier of the disease.
Antitoxins
Diphtheria serum is obtained from the blood of a person or horse who has been in contact with diphtheria toxin. Antivenom from human blood is not always available, so equine antitoxins are more commonly used. However, some people are allergic to the protein in the horse's blood and the therapeutic dose can cause fatal shock for them. A diluted solution (1:10) of horse serum is instilled into the conjunctival sac. The patient receives the required amount of antitoxin in a single dose.
Antibiotics and other measures
In order to destroy the causative agent of the infection, antibiotic therapy is required for at least 10 days. The drug for its implementation is Penicillin, Erythromycin or Cephalosporin. To avoid complications and allergies to Penicillin, a minimum of five to six weeks of bed rest must be observed.
In addition, stabilization of blood circulation is necessary, as well as careful monitoring of respiratory functions. In case of obstruction of the airways due to swelling, a tracheotomy is immediately performed - an operation to perform the mouth between the trachea and the external environment. In severe cases, the patient is intruded - a special tube is inserted into the larynx to start artificial respiration at any time.
In moderate and severe forms, detoxification therapy with glucose-saline solution, as well as glucocorticosteroids, is performed. Treatment also includes a high-calorie and fortified diet (food must be carefully processed), as well as rinsing and spraying with disinfectant solutions.
Prevention of disease
The most effective prevention of diphtheria is active vaccination. This is the introduction of a small amount of bacilli, which stimulate the body to produce antibodies. Although these antibodies do not interfere with further infection with diphtheria, they are able to neutralize the causes of complications - a bacterial toxin, and thus weaken the progression of the disease (antitoxic immunity).
Immunization of a child from the age of three months is carried out together with vaccination against tetanus and pertussis. DTP vaccination is recommended. The revaccination should be at 6 and 15 years old, and every ten years thereafter.
Passive immunization with equine antitoxins is beneficial for people who have had close contact with patients with diphtheria. It provides immediately limited long-term protection immediately.
Diphtheria - symptoms and treatment
What is diphtheria? We will analyze the causes of occurrence, diagnosis and treatment methods in an article by Dr.P.Aleksandrov, an infectious disease specialist with 12 years of experience.
Definition of disease. Causes of the disease
Diphtheria (from the Latin diftera - film; pre-revolutionary - "mothers crying disease", "mothers horror disease") - an acute infectious disease caused by toxigenic strains of diphtheria bacillus, which toxicly affect the circulatory system, nervous tissue and adrenal glands, and also cause fibrinous inflammation in the area entrance gates (places of infection). Clinically characterized by a syndrome of general infectious intoxication, maxillary lymphadenitis, tonsillitis, local fibrinous inflammatory processes.
Etiology
Kingdom - Bacteria
genus - Corynebacterium
species - Corynebacterium diphteriae
These are gram-negative rods, located at an angle of V or W. At the ends there are clavate thickenings (from the Greek coryne - mace) due to volutin granules. There is a property of metachromasia - staining is not the color of the dye (according to Neisser - in dark blue, and bacterial cells - in light brown).
Contains lipopolysaccharide, proteins and lipids. The cell wall contains the cord factor, which is responsible for adhesion (adhesion) to cells. Colonies of mitis, intermedius, gravis are known. They remain viable in the external environment: under normal conditions in the air they remain alive for up to 15 days, in milk and water they live up to 20 days, on the surfaces of things - up to 6 months. They lose their properties and die when boiled for 1 minute, in 10% hydrogen peroxide - in 3 minutes. Sensitive to disinfectants and antibiotics (penicillins, aminopenicillins, cephalosporins). They like culture media containing sugar (McLoud's chocolate medium).
Isolates pathogenic products such as:
1) Exotoxin (toxin synthesis is determined by the tox + gene, which is sometimes lost), which includes several components:
- necrotoxin (causes necrosis of the epithelium at the site of the entrance gate, damages blood vessels; this leads to plasma exudation and the formation of fibrinoid films, since the enzyme thrombokinase is released from the cells, which converts fibrinogen into fibrin);
- true diphtheria toxin - exotoxin (close in action to cytochrome B - the enzyme of cellular respiration; it replaces cytochrome B in cells and blocks cellular respiration). It has two parts: A (an enzyme that causes a cytotoxic effect) and B (a receptor that facilitates the penetration of A into the cell);
- hyaluronidase (destroys hyaluronic acid, which is part of the connective tissue, which causes an increase in membrane permeability and the spread of the toxin outside the focus);
- hemolytic factor;
2) Neuraminidase;
3) Cystinase (allows you to distinguish diphtheria bacteria from other types of corynebacteria and diphtheroids).
Epidemiology
Anthroponosis. The generator of the infection is a person suffering from various forms of diphtheria and a healthy carrier of toxigenic strains of diphtheria microbes. A possible source of infection for humans is domestic animals (horses, cows, sheep), in which the pathogen can be localized on the mucous membranes, cause ulcers on the udder, mastitis.
The most dangerous in terms of the spread of infection are people with diphtheria of the nose, throat and larynx.
Transmission mechanisms: airborne (aerosol), contact (through hands, objects), alimentary route (through milk).
A person is sick who does not have natural resistance (resistance) to the pathogen and does not have antitoxic immunity of the required level (0.03 - 0.09 IU / ml - conditionally protected, 0.1 and above IU / ml - protected). After a disease, immunity lasts for about 10 years, then a second disease is possible. The incidence is influenced by the coverage of the population with preventive vaccinations. Seasonality is autumn-winter. When carrying out a full course of immunization against diphtheria in childhood and regular revaccination (every 10 years), a stable tense immunity is developed and maintained, which protects against the disease.
Despite the successes of modern health care, mortality from diphtheria at the world level (mainly underdeveloped countries) remains within 10%.
If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Diphtheria symptoms
The incubation period is from 2 to 10 days.
The course of the disease is subacute (i.e., the main syndrome appears 2-3 days after the onset of the disease), however, with the development of the disease at a young and mature age, as well as with concomitant pathologies of the immune system, it can change.
Diphtheria Syndromes:
- syndrome of general infectious intoxication;
- tonsillitis (fibrinous) - leading;
- regional lymphadenitis (maxillary);
- hemorrhagic;
- edema of the subcutaneous fat.
The onset of the disease is usually accompanied by a moderate rise in body temperature, general malaise, then the clinical picture diverges according to the form of the disease.
Atypical form (characterized by a short fever for two days, mild discomfort and sore throat during swallowing, an increase in the maxillary lymph nodes up to 1 cm, weakly sensitive to light touch);
Typical form (quite noticeable heaviness in the head, drowsiness, lethargy, weakness, pallor of the skin, enlargement of the maxillary lymph nodes from 2 cm or more, pain when swallowing):
a) common (primarily common or developing from localized) - an increase in body temperature to febrile numbers (38-39 ° C), noticeably pronounced weakness, weakness, pallor of the skin, dry mouth, sore throat when swallowing moderate intensity, painful lymph nodes up to 3 cm ;
b) toxic (primarily toxic or originating from common) - characterized by severe headache, apathy, lethargy, pallor of the skin, dry mucous membrane of the mouth, possible occurrence of abdominal pain in children, vomiting, temperature 39-41 ° C, sore throat when swallowing , painful lymph nodes up to 4 cm, swelling of the subcutaneous fatty tissue around them, spreading in some cases to other parts of the body, difficulty in nasal breathing - nasal voice.
The degree of edema of the subcutaneous fat:
- subtoxic form (unilateral or parotid edema);
- toxic grade I (up to the middle of the neck);
- toxic grade II (up to the collarbones);
- toxic grade III (edema passes to the chest).
In severe toxic forms of diphtheria due to edema, the neck visually becomes short and thick, the skin resembles a jelly-like consistency (a symptom of "Roman consuls").
The pallor of the skin is proportional to the degree of intoxication. The deposits on the tonsils are asymmetrical.
c) hypertoxic - acute onset, pronounced syndrome of general infectious intoxication, obvious changes at the entrance gate, hyperthermia from 40 ° C; joins acute cardiovascular failure, unstable blood pressure;
d) hemorrhagic - soaking of fibrinous deposits with blood, bleeding from the nasal passages, petechiae on the skin and mucous membranes (red or purple spots formed when capillaries are damaged).
If, in the absence of adequate treatment, the body temperature returns to normal, then this cannot be unequivocally regarded as an improvement - it is often an extremely unfavorable sign.
Distinguish between rare diphtheria in vaccinated (similar to atypical diphtheria) and diphtheria in combination with streptococcal infection (there are no fundamental differences).
Other forms of diphtheria infection:
- larynx (subfebrile condition - a slight increase in temperature; not a pronounced syndrome of general infectious intoxication, catarrhal first - a soundless cough with phlegm, with difficulty both inhaling (stronger) and exhaling (less pronounced), changes in timbre or loss of voice; then the stenotic period, accompanied by difficulty breathing and retraction of labile places of the chest; further period of asphyxia - an agitated state, accompanied by sweating, blue discoloration of the skin and subsequently alternating respiratory depression, drowsiness, heart rhythm disturbances - may end in death);
- nose (the temperature is normal or slightly elevated, there is no intoxication, first one nasal passage is affected with the manifestation of serous-purulent or purulent discharge with hemorrhagic saturation in it, then the second course. Wetting and crusting occurs on the wings of the nose, possibly the appearance of drying crusts on the forehead, cheeks and chin area.Possible edema of the subcutaneous fatty tissue of the cheeks and neck in toxic forms);
- eyes (expressed by edema and hyperemia of the conjunctiva of moderate intensity, grayish purulent discharge from the conjunctival sac of moderate severity. In the membranous form - significant edema of the eyelids and the formation of hard-to-remove gray-white films on the conjunctiva);
- wounds (long-term non-healing wounds with redness of the edges, dirty gray plaque, infiltration of surrounding tissues).
Features for pharyngoscopy:
a) atypical (hyperemia and hypertrophy of the tonsils);
b) typical (not pronounced redness with a bluish tinge, filmy plaque, swelling of the tonsils. At the onset of the disease, it is white, then gray or yellow-gray; removed with pressure, torn - after removal, leaves a bleeding wound. The film is dense, insoluble and quickly drowns in water, protrudes above the tissue. Low painfulness is characteristic, since there is anesthesia):
Diphtheria pathogenesis
Entrance gates - any area of \u200b\u200bintegument (more often the mucous membrane of the oropharynx and larynx). Following the fixation of bacteria, reproduction occurs at the site of introduction. Further, the production of exotoxin causes necrosis of the epithelium, tissue anesthesia, slowing down of blood flow, and the formation of fibrinous films. Diphtheria microbes do not spread outside the focus, but the toxin spreads through the connective tissue and causes dysfunction of various organs:
Classification and stages of development of diphtheria
1. By clinical form:
a) atypical (catarrhal);
b) typical (with films):
- localized;
- common;
- toxic;
2. By severity:
- lightweight;
- medium;
- heavy.
3. By carrier:
- transient (once detected);
- short-term (up to 2 weeks);
- medium duration (15 days - 1 month);
- protracted (up to 6 months);
- chronic (more than 6 months).
4. By localization:
- pharynx (90% of occurrence);
- larynx (localized and widespread);
- nose, eyes, genitals, skin, wounds, combined.
5. With diphtheria pharynx:
a) atypical;
b) typical:
6. By the nature of the inflammation:
Complications of diphtheria
- 1-2 weeks: infectious-toxic myocarditis (cardialgia, tachycardia, pallor, spreading of the borders of the heart, shortness of breath);
- 2 weeks: infectious-toxic polyneuropathy (III, VI, VII, IX, X);
- 4-6 weeks: paralysis and paresis (flaccid peripheral - paresis of the soft palate);
- infectious toxic shock;
- infectious toxic necrosis;
- acute adrenal insufficiency (pain in the epigastrium, sometimes vomiting, acrocyanosis, sweating, decreased blood pressure, anuria);
- acute respiratory failure (laryngeal diphtheria).
Diagnosis of diphtheria
Diphtheria treatment
It is carried out in stationary conditions (mild forms may not be recognized and treated at home).
The most effective start of therapy in the first three days of the disease. The mode in the hospital is boxed, bed (since there is a risk of developing heart paralysis). The terms for localized diphtheria are 10 days, for toxic - 30 days, for other forms - 15 days.
Diet №2 according to Pevzner in the midst of the disease (mechanically and chemically sparing, full-fledged composition), then diet №15 (common table).
At the very first time, the administration of anti-diphtheria serum (i / m or i / v) after the test is indicated medically:
- unburdened course - 15-150 thousand IU;
- with the risk of an unfavorable outcome - 150-500 thousand IU.
An integral part of the treatment is antibiotic therapy (antibiotics of the penicillin, aminopenicillin, cephalosporin series).
Pathogenetic therapy includes detoxification, hormonal support if necessary.
As symptomatic therapy, drugs of the following groups can be used:
- antipyretic at a temperature in adults over 39.5 ℃, in children over 38.5 ℃ (paracetamol, ibuprofen);
- anti-inflammatory and antimicrobial agents of local action (tablets, lozenges, etc.);
- sedatives;
- antiallergic agents;
- antispasmodics.
Carriers are treated with antibiotics for common reasons.
Discharge rules:
- the disappearance of the clinical picture of the disease;
- cessation of excretion of the pathogen (two negative cultures of mucus from the oropharynx and nose, performed no earlier than 14 days after the normalization of the clinic with an interval of 2-3 days).
After discharge from the hospital, final disinfection is carried out in the box.
Forecast. Prevention
The most important way to prevent diseases with severe forms of diphtheria infection around the world is to vaccinate. The primary course is carried out in childhood, then regular revaccinations are carried out in an adult state (once every 10 years). Vaccination saves not from the carrier of bacteria, but from the toxin produced by the bacterium, which causes a severe clinical picture. In this light, it becomes clear the need to constantly maintain the protective level of antitoxic immunity, to regularly conduct revaccination (in the Russian Federation - the ADS-m vaccine).
Diphtheria is an acute infectious disease that is life-threatening. It occurs in the form of acute inflammation of the upper respiratory tract, mainly of the pharynx (about 90% of cases), nose, skin in places of its damage, eyes or genitals.
The main threat, however, is not inflammation, but poisoning by the toxin produced by the bacterium - the causative agent of the disease, while the cardiovascular and nervous systems are mainly affected.
The causative agent of diphtheria and routes of infection
The causative agent of diphtheria is Corynebacterium diphteriae - gram-positive bacteria in the form of sticks with characteristic flask-shaped thickenings at the ends, which are arranged in pairs in smears, at an angle in the form of a Roman numeral V in relation to each other. Diphtheria bacilli in the process of vital activity secrete diphtheria toxin, the enzyme neuraminidase and other biochemically active compounds.
The synthesis of diphtheria toxin by microbial cells is controlled by a special tox gene. Bacteria can lose it in the course of their vital activity, losing along with it their ability to produce toxin (toxigenicity). Conversely, initially nontoxigenic strains can acquire pathogenic properties, fortunately, this happens extremely rarely.
The disease is transmitted by airborne droplets from patients with diphtheria or from healthy carriers of the infection, much less often through household items.
Risk group
Children aged 3–7 years are most susceptible to diphtheria infection, but in recent years, the incidence of adolescents and adults has increased.
The source of infection is sick people or healthy carriers of toxigenic bacteria. The most contagious are those suffering from diphtheria of the pharynx, nose and larynx, since they actively excrete pathogens with exhaled air. Patients with diphtheria of the eyes, skin can spread the infection by contact (hands, household items). Healthy carriers of bacteria are much less infectious, but the absence of any external signs of their condition does not allow them to control the spread of their infection, because they can only be detected by chance during mass dispensary examinations. As a result, most cases of diphtheria infection are due to contact with healthy carriers of diphtheria bacillus.
The incubation period (the time from the moment of infection until the first signs of the disease appear) is 2-10 days.
Diphtheria toxin
The toxin produced by the diphtheria bacillus consists of several components. One of them - the enzyme hyaluronidase destroys the hyaluronic acid of the capillaries and increases their permeability, which leads to the exit from the vessels and the saturation of the surrounding tissues with blood plasma with the deposition of fibrinogen protein. The second component, necrotoxin, destroys epithelial cells with the release of the thrombokinase enzyme. Thrombokinase promotes the conversion of fibrinogen to fibrin and the formation of a fibrin film on the surface of tissues. Under the action of diphtheria toxin on the palatine tonsils, which are covered with several layers of epithelial cells, a fibyrin film is formed, penetrating deep into the epithelium of the tonsils and tightly adhered to it.
The third (main) component - the toxin itself, is able to block the processes of cellular respiration and the synthesis of protein molecules. The most sensitive to its action are capillaries, myocardial cells and nerve cells. As a result, myocardial dystrophy and infectious-toxic myocarditis develop, damage to capillaries leads to infectious-toxic shock, damage to Schwann cells (auxiliary cells of the nervous tissue) leads to demyelination of nerve fibers (destruction of the electrically insulating layer of myelin with impaired conduction of nerve impulses along nerve fibers). In addition, diphtheria toxin causes general intoxication of the body.
Symptoms and course
Pharyngeal diphtheria usually begins with a slight increase in temperature, slight pain when swallowing, redness and swelling of the tonsils, the formation of a specific membranous plaque on them, an increase in the anterior upper cervical lymph nodes. The color of the films is usually white in the first 2-3 days of the disease, but then it becomes gray or yellowish-gray. After about a week, the disease either ends with recovery (a mild form, usually in those vaccinated against diphtheria), or turns into a more severe toxic form, due to the systemic action of diphtheria toxin.
The toxic form of diphtheria is always very difficult. It is characterized by a very high body temperature (39.5-41.0 ° C), severe headaches, drowsiness, and apathy. The skin becomes pale, the mouth is dry, and children may experience multiple vomiting and abdominal pain. Swelling of the tonsils becomes pronounced, can lead to complete closure of the entrance to the pharynx, spreads to the soft and hard palate, often also to the nasopharynx, breathing becomes difficult, the voice often becomes nasal. Plaque spreads to all tissues of the oropharynx. The classic sign of a toxic form of pharyngeal diphtheria is swelling of the subcutaneous tissue in the neck, and sometimes the chest, as a result of which the skin acquires a gelatinous consistency. The anterior upper cervical lymph nodes are significantly enlarged and painful.
Diphtheria of the nose proceeds against the background of normal or slightly elevated body temperature, there is no intoxication. From the nasal passages, serous-purulent or bloody-purulent discharge is visible. On the wings of the nose, cheeks, forehead and chin areas of wetness appear, and then dry crusts. Filmy deposits are visible inside the nose. The pathological process can also affect the paranasal sinuses. In the toxic form, edema of the subcutaneous tissue of the cheeks and neck is observed.
Diphtheria of the eye proceeds as a banal conjunctivitis and is characterized by moderate hyperemia and edema of the conjunctiva of the eyelid, a small amount of serous-purulent discharge from the conjunctival sac (catarrhal form). The membranous form is manifested by pronounced edema of the eyelids, the presence on their conjunctiva of hard-to-remove grayish-white films. The toxic form is also accompanied by swelling of the tissue around the orbit.
Skin diphtheria leads to prolonged non-healing of any skin lesions, hyperemia, there is a dirty gray plaque on the skin, dense infiltration of the surrounding skin is noted.
Diagnostics
Diphtheria is diagnosed on the basis of the patient's examination data and the test results. On examination for the diagnosis of diphtheria, the following signs say: the presence of characteristic films, as well as difficulty breathing and a whistling noise on inspiration, not characteristic of angina, a barking cough. The diagnosis of diphtheria by the characteristic clinical signs with a mild disease is more difficult to make.
Analyzes:
Complete blood count - signs of an acute inflammatory process.
Examination of a smear under a microscope (bacterioscopy) - identifying bacteria with a characteristic appearance Corynebacterium diphteriae.
Bacteriological research - sowing of biological material on a special nutrient medium and cultivation of colonies of microorganisms.
Determination of the level (titer) of antitoxic antibodies (high titer - 0.05 IU / ml and above allows to exclude diphtheria).
Serological research - determination of specific antibodies in blood serum using RPGA, ELISA, etc.
Pharyngeal diphtheria should be differentiated from acute tonsillitis (follicular and lacunar forms), Simanovsky-Vincent's tonsillitis (fungal infection), syphilitic tonsillitis, pseudo-film tonsillitis with infectious mononucleosis, paratonsillar abscess, mumps, leukemia. In children, it is necessary to withdraw the diagnosis of false croup.
Treatment
All patients with diphtheria, regardless of the severity of the condition, must be hospitalized in an infectious diseases hospital.
Treatment is as follows:
The diet is a fortified, high-calorie, thoroughly cooked food.
Etiotropic therapy (that is, aimed at eliminating the cause of the disease) - the introduction of anti-diphtheria serum (PDS), the dose and number of times of administration depend on the severity and form of the disease. In the mild form, the PDS is injected once intramuscularly at a dose of 20-40 thousand IU, in the moderate form - 50-80 thousand IU once or, if necessary, repeatedly in the same dose after 24 hours. In the treatment of a severe form of the disease, the total dose is increased to 90–120 thousand IU, or even up to 150 thousand IU (infectious-toxic shock, disseminated intravascular coagulation syndrome). In this case, 2/3 of the dose is administered immediately, and during the first day of hospitalization, 3/4 of the total dose should be administered.
Antibiotics: in mild forms - erythromycin, rifampicin orally, in moderate and severe forms - injection of penicillins or cephalosporins. The duration of the course is 10-14 days. Antibiotics do not affect diphtheria toxin, but they reduce the number of bacteria that make it.
Local treatment - rinsing and irrigation with disinfectant solutions.
Detoxification therapy - glucose-salt solutions, taking into account the daily need for fluid and its losses (moderate and severe form).
Glucocorticosteroids - for moderate and severe forms.
Treatment of bacteria carriers is carried out with antibiotics: tetracyclines (children over 9 years old), erythromycin, cephalosporins against the background of general strengthening therapy and elimination of chronic foci of infection.
Complications
Among the most serious complications of diphtheria on the cardiovascular system are myocarditis, heart rhythm disturbances.
Neurological complications of diphtheria are caused by damage to various cranial and peripheral nerves and are manifested by accommodation paralysis, strabismus, paresis of the extremities, and in more severe cases, paralysis of the respiratory muscles and the muscles of the diaphragm.
Secondary complications of diphtheria are such severe pathological conditions as acute disorders of cerebral circulation (thrombosis, embolism), metabolic encephalopathy, cerebral edema, toxic kidney damage, diphtheria hepatitis, as well as infectious-toxic shock and disseminated intravascular coagulation syndrome (DIC syndrome). violation of the blood coagulation system). The toxic form of diphtheria can lead to acute renal, cardiovascular, respiratory, or multiple organ failure.
Nonspecific complications of diphtheria are paratonsillar abscess, otitis media, pneumonia.
Vaccination
Vaccination against diphtheria is carried out with toxoid, that is, inactivated toxin. In response to its introduction, antibodies are formed in the body not to Corynebacterium diphteriae, but to diphtheria toxin.
Diphtheria toxoid is a part of combined domestic vaccines DPT (associated, that is, complex, vaccine against whooping cough, diphtheria and tetanus), AaKDS (vaccine with acellular pertussis component) and ADS (diphtheria-tetanus toxoid), also "sparing" vaccines ADS-M and AD-M. In addition, SanofiPasteur vaccines are registered in Russia: Tetrakok (against diphtheria, tetanus, whooping cough, poliomyelitis) and Tetraxim (against diphtheria, tetanus, pertussis, poliomyelitis, with acellular pertussis component); D.T. Vax (diphtheria-tetanus toxoid for vaccination of children under 6 years of age) and Imovaks D.T. Adyult (diphtheria-tetanus toxoid for vaccination of children over 6 years of age and adults), as well as Pentaxim (vaccine against diphtheria, tetanus, pertussis, poliomyelitis and haemophilus influenzae with acellular pertussis component).
According to the Russian vaccination calendar, children under one year of age are vaccinated at 3, 4–5 and 6 months. The first revaccination is carried out at 18 months, the second at 7 years old, and the third at 14. Adults should be revaccinated against tetanus and diphtheria every 10 years.
Diphtheria is an acute infectious disease caused by diphtheria bacteria, transmitted mainly by airborne droplets, characterized by inflammation, most often of the mucous membranes of the oral and nasopharynx, as well as the phenomena of general intoxication, damage to the cardiovascular, nervous and excretory systems.
The causative agent of diphtheria is a toxigenic strain of the diphtheria microbe. It looks like a stick with thickening at the ends. Microbes are arranged in the form of the letter V. They secrete dangerous poisons - exotoxin and neuraminidase. In addition, they break down cystine and ferment glucose, and are able to reduce nitrates to nitrites.
In connection with the ability of microorganisms to ferment starch, the disease was divided into three clinical forms: the first is light, in which starch is not fermented, the second is medium, intermediate, and the third is heavy, with the ability to ferment starch. But in essence, such a relationship does not exist at all. Only the largest microorganism can produce toxins.
The causative agent of diphtheria
Why does diphtheria develop, and what is it? The incubation period for diphtheria ranges from 3 to 7 days. The manifestations of diphtheria are diverse and depend on the localization of the process and its severity.
The source of infection is humans. The transmission of the pathogen is carried out mainly by airborne droplets, but infection is also possible by contact-household (through infected objects). For diphtheria, autumn-winter seasonality is characteristic. In modern conditions, when mainly adults are sick, diphtheria occurs throughout the year.
The causative agent of diphtheria is a diphtheria bacillus, the carrier of which is a sick person or a person who carries an infection during the incubation period of a diphtheria bacillus, as well as for some time after recovery.
Diphtheria symptoms
The incubation period for diphtheria is from 2 to 10 days. When a diphtheria bacillus enters the body, a focus of inflammation develops at the site of its introduction, in which the pathogen multiplies, releasing a toxin.
With lymph and blood, the toxin is carried throughout the body, causing damage to both the mucous membrane (or skin) at the site of introduction of the pathogen, and internal organs and systems. Since the pathogen most often enters the pharynx, local changes most often occur in it. In addition, an inflammatory focus can develop in the nose, larynx, ear, genitals, eyes, and the wound surface of the skin.
Signs of diphtheria depend on the location of the pathogen. Among the general symptoms characteristic of all forms of the disease, the following can be distinguished:
- thick gray deposits covering the throat and tonsils;
- sore throat and hoarseness;
- and swelling around them (the so-called "bull's neck");
- difficulty breathing or rapid breathing;
- discharge from the nose;
- fever and chills;
- general malaise.
Symptoms of diphtheria depending on the clinical form:
- Most often (in 90% of all cases of morbidity) occurs oropharyngeal diphtheria... The duration of the incubation period is from 2 to 10 days (from the moment of human contact with the carrier). When Leffler's stick penetrates the oral mucosa, it damages it and causes tissue necrosis. This process is manifested by severe edema, the formation of exudate, which is later replaced by fibrin films. Hard-to-remove plaque covers the tonsils, can go beyond them, spreading to adjacent tissues.
- With diphtheria croup, the larynx, bronchi, trachea can be affected... There is a strong cough, which leads to the fact that the voice becomes hoarse, the person turns pale, it is difficult for him to breathe, the heart rhythm is disturbed, cyanosis. The pulse becomes weak, blood pressure drops sharply, disturbances in consciousness, a convulsive state may disturb. The form is dangerous because it can lead to suffocation and death.
- Diphtheria of the nose. In cases with nasal diphtheria, a very slight intoxication of the body, bloody discharge, serous-purulent discharge, nasal breathing difficulties will be characteristic. In this form of diphtheria, the nasal mucosa: swollen, hyperemic, with sores, with erosions or fibrinous overlays (easy to remove, look like shreds). Also on the skin around the nose, irritation and crusts sag. Basically, diphtheria of the nose is manifested in combination with: diphtheria of the oropharynx, sometimes eyes, and / or larynx.
- With common diphtheria first, the body temperature rises to thirty-eight degrees and above. Patients move less, feel tired, sometimes there are attacks of nausea and vomiting. Plaque on the tonsils after a couple of days spreads throughout the oral cavity - on the tongue, pharynx, palate. Lymph nodes are significantly enlarged, they are painful when palpated.
- Toxic form - complication of untreated previous forms. The body temperature rises to 40 ° C, symptoms of intoxication syndrome appear: chills, weakness, joint pain, sore throat. Patients experience vomiting, agitation, euphoria and delirium. The skin turns pale, and the mucous membrane of the pharynx swells and turns red. Complete closure of the larynx is possible. Fibrinous plaque covers most of the mucous membrane of the oropharynx, and the films become coarse and thick. Patients have cyanosis of the lips, heart rate increases, blood pressure drops, and an unpleasant, putrid odor emanates from the mouth.
Early treatment of diphtheria ensures complete recovery, without any complications, although the duration of cure depends on the severity of the infection. In the absence of timely treatment, serious complications are possible, including those of the heart, which can lead to coma, paralysis or even death.
Diagnostics
It can be difficult to diagnose diphtheria because the symptoms are similar to a number of other diseases -, etc. In order to accurately establish the diagnosis and prescribe the proper treatment, laboratory tests are necessary:
- Bacteriological (swab from the oropharynx). Using this method, the pathogen is isolated and its toxic properties are established;
- Serological. Ig G and M are determined, indicating the strength of the immune system, which speak of the severity of the ongoing inflammatory process;
- The PCR method is used to identify the DNA of the pathogen.
It also requires a diagnosis of complications caused by diphtheria.
Diphtheria: photo
How people diagnosed with diphtheria look like, the photo is presented below.
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Complications
The reasons for the development of complications are the effect of diphtheria bacillus toxins on the body and the late administration of serum:
- myocarditis;
- infectious toxic shock;
- DIC syndrome;
- damage to the adrenal glands;
- multiple organ failure;
- respiratory failure;
- poly- or mononeuritis;
- toxic nephrosis;
- cardiovascular insufficiency;
- and etc.
The time of occurrence of the above complications depends on the type of diphtheria and its severity. For example, toxic myocarditis can develop at 2-3 weeks of the disease, and neuritis and polyradiculoneuropathy - against the background of the disease or 1-3 months after complete recovery.
Diphtheria treatment
Regardless of the severity of the course of diphtheria, treatment in children and adults is carried out in a hospital (in a hospital). Hospitalization is mandatory for all patients, as well as for patients with suspected diphtheria and bacterial carriers.
Upon confirmation of the presence of diphtheria, antitoxic anti-diphtheria serum is immediately administered, which helps to neutralize the exotoxin in the blood. The dose of antidiphtheria serum is determined by the severity of the disease. If a localized form is suspected, serum administration can be postponed until the diagnosis is clarified. If the doctor suspects a toxic form of diphtheria, then serum treatment should be started immediately. Serum is injected intramuscularly or intravenously (for severe forms).
In combination with serum, antibacterial drugs are prescribed. Of the entire spectrum, erythromycin (as well as penicillin, ampiox, ampicillin, tetracycline) is the most popular, which destroys the pathogen. Already at this stage, a person not only begins to recover, but his body is no longer exposed to the action of the diphtheria bacillus, which is the most important at the time of diagnosis.
Another important aspect in the treatment of diphtheria is the weakening of the intoxication of the body. For this, the introduction of polyionic solutions, glucocorticoids, and a potassium mixture is used. If such measures do not bring results, then blood purification (plasmapheresis) is indicated.
Prevention
Non-specific prevention consists in observing the following rules:
- Timely identify and isolate patients and bacteria carriers.
- Carry out current and final disinfection.
- Examine all persons in contact with the patient once.
- Monitor patients with angina for three days.
- Conduct an annual medical examination of schoolchildren.
- Monitor diphtheria convalescents for 3 months after discharge from the infectious diseases department.
Diphtheria vaccine
The most effective prevention of diphtheria is active vaccination. This is the introduction of a small amount of bacilli, which stimulate the body to produce antibodies. Although these antibodies do not interfere with further infection with diphtheria, they are able to neutralize the causes of complications - a bacterial toxin, and thus weaken the progression of the disease (antitoxic immunity).
You can get vaccinated against diphtheria at any vaccination office. Vaccinations against diphtheria are included in the National Vaccination Schedule. Children are vaccinated in three stages (at 3, 4.5 and 6 months). At 18 months, 6-7 and 14 years old, revaccinations are performed. Thereafter, children and adults should be vaccinated against diphtheria every 10 years.
After a previous illness, an unstable immunity is formed, and after about 10-11 years a person can get sick again. Recurrent disease is mild and easier to tolerate.
Forecast
In the case of localized forms of mild and moderate diphtheria, as well as with the timely administration of antitoxic serum, the prognosis for life is favorable. The prognosis can be aggravated by a severe course of a toxic form, the development of complications, and a late start of therapeutic measures.
At present, due to the development of means to help patients and mass immunization of the population, mortality from diphtheria is no more than 5%.
