Diphtheria

1. Tashkent Medical Academy Diphtheria Department of Infectious and Pediatric Infectious Diseases Lecturer: Prof. Osipova SO.

2. The aim of the lecture. The educational goal - humane education and professional attitude to the patient.The objectives of the lecture is to master the students methods of diagnosis and treatment of diphtheria.2. Issues to be discrimination.2.1. Determination diphtheria - 2 min.2.2. Introduction - study the social significance of diphtheria - 10 min.2.3. Etiology - 10 min.2.4. Epidemiologiya- 10 min.2.5. Pathogenesis - 10 min.2.6. Clinic - 30 min.2.7. Complications - 3 min.2.8. Diagnosis - 5 min.2.9. Treatment - 7 min.2.10. Prophylaxis - 3 min.

3. determination Diphtheria - an acute infectious disease with airborne transmission mechanism; characterized croupous or diphtheritic inflammation of the mucous membrane in the gate of infection - in the throat, nose, larynx, trachea, rarely in other organs and general intoxication.

4. Pathogen - Corynebacterium diphteriae - toxigenic diphtheria bacillus • Gram-positive • Stable in the environment • Coli, which are a morphological feature of cone-shaped thickening at the ends and the location of each species of microbes other at an angle in a Roman numeral V

5. Allocate exotoxin neuraminidase • Ferment glucose, cleave cystine, reduce nitrates to nitrites. • Fermented starch (variant gravis), with respect to its other indifferent (variant mitis). There is also an intermediate version of microorganisms (intermedius). • Synthesis of diphtheria toxin microbial cells deterministic special gene tox, is localized in the lysogenic phage DNA. • The toxin produce large-sized specimens of the pathogen, which is marked spontaneous production of phage.

6. The source of infection - patients or healthy carriers of toxigenic diphtheria germs. • The greatest danger is posed by the epidemic of diphtheria patients throat, nose and throat, actively releasing pathogens into the environment in the expired air (less dangerously ill with diphtheria eyes, skin, wounds and other sites that can spread the infection by contact (through the hands, household items). • Infective ability of healthy carriers of toxigenic Corynebacterium ten times lower than that of patients with damage to the tissues of the respiratory tract.

7. Entrance gate - virtually all areas of cover (skin and mucous membranes) of host (usually the mucosa of the oropharynx, much less often - the larynx, nose, conjunctiva, genital wound surface, skin, etc.). • Toxigenic Corynebacterium fixed on the tissue cells, multiply, and during the life of produce exotoxin. • Microbial cells are directly involved in the defeat of the microorganism is not accepted.

8. Diphtheria exotoxin composed of several fractions: • hyaluronidase - destroys hyaluronic acid and increases the capillary permeability (yield beyond the liquid portion of blood vessels, tissues affected impregnation plasma containing, among other components fibrinogen); • nekrotoksin - causes necrosis of the epithelium at the site of infection gate, accompanied by the release of epithelial cells trombokinazy (promotes the conversion of fibrinogen to fibrin and the formation on the surface of the affected tissues fibrin film. • The palatine tonsils, in contrast to other organs, are coated pseudostratified epithelium. The result is a diphtheria fibrin film penetrates deep into the epithelium and adherent to the tissues);

9. true diphtheria toxin (its main component) • able to displace the cellular structures of cytochrome b and thus block them in the process of cellular respiration and protein synthesis molekul.Naibolee sensitive to these changes are the myocardium, capillaries and nerve cells. • In cardiomyocytes evolving phenomenon myocardiodystrophy with subsequent necrosis, myolysis and development of infectious-toxic myocarditis. • The defeat of the capillaries in diphtheria is accompanied by an infectious-toxic shock. • Damage to nerve cells is accompanied by degenerative changes in Schwann cells and nerve fibers demielinizatsiey. Along with the aforementioned, the overall effect of diphtheria toxin manifested phenomena of the general intoxication.

10. diphtheria nose • Proceeds with normal or low grade fever in the absence of intoxication. • Originally affected only one of the nasal passages with serous-purulent or bloody-purulent discharge. • Soon amazed and second nasal passage. On the wings of the nose there are sites and soak brown. • Dry crust without inflammatory reactions occur on the cheeks, forehead and chin. • In the propagation of diphtheria of the nose in the pathological process involved sinuses. • When toxic diphtheria of the nose there is edema of the subcutaneous tissue of the cheeks and neck.

11. diphtheria nose

12. diphtheria throat • 90-95% of all cases of diphtheria • There are the following forms: • Localized form: • Only raids on the tonsils • distinguish: • filmy • Ostrovchatuyu • catarrhal • Common form: • Plaque extends beyond the mucous membrane of the tonsils palatine arches, language • Toxic form - the most severe form of diphtheria: • sub-toxic form • Toxic diphtheria I, II, III degree

13. Diphtheria larynx (diphtheria, or true croup) • For rapidly progressive disease • Catarrhal stage (1-2 days) • there is an increase in body temperature, usually moderate • increasing hoarseness • cough, initially "barking", then loses its sonority • stenotic stage • growing stenosis symptoms of upper respiratory tract: • noisy breathing • voltage auxiliary inspiratory respiratory muscles • Asfiksicheskaya stage • manifested severe gas exchange disorder • cyanosis • loss of pulse at the height of inspiration • Sweats • Death by asphyxiation.

14. True croup: turn on the auxiliary muscles, inspiratory retractions supraclavicular fossae

15. complications • myocarditis • Toxic shock • Neuritis and polyneuritis • nephrotic syndrome

16. diagnostics • Characteristic grayish fibrinous coating on the skin or mucous • Seeding medium material Leffler, Clauberg, et al. • Serological methods of study (increase in antibody titer)

17. differential diagnosis • sore throat • kissing disease • "False croup" • Membranous adenoviral conjunctivitis (eye in diphtheria). Фолликулярная ангина

18. treatment • bed rest • The introduction of specific antitoxic serum method Bezredko • vitamin therapy • Correction of acid-base status

19. Doses of diphtheria serum in various forms of diphtheria (thous. Antitoxic units) Form diphtheria first dose of treatment Localized diphtheria throat ostrovchataya 10-15 10-20 Localized diphtheria throat filmy 15-30 20-40 Common 30-40 50-60 Subtoxic 40-50 60-80 Toxic I degree 50-70 80-120 II degree 60-80 150-200 III degree 100-120 250-350 Hypertoxic 100-120 Less than 450 Localized nasal diphtheria 15-20 20-40 Localized cereals 15-20 30-40 Common cereals 30-40 60-80 (up to 120) Localized nasal diphtheria 10-15 20-30 Genital 10-15 15-20 Eye 10-15 10-30 Skin 10 10-30

20. treatment bacillicarriers • Restorative therapy (multivitamin, a balanced diet, UFO, etc.) • Treatment of chronic diseases of the nasopharynx • Antibiotic - erythromycin, tetracycline.

21. Профилактика (календарный план вакцинации)