Children began to be vaccinated against diphtheria, but before that, mortality from this infectious disease was quite high. Now children are more protected, but none of the vaccinated are immune from infection. You will learn about the symptoms, treatment and prevention of diphtheria in children by reading this article.
What it is?
Diphtheria is a bacterial infection that causes Löffler's bacillus. These bacteria of the genus corynebacteria themselves are not particularly dangerous. Poisonous exotoxin, which is produced by microbes in the course of their vital activity and reproduction, is dangerous for humans. It blocks protein synthesis, practically depriving the cells of the body of the ability to perform their natural functions.
The microbe is transmitted by airborne droplets - from person to person. The more pronounced the symptoms of diphtheria in a patient, the more bacteria he spreads around him. Sometimes infection occurs through food and water. In countries with hot climates, Löffler's bacillus can also spread through contact and household use.
A child can become infected not only from a sick person, but also from a healthy person who is a carrier of a diphtheria bacillus. Most often, the causative agent of the disease affects the organs that are the first to meet on its way: the oropharynx, larynx, less often the nose, genitals, skin.
Today, the prevalence of the disease is not too high, since all children are required to be vaccinated with DPT, ADS. The letter "D" in these abbreviations means the diphtheria component of the vaccine. Due to this, the number of infections over the past 50 years has been significantly reduced, but it has not been possible to completely eradicate the disease.
The reasons are that there are parents who refuse to vaccinate their child, and their sick children spread diphtheria bacillus to others. Even a vaccinated child can become infected, but his disease will proceed more mildly, and it is unlikely that it will come to severe intoxication.
Signs
The incubation period, during which the bacillus is only "examined" in the body, without causing any changes, is from 2 to 10 days. In children with stronger immunity, the incubation period lasts longer, babies with weakened immune defenses can demonstrate the first signs of an infectious disease for 2-3 days.
These signs may remind parents of a sore throat. The baby's temperature rises (up to 38.0-39.0 degrees), a headache appears, as well as a fever. The skin looks pale, sometimes somewhat bluish. From the first day of illness, the child's behavior changes dramatically - he becomes lethargic, apathetic, drowsy. Painful sensations appear in the throat, it becomes difficult for the child to swallow.
When examining the throat, enlarged palatine tonsils are clearly visible, the mucous membranes of the oropharynx look swollen and reddened. They are increased in size. The palatine tonsils (and sometimes the adjacent tissues) are covered with a plaque that resembles a thin film. It is most often gray or gray-white in color. The film is very difficult to remove - if you try to remove it with a spatula, bleeding marks remain.
The child's voice becomes hoarse or disappears altogether. However, this symptom cannot be considered a mandatory sign of diphtheria. He's more individual.
A symptom that may indicate diphtheria is swelling of the neck. Her parents will notice without difficulty. Against the background of soft tissue edema, enlarged lymph nodes can also be felt.
The most severe form of diphtheria is manifested - toxic. With her, all of the above symptoms are more pronounced - the temperature rises to 40.0 degrees, the child may complain of severe pain not only in the throat, but also in the abdomen. Plaques on the tonsils and arches are very dense, serous, solid. The intoxication is strong.
Swelling of the neck is pronounced, the lymph nodes are greatly enlarged and painful. It is difficult for a baby to breathe through his nose due to hyperemia of the tonsils, sometimes an ichor is released from the nose.
The most severe manifestations are hypertoxic diphtheria. With her, the child is often unconscious or delirious, he has convulsions. All symptoms (fever, fever, swelling of the larynx and tonsils) develop rapidly. If the correct medical care is not provided in time, a coma occurs in two or three days. Death is possible due to the developed insufficiency of the cardiovascular system.
However, not all forms of diphtheria are so dangerous. Some (for example, diphtheria of the nose) proceed almost without symptoms and do not threaten the child's life.
The danger
A rather dangerous complication of diphtheria is the development of diphtheria croup. In this case, stenosis of the respiratory system occurs. Due to edema, the larynx narrows, the trachea and bronchi swell. In the best case, this leads to a change in the voice, its hoarseness, difficulty in breathing. At worst, it leads to suffocation.
The most dangerous complication of diphtheria is the development of myocarditis (inflammation of the heart muscle). Violation of the heart rhythm, impaired pulmonary breathing in 2-3 days can lead to the development of respiratory, as well as cardiovascular failure. This condition is also fatal for a child.
Due to the action of a strong toxin, renal failure can develop, as well as neurological disorders such as neuritis, regional paralysis. Paralysis is most often temporary in nature and after a while after recovery disappears without a trace. In the overwhelming majority of cases, paralysis of the cranial nerves, vocal cords, soft palate, muscles of the neck and upper limbs is recorded.
Some of the paralytic changes occur after the acute stage (on the 5th day), and some appear after the transferred diphtheria - 2-3 weeks after the visible recovery.
The most common complication of diphtheria is acute pneumonia (pneumonia). As a rule, it occurs after the acute period of diphtheria has been left behind (after 5-6 days from the onset of the disease).
The most important danger lies in untimely diagnosis. Even experienced doctors cannot always recognize diphtheria in the first day or two. Namely, this time is important in order to introduce the child with anti-diphtheria serum, which is an antitoxin, a substance that suppresses the toxic effects of exotoxin. Most often, with a lethal outcome, it is precisely the fact of untimely diagnosis that is revealed, as a result, the failure to provide the correct assistance.
To prevent such situations, all doctors have clear instructions in case of detecting dubious symptoms, which, even indirectly, may indicate that the child has diphtheria.
Varieties
A lot in the choice of treatment tactics and in the prognosis for recovery depends on what type of diphtheria and to what extent struck the baby. If the disease is localized, then it is more easily tolerated than the diffuse (common) form. The smaller the site of infection, the easier it is to cope with.
The most common form that occurs in children (approximately 90% of all cases of diphtheria) is oropharyngeal diphtheria. It happens:
- localized (with insignificant "islands" of plaque);
- spilled (with the spread of inflammation and plaque beyond the pharynx and oropharynx);
- subtoxic (with signs of intoxication);
- toxic (with a violent course, swelling of the neck and severe intoxication);
- hypertoxic (with extremely severe manifestations, with loss of consciousness, critically large and extensive raids and swelling of the entire respiratory system);
- hemorrhagic (with all signs of hypertoxic diphtheria and general systemic infection with a diphtheria bacillus through the bloodstream).
With the development of diphtheria croup, the child's condition worsens, and at the same time, the croup itself at the place of occurrence is divided into:
- diphtheria of the larynx - a localized form;
- diphtheria of the larynx and trachea - spilled form;
- descending diphtheria - the infection quickly moves from top to bottom - from the larynx to the bronchi, affecting the trachea along the way.
Diphtheria of the nose is considered the most mild type of ailment, since it is always localized. With it, nasal breathing is disturbed, mucus with impurities of pus, and sometimes blood, leaves the nose. In some cases, nasal diphtheria is concomitant and accompanies pharyngeal diphtheria.
Diphtheria of the organs of vision manifests itself as a common bacterial conjunctivitis, for which, by the way, it is quite often taken for the lesion of the mucous membrane of the eyes by Löffler's bacillus. Usually the disease is one-sided, with no fever or intoxication. However, with toxic diphtheria of the eyes, a more violent course is possible, in which the inflammatory process spreads to both eyes, the temperature rises slightly.
Skin diphtheria can develop only where the skin is damaged - there are wounds, abrasions, scratches and ulcers. It is in these places that the diphtheria bacillus will begin to reproduce. The affected area swells, becomes inflamed, and a gray, dense diphtheria plaque develops on it rather quickly.
It can persist for quite a long time, while the general condition of the child will be quite satisfactory.
Genital diphtheria in childhood is rare. In boys, foci of inflammation with typical serous plaques appear on the penis in the region of the head, in girls, inflammation develops in the vagina and manifests itself as bloody and serous purulent discharge.
Diagnostics
In time and quickly, existing laboratory tests help to recognize diphtheria in a child. The child must take a swab from the pharynx on the diphtheria stick. Moreover, it is recommended to do this in all cases when a dense grayish coating is noticeable on the tonsils. If the doctor does not neglect the instructions, then it will be possible to establish the disease in time and inject the baby with antitoxin.
A smear is not very pleasant, but rather painless. With a clean spatula, the doctor runs over the filmy coating and sends the scraping into a sterile container. Then the sample is sent to a laboratory, where specialists can determine which microbe caused the disease.
After establishing the fact of the presence of corynebacterium, and this usually happens 20-24 hours after the laboratory technicians receive the material, additional tests are taken to establish how toxic the microbe is. In parallel, specific treatment with anti-diphtheria serum begins.
As additional tests, a blood test for antibodies and a complete blood count are prescribed. It should be noted that antibodies to diphtheria bacillus are available in every child who was vaccinated with DPT. On the basis of this analysis alone, the diagnosis is not made.
With diphtheria, the amount of antibodies rises rapidly, and at the stage of recovery it decreases. Therefore, it is important to monitor the dynamics.
A general blood test for diphtheria in the acute stage shows a significant increase in the number of leukocytes, high ESR rates (the erythrocyte sedimentation rate in acute inflammation increases significantly).
Treatment
Diphtheria should be treated exclusively in the hospital - according to clinical guidelines. In a hospital setting, the child will be under the round-the-clock supervision of doctors who will be able to respond in time to complications if they appear. Children are hospitalized not only with a confirmed diagnosis, but also with suspicion of diphtheria, since delay in this ailment can have very disastrous consequences.
In other words, if the called doctor discovers a gray, dense plaque and a number of other symptoms in the child's throat, then he must immediately send the baby to an infectious diseases hospital, where he will be prescribed all the necessary examinations (smear, blood tests).
Löffler's bacillus, although a bacterium, is practically not destroyed by antibiotics. Not a single modern antibacterial drug acts on the causative agent of diphtheria in the right way, and therefore antimicrobial agents are not prescribed.
Treatment is based on the introduction of a special antitoxin - PDS (anti-diphtheria serum). It stops the effect of the toxin on the body, and the child's own immunity gradually copes with the stick as such.
Humanity owes the appearance of this serum to horses, since the drug is obtained by hypersensitization of these graceful animals with a diphtheria stick. Antibodies from horse blood, which are contained in serum, help the human immune system to maximize mobilization and begin the fight against the causative agent of the disease.
If a severe form of diphtheria is suspected, doctors in the hospital will not wait for the test results and will inject the baby with serum immediately. PDS is done both intramuscularly and intravenously - the choice of the method of administration is determined by the severity of the child's condition.
Equine PDS serum can cause severe allergies in a child, like any foreign protein. It is for this reason that the drug is prohibited for free circulation and is used only in hospitals, where a child who develops a quick reaction to PDS can be provided with timely assistance.
During the entire treatment, you will need to gargle with special antiseptics that have a pronounced antibacterial effect. The most commonly recommended spray or octenisept solution. If laboratory tests show the attachment of a secondary bacterial infection, then antibiotics can be prescribed in a small course - for 5-7 days. Most often, drugs of the penicillin group are prescribed - "Ampicillin" or "Amoxiclav".
To reduce the negative effect of exotoxin on the child's body, droppers are prescribed with detoxifying drugs - saline, glucose, potassium preparations, vitamins, especially vitamin C. If it is very difficult for a child to swallow, Prednisolone is prescribed. To save the life of a child, in severe toxic forms, plasmapheresis procedures (transfusion of donor plasma) are performed.
After the acute stage, when the main danger has passed, but the likelihood of complications remains, the child is assigned a special diet, which is based on gentle and soft food. Such food does not irritate the affected throat. These are cereals, soups, mashed potatoes, jelly.
Everything spicy, as well as salty, sweet, sour, spices, hot drinks, soda, chocolate and citrus fruits are excluded.
Prevention
A person can get diphtheria several times in a lifetime. After the first disease, acquired immunity usually lasts for 8-10 years. But then the risks of getting infected again are high, however, repeated infections are much milder and easier.
A specific prophylaxis is vaccination. DTP and ADS vaccines contain anti-diphtheria toxoid in their composition. In accordance with the national vaccination calendar, they are given 4 times: at 2-3 months after birth, the next two vaccinations are carried out with an interval of 1-2 months (from the previous vaccination), and the fourth vaccine is administered one year after the third vaccination. A child is revaccinated at the age of 6 and 14, and then the vaccine is given every 10 years.
Early detection of the disease prevents its widespread spread, which is why, if you suspect a sore throat, paratonsillar abscess or mononucleosis of an infectious nature (diseases similar in symptoms to diphtheria), it is important to immediately conduct laboratory tests.
In the team where the child is diagnosed with diphtheria, a seven-day quarantine is declared, and swabs from the pharynx to the diphtheria bacillus are taken from all children without fail. If in such a team there is a child who, for some reason, has not been vaccinated with DTP or ADS, he must be injected with anti-diphtheria serum.
Much depends on parents in the prevention of this disease. If they taught the child hygiene, constantly strengthen his immunity, make sure that the baby grows healthy, do not refuse preventive vaccinations - then we can assume that they protect the child as much as possible from a dangerous disease, the course of which is unpredictable. Otherwise, the consequences can be very sad.
All about the rules of vaccination against diphtheria, see the next video.
