Diphtheria has obvious pleomorphism, which is rod-shaped or slightly curved, with one or both ends slightly enlarged, and metachromatic granules is common at both ends. According to the difference of morphology, biochemical characteristics, colony and virulence, bacteria can be divided into heavy intermediate type and light type, and their frequency of occurrence varies in different regions and different periods. Diphtheria is weak in invasion, but it can produce strong exotoxin, which is the main cause of disease.
symptom
Mild sore throat; In severe cases, the onset is more acute, the sore throat is severe, and there may be high fever, irritability, shortness of breath, cyanosis and circulatory failure.
clinical picture
According to the severity of symptoms, it can be divided into two types.
1. limited type
Systemic symptoms may include fever, fatigue and discomfort. The local symptoms are mild, including mild sore throat and gray false membrane on one or both tonsils. The pseudomembrane may go beyond the palatal arch and cover the soft palate, uvula or posterior pharyngeal wall. The false membrane is not easy to wipe off, and it is forcibly separated, leaving a bleeding wound on the side.
2. Poisoning type
The onset is more urgent, the pseudomembrane expands rapidly, and the symptoms of systemic poisoning appear quickly. If combined with streptococcal infection, there is often high fever, local tonsils, uvula, soft palate and other tissues are severely swollen, cervical lymph nodes are swollen, and even the neck is thickened as "bovine neck".
check
The total number of white blood cells and neutrophils increased. Diphtheria can be found by swab culture and smear examination of nose and pharynx, and the virulence test is positive.
diagnose
According to the history, symptoms and signs, combined with bacteriological examination, the diagnosis is not difficult. However, a negative examination can not rule out this disease, and it should be repeated many times. If necessary, Sikh test and toxicity test are feasible in order to make an early diagnosis. If the clinical manifestations are suspected of diphtheria, it can be treated first.
Complications of pharyngeal diphtheria
Although diphtheria toxin can affect the whole body cells, the heart, nervous system and kidney are the most obvious. Severe diphtheria can be complicated with myocarditis or peripheral nerve paralysis, and occasionally toxic nephritis can occur.
1. Cardiovascular system
(1) Peripheral circulatory failure is characterized by nausea and vomiting, pallor and decreased blood pressure. If myocardial damage occurs at the same time, the symptoms of circulatory failure can be aggravated.
(2) Myocarditis usually occurs in the second week of the course of the disease, and is characterized by fatigue, pallor, dyspnea, enlarged heart, weak heart sound, tachycardia or bradycardia, arrhythmia, hepatomegaly, etc. Electrocardiogram often shows low voltage ST segment and T wave changes, bundle branch and atrioventricular block, or other arrhythmia. Patients can die of heart failure.
2. Peripheral nerve paralysis
It is characterized by relaxation paralysis, which mostly occurs in the course of 3 ~ 4 weeks, and soft palate paralysis is the most common. The language is slightly nasal, choking out from the nostrils when swallowing fluid, and the uvula reflex disappears. Followed by eye muscle paralysis, strabismus, ptosis, pupil dilation and so on. Facial nerve paralysis can also occur, which is characterized by skewed mouth.
3. Toxic nephropathy
It is rare, mainly manifested as decreased urine volume, white blood cells and casts in urine, and generally no hematuria. Diphtheria can be secondary to bacterial infection, such as cervical lymphadenitis, lymphadenitis, otitis media, pneumonia, etc. Occasionally, abscess around tonsils occurs, and it is necessary to give enough antitoxin before incision and drainage.
Treatment of pharyngeal diphtheria
1. General treatment: patients should stay in bed and reduce their activities, generally not less than 3 weeks, and those with extensive pseudomembrane should be extended to 4 ~ 6 weeks. Pay attention to oral and nasal hygiene.
Antibiotic treatment: Antibiotics can inhibit the growth of diphtheria bacilli, thus preventing the production of toxins. Penicillin is often used, which takes about 7 ~10 days until the symptoms disappear and the culture of diphtheria turns negative. Those who are allergic to penicillin or who are still positive after applying penicillin 1 week can switch to erythromycin and take it orally or intravenously for four times. The course of treatment is the same as above. Amoxicillin, penicillin and rifampicin may also be effective.
2. Antitoxin therapy: Antitoxin can neutralize free toxins, but it cannot neutralize bound toxins. The effect of application on the first 3 days of the course of disease is better, and the curative effect will be significantly reduced later, so it should be used as early as possible. The dosage depends on the scope and location of the pseudomembrane and the treatment time. After 3 days of onset, the dose of the treatment was doubled. The antitoxin can be given by intramuscular injection or intravenous drip after dilution. If the lesion continues to expand after 24 hours, the same amount of intramuscular injection can be used again. Before injecting antitoxin, you should ask about the allergic history and make a skin allergy test. Only those who are negative in the test can be used, and those who are positive can be given desensitization.
3. Treatment:
(1) Children should be strictly isolated and pay attention to oral and nasal care.
(2) Diphtheria antitoxin and penicillin should be injected, and the dosage of antitoxin should be determined according to the severity of the disease and the scope of false membrane, and the injection can be repeated once if necessary. Penicillin has the effect of eliminating diphtheria Bacillus and preventing secondary infection, so it should be used in sufficient amount as soon as possible.
(3) Patients with dyspnea and laryngeal obstruction should be treated with tracheotomy in time.
(4) Pay close attention to the heart condition. If there is myocardial damage, the child should stay in bed for 3 ~ 6 weeks.
(5) For diphtheria carriers, penicillin or erythromycin should be given first. If the bacterial culture continues to be positive, tonsillectomy can be considered.
Prevention of pharyngeal diphtheria
1.3 ~ 5 months old infants receive one shot of DTP, DTP and DTP vaccine every month, and ***3 shots are the primary immunization. 1 strengthen at the age of half to two years 1 needle. Inoculate purified diphtheria and tetanus diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diphtheria diph Adults should also strengthen immunization when necessary.
2. Diphtheria patients should be isolated and actively treated in time until the systemic and local symptoms disappear and the culture of nasopharyngeal or other lesions is negative for 2 consecutive times. The isolation should not be released earlier than 7 days after treatment. Patients' secretions and utensils must be strictly disinfected. Respiratory secretions should be treated with double amount of 5% coal phenol soap (Lysol) or carbolic acid 1 hour. Contaminated clothes and utensils should be boiled for 15 minutes. Those who cannot be boiled should be soaked with 5% coal phenol soap or carbolic acid 1 hour.
3. Contacts in collective children and adult institutions should be kept for 7 days, and nasopharyngeal swab culture and diphtheria toxin test should be made. Close contact with adults should also do these tests. Recommended reading:
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