How it is transmitted and why it returns
The pathogen is transmitted by airborne droplets during coughing and talking, less often through objects and contaminated hands. The source can be not only a patient, but also a healthy carrier who has no complaints. As long as vaccination coverage is high in a community, outbreaks will not occur. But with a decrease in coverage and in groups where there are many unvaccinated people, the infection returns, and adults also get sick, for whom decades have passed since childhood vaccinations without revaccination. Therefore, protection depends not only on vaccinations in childhood, but also on their repetition in adulthood.
- Airborne transmission
- Contact path through objects
- Source: sick or asymptomatic carrier
- Increased risk with low vaccination coverage
- Loss of protection in adults without revaccination
Symptoms
The disease begins gradually: moderate sore throat, temperature is often not very high, weakness and pallor increase. When examined, dense films are visible on the tonsils, which are difficult to remove and do not rub between spatulas - this is how they differ from purulent deposits in sore throat. The lymph nodes of the neck become enlarged, and in severe forms, swelling of the neck and subcutaneous tissue develops. If the films spread to the larynx, hoarseness, barking cough and increasing difficulty breathing appear - this condition is called diphtheria croup and it is life-threatening.
- Dense gray-white films on the tonsils
- Moderate sore throat with severe weakness
- Enlarged cervical lymph nodes, swelling of the neck
- Pallor, lethargy, rapid pulse
- Hoarseness, barking cough, noisy breathing with croup
- Nasal diphtheria in children: bloody discharge, irritation of the skin under the nose
How is it different from a sore throat?
A common sore throat usually begins violently, with a high fever and very severe sore throat, and the plaque on the tonsils is loose, easily removed and rubbed. With diphtheria, the pain is moderate, but the general condition noticeably suffers, the skin is pale, the pulse is rapid. The films are dense, extend beyond the tonsils, and when you try to remove them, the mucous membrane bleeds. Additional clues include swelling of the neck and lack of effect from conventional treatment. However, it is not always possible to distinguish these conditions by eye, therefore, if suspected, be sure to take a smear and begin treatment without waiting for the result.
- Sore throat: violent onset, high temperature, loose coating
- Diphtheria: gradual onset, moderate pain, severe general condition
- The film is fused to the mucous membrane and bleeds
- Plaque extends beyond the boundaries of the tonsils
- Swelling of the neck is characteristic of diphtheria
Diagnostics
The main laboratory method is to inoculate a swab from the throat and nose with a diphtheria bacillus to determine its ability to produce toxin. The material is taken before starting antibiotics. A complete blood count shows signs of bacterial inflammation, but is not specific. Since the toxin affects the heart and nerves, it is imperative to perform a dynamic ECG, monitor urine tests and blood biochemistry. An examination by an otolaryngologist is needed to assess the spread of films to the larynx. Contact persons are also examined: carriers are identified among them.
- Swab from the throat and nose for diphtheria bacillus
- Determination of pathogen toxicity
- General blood test
- ECG repeated during the illness
- General urine analysis and blood biochemistry
- Examination of contact persons
Treatment and prevention
Treatment is carried out only in the hospital. The antitoxic diphtheria serum plays a decisive role: it neutralizes the toxin that has not yet contacted the tissues, so it must be administered as early as possible, focusing on the clinical picture, and not on the culture result. Antibiotics destroy the bacterium itself and stop its release, but do not neutralize the toxin. Strict bed rest is required, since the load on the heart during this period is dangerous. Diphtheria croup may require airway management. The basis of prevention is vaccinations according to the calendar in childhood and revaccination of adults every ten years.
- Hospitalization and isolation of the patient
- Early administration of antitoxic serum
- Antibacterial therapy
- Strict bed rest and observation by a cardiologist
- Maintaining airway patency during croup
- Vaccination of children according to the calendar and revaccination of adults
- Examination and observation of contact persons