Diphtheria (or diphtheria) –
infectious disease that is caused by bacillus
Corynebacterium. It is characterized by a primary lesion of the upper
respiratory tract as well as symptoms resulting from
spread of bacterial toxin throughout the body. Until the end of XIX
century in all parts of the world was considered a serious contagious disease
coping with the spread of which helped vaccination
Болезнь дифтерия впервые была описана
Гиппократом в V веке до нашей эры и на протяжении всей
History was one of the leading causes of death. She is по-прежнему
poses a danger, especially for temperate regions
in the colder months of the year. More often всего поражает children в возрасте до 10
Disease foci grow in some regions to
the scale of epidemics, have been repeatedly described by European doctors.
For example, 1613 is listed in the history of Spain as “suffocating”, and in 1735
The disease engulfed the population of New England. Until 1826, bye
Bretono did not give the disease a name (diphtheria from the Greek diphthera, that
means “skin”), it was known by various names. AT 1856 г.
ATиктор Фоерджод зафиксировал и описал эпидемию дифтерии в
California AT 1878 году заболела вся семья английской королевы
ATиктории. For two princesses, this was fatal.
ATпервыевозбудитель дифтерии была выделен
and identified by the German bacteriologist Klebs in the second half
XIX century. His colleague Friedrich Leffler managed to hold
classification and cultivate Corynebacterium in 1884. is he
also proved that the bacterium is capable of producing exotoxin. ATскоре
Joseph O’Dwyer invented a tube for laryngeal intubation in patients with
AT 1890 году Шибосабуро Китасато и Эмиль фон Беринг провели
immunization of guinea pigs with heat-treated diphtheria toxin.
is heи доказали, что антитоксин, сделанный из сыворотки крови
immunized animals can cure the disease. But first
Attempts to heal people were unsuccessful.
Нужный препарат смогли создать только через четыре
of the year. For his discovery, Bering received the Nobel Prize in 1901.
Симптомы дифтерии у взрослых и children
may manifest as lesions of the larynx. Characteristic plaque
serves as a good marker of bacterial contamination difference from
viral. The infection is insidious and can not only make itself known.
признаками токсического воздействия на системы
organism, but also the manifestation of skin diseases.
The incubation period for diphtheria of the respiratory tract is from 2
up to 5 days. Initial symptoms include sore throat, malaise and
a slight increase in temperature. Typical clinical manifestation
— наличие серовато-белой плёнки и фиброзного
pseudomembrane, which is formed during the first
several days and covers the tonsils, throat and larynx.
Laryngeal diphtheria is characterized by a gradual increase
хрипоты и стридорозным дыханием, чаще встречающемся у children,
development of croup. On the part of the nose, there are single or
double-sided transparent discharge in which over time
an admixture of blood appears. As the disease progresses in
membrane may begin necrotic changes, manifested in
the form of green and black spots. Attempts to remove them usually lead to
The expansion of the membrane correlates with the severity of the disease and
suffocation, which can be fatal.
ATздутия шейных лимфатических узлов (лимфаденит) и отёк окружающих
soft tissue leads to the formation of a characteristic “bull neck”. With
In the absence of treatment, the disease usually lasts 1–2 weeks, and
mortality is about 10%.
The most common complications are:
Myocarditis can lead to heart failure and
subsequent death. Neurological symptoms occur in 75%
patients with severe disease and range from complete to
slight temporary paralysis of motor nerves. Paralysis of the diaphragm
can lead to secondary pneumonia and respiratory
Respiratory forms are also caused by non-toxic strains.
Corynebacterium, but as a rule, in this case they are softer and
pass without membrane formation. Measures for suspected diphtheria
- ATведение дифтерийного антитоксина
after testing for hypersensitivity to horse serum.
This is crucial for survival.
- Confirmation of diagnosis with appropriate bacterial
- ATведение антибиотиков.
- Maintain airway and thorough
control of heart rhythm disturbances or other manifestations
Cutaneous diphtheria may be caused by toxigenic Corynebacterium
or C. ulcerans. It usually appears on the limbs (especially
legs) and genitals. Defeat starts with bubbles and quickly
forms a small clearly demarcated, and sometimes multiple
ulcers. They can be difficult to distinguish from impetigo.
AT клиническом описании указывается, что язвы слегка выступают
above the skin surface and covered with hard gray scabs. These
non-healing injuries can be difficult to distinguish from others.
chronic bacterial infections. Cutaneous diphtheria is often associated with
parallel diseases caused by Staphylococcus aureus
or streptococcus group A.
The main role of laboratory diagnosis of diphtheria is
creating fast and reliable clinical validation methods
diagnosis. However, very often the disease is difficult to diagnose by
clinical signs because it can be confused with other
- severe streptococcal tonsillitis;
- Infectious mononucleosis;
- angina vincent.
Laboratory diagnosis помогает медикам определить уровень
epidemiological risk to exclude isolation of the patient. She is
based on the cultivation of bacteria from samples taken from
oropharyngeal swabs, ulcers and other lesions in the patient. Causative agent
grown on blood and agar. The latter inhibits the growth of normal
flora and allows diphtheria stick together with other pathogens
(yeast and staphylococcus) grow in colonies.
The infection is treated with antitoxin and antibiotics. Their task is
destroy bacteria and prevent their further spread.
Benzylpenicillin is suitable from the penicillin group. All of them
active against C. diphtheria and C. ulcerans. If erythromycin
poorly tolerated due to side effects
gastrointestinal tract, alternative macrolides are prescribed –
азитромицин или clarithromycin.
Recommended doses and treatment regimens
- Benzylpenicillin is introduced
intramuscularly from 25 thousand to 50 thousand units / kg per day for children and
1.2 million units / kg per day for adults in two divided doses.
Parenteral erythromycin – 40 mg / kg per day up to 2 grams per day.
Injections are made until the patient is comfortable.
- Antibiotic treatment continues for 14 days. When
need increases to 24 days.
- Before assignment, an analysis of the detected resistance is performed.
bacteria to various antibiotics.
During recovery, all patients must undergo the first or
re-vaccination because infection does not necessarily cause
protective immunity. Treatment of skin diphtheria involves thorough
cleaning the lesion with soap and water. Patients should be treated
antibiotics, however, administration of antitoxin is indicated only for
patients with fairly large ulcers (more than two square
Myocarditis and neuropathy, often accompanying the disease,
treated symptomatically. For example, when endocarditis is prescribed
in-lactam antibiotic in combination with aminoglycosides, and
without them. Monotherapy may be preferred depending on
the age of the patient or preexisting renal
failure. Cases of endocarditis are not mainly related to
toxigenic form of the disease and do not require treatment
Antitoxin (DAT) does not affect the tissue of the toxin bound, but
neutralizes circulating. Its quick introduction is
critical for disease progression. Treatment delay
increases the risk of possible complications. In many countries dat
available only upon request of the relevant authorities
Diphtheria antitoxin is a hyperimmune serum manufactured by
based on the blood of horses. Before its introduction, the patient is checked for
sensitivity (skin test), and the dose depends on the location and
membrane size, degree of toxicity and duration
The drug is mixed with saline and injected intravenously into
for 2-4 hours. At this time it is necessary to monitor any
signs of anaphylactic shock. Antitoxin pre
heated to a temperature of 32−42 degrees. Perhaps temporary
increase in body temperature, which is reduced by
antipyretics. In more severe cases, it may be necessary
cool ice bath. Febrile reactions are not detected in
To avoid infection, all children
must be vaccinated during the first months of life.
The diphtheria vaccine is one of the oldest and most
safe. Its clinical efficacy is estimated at 97%.
Contraindications for a person can be severe allergic
reaction (in the anamnesis) to any of its components. Immunosuppressants
and pregnancy are not considered a contraindication. Clinical diphtheria
does not necessarily provide immunity. Vaccination schedules
developed by the health authorities of each state.
Standard measures include at least three doses during the first
years of life with revaccination at school age (5–14 years).
Необходимость повторной вакцинации дифтерии у взрослых
определяется с помощью серологических исследований. If a
immunity level at any age social or ethnic
groups are low, then potential interventions include mass immunization.
Individual vaccination is given before the trip.
to endemic areas or in combination with other vaccinations.
If a disease is detected, the patient must be isolated,
and local health authorities are required. A patient
remains in quarantine until 48 hours after the start of treatment
antibiotics. All people who are in close contact with
больным и имевшие возможность заразиться. More often
всего в таких случаях профилактика дифтерии
includes a course of antibiotics.
Treatment of pets is justified only in some cases,
например, когда контактирующие люди не защищены vaccinations.
Infected pathogen, but clinically healthy animals by
European veterinary regulations do not need treatment.
Observe the appropriate control measures. AT
suspicious cases are taken into account any restrictions in
prescribing drugs and laboratory tests
анализы. AT терапии животных нельзя применять лекарства и
Schemes assigned to people:
- Macrolide erythromycin is the preferred antimicrobial
agent for the treatment of diphtheria caused by C. ulcerans in humans.
However, it is not licensed for animals in some countries.
- Penicillin is also recommended for treating people, but it turned out
ineffective in the fight against diphtheria in dogs in France.
For infected animals
enrofloxacin is used, but its results show
limited effect. Spiramycin in combination with metronidazole
Used successfully to treat dogs. Medical intervention
without clinical signs in many cases
impractical due to the high cost of long courses
Milk goats and cows are an exception.
man uses. They must be treated with antibiotics under strict
veterinary supervision. AT задачу государственных органов
health care includes monitoring to ensure that all dairy
products were tested for the possibility of infection.
The disease can cause epidemics because it is easy
transmitted from person to person by airborne droplets
discharge or by direct contact. AT Соединённых Штатах и
In Europe, C. diphtheria infections began to occur rarely and in
Mostly imported from other regions.
AT неэндемичных странах циркуляция toxigenic и неtoxigenic
strains, as well as the correlation between infection and vaccinations so far
pores are not fully understood. Large-scale vaccination campaigns
transferred diphtheria to a number of rare diseases, but it is still
остаётся актуальной проблемой в Южной Америке, ATосточной Европе,
Юго-ATосточной Азии и Африке.
Diphtheria was formerly called childhood illness. Only thanks
comprehensive vaccination programs were almost forgotten in developed
countries. However, in countries where the level of vaccination remains
low, the bacteria circulation continues. AT 2013 г. ATсемирной
The World Health Organization has registered
4680 случаев diseases. 80% of cases lived in such countries:
Число зарегистрированных случаев в странах Юго-ATосточной Азии
continues to increase. AT связи с растущей глобализацией,
There is a need to solve this problem. Current priorities
- improvement of the surveillance system;
- expansion of laboratory diagnostics;
- introduction of modern testing methods;
- identification of gaps in population immunity;
- устранение причин плохого охвата vaccinations.
AT 2013 году это заболевание привело к 2500 смертей, хотя охват
DTP vaccinations amounted to about 83%. However effectiveness
The measures taken were not higher than 30% in problem regions. Control
diphtheria is based on widespread childhood vaccination.
Typically, diphtheria epidemics appear periodically. Last
a huge wave was observed throughout the 1990s in Russia and
states of the former Soviet Union. She is отличалась большой долей
cases of adults and adolescents.
This is due to:
- a sharp drop in living standards;
- lack of vaccinations;
- inadequate vaccination in these age groups.
Episodic foci of epidemics are constantly fixed in some
States of Asia and Africa. Unfortunately, the statistics figures from these
countries are greatly understated due to lack of medical
The bacterium C. ulcerans is most common in domestic
animals, its transfer from person to person is not registered.
The source of infection may be contaminated food, for example,
Due to the lack of sufficient observation
and diagnostics in many countries this form of diphtheria is still bad
studied. Today in medical institutions of the European Union
there are two diagnostic protocols at the same time:
- EU 2008
- ATОЗ 1994 г.
Health care standards do not require any
antiepidemiological actions, besides antibiotic treatment, in
against non-toxigenic strains of C. diphtheria (NTTB).
To date, diphtheria continues to pose a threat
therefore, it is necessary to know about the symptoms and causes of the disease.
The prevention and treatment of diphtheria should be
qualified specialists, and violation of immunization programs
significantly increases the likelihood of circulation toxigenic