PROFESSOR OLHA GOLUBOVSKA TALKS ABOUT THE INFECTIOUS DISEASES – DIPHTHERIA
Because of the low level of vaccination cover against infectious diseases, Ukraine faces the growth of various vaccine-controled infections. Currently there is measles. Recently, society was shaken by a statement of the case of diphtheria. Features of this infectious disease are told by doctor of medical sciences, professor, head of the department of infectious diseases of O.O.Bogomolets National Medical University Olha Golubovska.
Diphtheria is an acute infectious disease characterized by the development of specific changes in the oropharynx, larynx, rarely – the entire tracheobronchial tree in the form of typical fibrinous fur, as well as the possible development of cardiac complications (early and late myocarditis), the nervous system (polyneuropathy) and the kidneys (nephro-nephritis). The main factor of the pathogenicity of the pathogen that causes the above changes is exotoxin, which in its power yields only to the botulinum and tetanus toxins; when it binds to tissues, it blocks the synthesis of protein by the cell and its death. Prior to the introduction of vaccination programs for children, launched in the 30s of the last century, diphtheria was one of the most dangerous children’s illnesses, leading to devastating epidemics. Thus, until the administration of a specific serum for the treatment of patients, mortality could reach 50%, but even now, if it is present, one in ten patients can die from this disease.
How is the disease transmitted and what kind immunity develops?
The only source of infection is a human (a patient with diphtheria or a carrier). The disease is transmitted by airborne route, less frequently – by direct contact (for example, the skin form, that is widespread in some tropical countries); in countries with moderate climate, including Ukraine, the seasonal nature of the disease is characterized by autumn-winter, in hot countries there is no seasonal difference, the disease occurs all year round. Diphtheria is less contagious than measles, among 10 people who had contacted with an infected person, disease developes in only 1-2, the other remain carriers, including transitory.
After an illness or vaccination, a fairly stable antitoxic immunity is formed, but repeated cases of the disease and even diphtheria in the vaccinated people are possible, however, the course of the disease is usually mild. In rare cases, the infection does not lead to the formation of protective immunity.
The “quality” of immunity depends on the level of specific antibodies (IgG): if this level is less than 0.01 IU / ml, the body remains unprotected, the antibody concentration at 0.01 IU / ml provides only partial protection, the level of 0.1 IU / ml and hogher is considered to provide full protection at the moment, a level of 1 IU / ml and above provides full long-term protection against infection.
Immune mother gives her child protection in the first few months of life.
What are the features of the clinical course of the disease at the present stage?
The incubation period (from the time of infection until the first clinical symptoms appear) is 2-10 days, the shorter it is, the more severe the disease progresses. Unlike classical tonsillitis, the disease begins more gradually with a slow increase in symptoms of intoxication (fever, moderate sore throat), cervical lymph nodes enlargement. In the oropharynx, the nasal passages characteristic fibrinous furs can be seen, which are difficult to remove by a spatula that causes bleeding. There may be swelling of the mucous membranes, neck, sometimes – significant. When the larynx is involved, the voice becomes hoarse, the symptoms of intoxication are less pronounced, but it is one of the most dangerous forms of diphtheria, not only because possible obstruction of the respiratory tract (true croup), but also there is a risk of tearing off the fur and getting it to the anatomical areas, which leads to reflex heart stop. Further, myocarditis, polyneuritis (up to 6 weeks from the onset of the disease), kidney damage can develop. In the acute period, there may be a shock, a violation of blood clotting.
The last epidemic of diphtheria in our country, which exploded in the 90s, was characterized by those features – a large number of adult patients, frequent lack of characteristic, classical changes in the oropharynx, leading to diagnostic errors, late hospitalization, and, consequently, the late appointment of specific treatment , frequent development of severe diphtheria myocarditis (they were the main cause of death), polyneuritis, etc.
What is used for treatment of diphtheria?
Treatment of diphtheria is carried out only in the conditions of the in-patient department. Hospitalization is mandatory for all patients, as well as patients with suspicion of diphtheria and bacterial carriers. The main thing in the treatment of all forms of diphtheria (except for carriers) is the administration of antitoxic anti-diphtheria serum (antitoxin), which neutralizes the effect of the toxin, but only that toxin which circulates in the blood; if the toxin is already in contact with the tissues, it will not be able to neutralize it. That is why timely diagnosis of this disease is extremely important. Antibiotics are also prescribed.
What should doctors remember?
First of all, diphtheria refers to those infectious diseases, the diagnosis of which can be established according to a typical clinical features. Diagnostic criteria for clinical diagnosis include the following: – characteristic fibrinous dense furs in the oropharynx, which can extend beyond the tonsils, often their one-sided lesions; minor sore throats, involvement in the pathological process of adjacent anatomical sites (nose, larynx). The presence of severe edema in the oropharynx, on the neck, should also be alarmed in terms of possible diphtheria. Any suspicious case of the disease is an indication for the hospitalization of patients in infectious establishments and the appointment of the appropriate treatment before the results of the laboratory investigations.
What should patients remember?
Diphtheria is a vaccine-controled infection. Immunity is provided by administering a diphtheria toxoid, which is often included in the tetanus toxoid (DP) vaccine or additionally a vaccine against pertussis (DTP). Diphtheria toxoid may also be included in combination with hepatitis B vaccines and hemophilic infection. After conducting the initial series of vaccinations from three doses, virtually all children are given protective titers antitoxin. Adults should receive a vaccine every 10 years; according to international recommendation they are shown a three-dose vaccination.
Division of Medical Consulting Work
Professor Olha Golubovska
