Presentation on theme: "Kharkiv National Medical University Department of infectious diseases"— Presentation transcript:
1Kharkiv National Medical University Department of infectious diseases DYPHTERIAANGINAAssociate professor D.V. Katsapov
2Angina – acute infection disease caused by streptococci and/or staphylococci, characterized by intoxication, fever, inflammatory process in lymphatic tissues of oropharynx (pharyngeal cycle of Pirogov - Valdeer) Tonsillitis – specific (diphtheria, Epstein-Barr mononucleosis, syphilis, tularemia, leucosis) inflammation of tonsils and regional lymph nodes, often with chronic course.
3DIPHTHERIA. Definition Diphtheria is a contagious acute localized infection of mucous membranes or skin caused by Corynebacterium diphtheriae. Respiratory diphtheria characterized by sore throat, fever, an adherent membrane (a pseudomembrane) and exudation thrown out on the mucous of tonsils, pharynx, larynx and nasal cavity.
4DIPHTHERIA. Hystory5th century BC - the disease was described in the by Hippocrates6th century AD - epidemics were described in the by AetiusBretano – described clinical pictureKlebs, Leffler – dyscovered and cultivated the pathogenRamon - introdused immunisation of diphteria anatoxin
5DIPHTHERIA. Etiology Causative agent – Corinеbacterium diphtheriae. 3 cultural and biological species:gravisintermediusmitisExotoxin – protein with antigenic properties. Two fragments:A – termostable, biosynthesis inhibitionB – termolabile, adhesion.
6DIPHTHERIA. Epidemiology Human carriers are the main reservoir of infectionTransmission - via respiratory droplets, nasopharyngeal secretions, and rarely fomites.In the case of cutaneous disease, contact with wound exudates.Season – autumn, winterImmunity – specific, antitoxic.i
7DIPHTHERIA. Pathogenesis Inoculation of the pathogenColonization of mucosal layers, fixation on cellular membranesAction of a toxin (A and B fragments)localized inflammatory reaction followed by tissue destruction and necrosisProduction of pseudomembranesRegional edemaGeneral reactionsAffection of distant organs:Myocardium,Kidneys,Nervous system
8DIPHTHERIA. Clinical classification By form:SubclinicalMildModerateSevereHypertoxicBacteriocarrierBy spread:LocalizedDiffused (in one anatomical region)Combined (in different regions)
9DIPHTHERIA. Clinical classification By localization:TonsillopharyngealNasalLaryngealTracheal and bronchialBy character of process:CatarrhalIsletMembranous
10DIPHTHERIA. Clinical manifestations Incubation period - 2 to 5 days (1-10 days)Gradual onset, moderate intoxicationModerate pharyngeal painWhite pseudomembranes (greyish)Local edemaParesis of soft palateAffection of miocardium
11DIPHTHERIA. Diffused form with hemorrhagic impregnation
13Predictors of gravity of clinical course Expressed intoxicationAffection of CNS (delirium, cramps)Affection of CVS (hemodynamic disturbances, collapse)Hemorrhagic syndrome (bleedings)Edema of cellular tissue of a neckLymphadenopathyComplications
14DIPHTHERIA. Complications Diphtheric croupMyocarditis (early and late)Polyneuritis and neuropathiesToxic nephritisAcute renal insufficiencySecondary pneumonia
15Diphtheritic croup THE CROUP STAGES CLINICAL FORMS DESCRIPTION Localized croup(I – III stage)Larynx is affected (membranes, edema)Severity is determined by the stage of croupDiffuse croupOther parts are involved besides the larynx (trachea, bronchus)THE CROUP STAGESI stagecatarrhalEdema and hyperemia of laryngeal mucous under laryngoscopyMild pyrexiaProductive cough → barking cough → hoarse voiceII stagestenoticGrey membranes on the laryngeal mucousIntoxication, hypoxemiaAphonia → soundless cough → noisy heavy respiration, breath is extendedAnxietyIII stageasphycticHypoxemia, cyanosisSomnolence, adynamyThready pulse, arrhythmiaForced positionStop of breathing
18DIPHTHERIA. Treatment antitoxin doses for adults Clinical form1st dose(IU)Dosing regimenCourse doseCommentSubclinical-Mild1In bacteriocarriers with catarrhal process– IUModerate1-2Repeatedly injected in the absence of the 1st dose effectSevere2-3(every hours)During the first 2 days of treatment all dose is injected. 2 and 3 doses make up ¾ of the 1st dose.Hypertoxic(every 12 hours)All doses are injected during first two days. 2 and 3 doses make up ¾ of the 1st dose.
19Clinical classification of angina By etiology:StreptococcusStrepto-staphylococcusStaphylococcusFusospirochetalBy localization of pathological process:palatine tonsils (tonsilla palatina)pharyngeal tonsil (tonsilla pharyngealis)lingual tonsil (tonsilla lingualis)tonsils of torus tubaris (tonsilla tubaris)tororum levatoriumlymphoid formations of pharynx posterior walllymphoid formations of larynx
20Clinical classification of angina By character of inflammatory process:catarrhallacunarfollicularnecroticBy severity:mildmoderatesevereBy rate:primaryrecurrentBy complications:uncomplicatedcomplicated
21Clinical manifestation of angina Course of angina:Incubation period (1-2 days)Initial period (few hours - to 1 day)Climax periodConvalescence (early and late)Criteria of angina severity:Degree and duration of feverLevel of intoxicationCharacter of inflammatory processFunctional disorders of nervous, cardiovascular and other systems and organs.Presence of early or late complications.
22Clinical manifestation of angina Complications of angina:tonsillar abscessparatonsillar abscessparapharyngeal phlegmonmediastinitiscervical lymphadenitisretropharyngeal abscesstonsillar sepsismyocarditisrheumatismglomerulonephritis
23Plaut-Vincent anginaPlaut-Vincent angina (trench mouth, acute necrotizing ulcerative gingivitis) is a polymicrobial progressive infection of the throat characterized by ulcerations, necrosis of the mucous membranes, bleeding, and foul breath.Etyology:-gram-positive Peptostreptococcus spp.,-gram-negative bacilli from Bacteroidales order-spirochetes (Borrelia spp. and Treponema spp.)
24Infectious mononucleosis Moderate onset with prodromal phaseModerate tonsillitis with necrotic detritus on surfaceGeneralized lymphadenopathyEnlargement lever and spleenPolymorphic rashIn blood test: atypical mononuclearsSpecific antibodies Ig G (ЕА) + Ig M (VCA);PCR