Gornic diphtheritic croup is observed in severe forms of diphtheria, manifested as signs of a common infectious disease. This form of diphtheria occurs as a result of a descending infection, nesting in the nasal cavity and nasopharynx in bacilli carriers. Diphtheria croup often occurs in children younger than 5 years, especially weakened by childhood infections, beriberi, alimentary deficiency, etc.
Pathological anatomy of laryngeal diphtheria.
In the onset of the disease, diphtheria bacillus causes an inflammatory reaction that does not differ from banal catarrhal inflammation. However, soon on the mucous membrane of the larynx ulcers are formed, on the surface of which appear yellowish-green films containing a large number of diphtheria rods. These films are tightly welded to the mucous membrane of the larynx, especially on its back surface and vocal folds. Later they are torn off, forming "molds" from the inner surface of the larynx. In some cases, diphtheria toxin causes ulcerative and necrotic lesions of the mucosa and underlying tissues, paralysis of the laryngeal nerves.
Symptoms and clinical course of laryngeal diphtheria.
The onset of the disease is devious and often resembles catarrhal pharyngitis: a small subfebrile condition, a pale face, adynamia, reddening of the throat and a slight runny nose. However, soon after the appearance of diphtheria raids, the general condition of the patient sharply worsens, the body temperature rises to 100-102 ° F, there is a violation of the voice, which becomes dull, inexpressive, almost hissing; There is a cough, breathing gets noisy, and with the increase of stenosis of the larynx - and a stridorous character, which indicates the onset of diphtheria croup.
In the clinical course of diphtheria of the larynx, three stages are distinguished:
- Stage of dysphonia, characterized by hoarseness of voice, barking cough; After 1-2 days dysphonia goes into aphonia.
- Dispnoethical stage, the signs of which come in the middle of the stage of dysphonia and on 3-4 days dominate in the clinical course of the disease: there is noisy stridorous respiration, spasm of the larynx is becoming more frequent with phenomena of inspiratory choking. In the patient's condition, signs of hypoxia predominate, the face acquires an earthy hue, the lips and nasolabial triangle are cyanotic, respiration is frequent, superficial, the pulse is frequent and threadlike, heart sounds are weakened and deaf, which may indicate the occurrence of toxic myocarditis. The child lies in bed with his head thrown back (the phenomenon of meningism), shows motor anxiety, a look extinct, wandering; The limbs are cold, the body is covered with cold sweat.
- The terminal stage is characterized by a pronounced toxic-anoxic syndrome, manifested by damage to the vasomotor and respiratory centers. If the disease reaches this stage, then any medical measures do not improve the condition of the patient, which eventually dies from paralysis of bulbar centers. When laryngoscopy in the debut stage, diffuse hyperemia, and swelling of the mucous membrane are revealed, which is covered with a light whitish coating, which turns into dirty gray or green films, tightly welded to the underlying tissues. When trying to remove them, ulcers and small-to-small hemorrhages (a symptom of "bloody dew") are revealed beneath them. These films can spread down to the underlying space and then into the trachea. In some cases, the swelling of the anterior larynx is revealed, which hides the picture of the lesion of the lining space and the trachea.
Diagnosis of laryngeal diphtheria.
In those cases when diphtheria of the pharynx develops together with diphtheria, the diagnosis of laryngeal diphtheria does not cause difficulties. If laryngeal diphtheria develops primarily and in isolation, it is possible to assume the presence of diphtheria infection, especially at the initial stage, only on the basis of epidemiological data.
Diphtheria of the larynx is differentiated with pseudocut, influenza laryngo- bronchitis and other acute infectious diseases of the larynx. Differentiate also with laryngeal stridor, laryngospasm, the foreign body of the larynx, zagrugal abscess, allergic edema, laryngeal papillomatosis, etc.
The final diagnosis is established only after bacteriological examination and obtaining a positive result. But even if this result is doubtful or negative or has not yet been obtained, and the clinical picture indicates a possible diphtheria disease, immediately begin to conduct specific serotherapy.
Treatment of laryngeal diphtheria.
Treatment for suspected diphtheria of the larynx is urgent and complex, conducted in a specialized hospital for infectious patients. It includes the following activities:
- Large doses of antidiphtheria antitoxic serum (3000 AE/kg), both intramuscularly and subcutaneously, simultaneously use antihistamines (suprastin, diazolin, etc.);
- Antibiotics in combination with hydrocortisone for the prevention of pneumonia, toxic pulmonary edema, and secondary complications; Prescribe cardiac and respiratory analeptics, vitamin B1 and cocarboxylase to prevent toxic damage to vital centers and diphtheria polyneuritis; Conduct intensive detoxification therapy;
- To prevent reflex spasms of the larynx, barbiturates (phenobarbital) are prescribed in small doses, often;
- Inhaling and laryngeal installations of proteolytic enzymes, hydrocortisone, alkaline-oil solutions, antibiotics, adrenaline, ephedrine;
- Small children are placed in an oxygen chamber, older children are prescribed mask oxygen or carbogen therapy;
- If obstructive asphyxia occurs, direct laryngoscopy with the aspiration of false membranes, thickened mucus; When asphyxia occurs, one should not expect to improve breathing and postpone tracheotomy, since respiratory laryngeal obstruction can occur instantaneously, and then all respiratory rehabilitation interventions may be overdue.
Complications of diphtheria of the larynx: bronchopneumonia, abscess, and perichondritis of the larynx, post-diphtheria polyneuritis (paralysis of the soft palate, extraocular muscles, accommodation disorders, paralysis of the extremities).
The prognosis for diphtheria of the larynx is serious, especially in children younger than two years old, whose infection often extends to the trachea and bronchi, causing severe forms of diphtheria bronchopneumonia. In hypertoxic forms, even in older children and adults, the prognosis remains cautious.