The Diphtheria is an upper respiratory infection with Coryne bacteria diphtheria. Feared the bacteria poisons (toxins), which resulted in life-threatening complications. A protective vaccine is available.

Word Origin

Pierre Fidele Bretonneau (1778-1862) developed the designation as diphtheria in the medical use of language was introduced. It was a French Gräzismus, derived from diphtheria, “the Gerbhaut” and the suffix-ITIS for inflammation, what he referred to the so-called neck tan, dark pseudo dead from mucous membranes and blood components involved. In French it developed diphtheria, which is the German form is derived. Previously, the disease as a (true) or Krupp Croup (of Scots croup, hoarseness “) denotes.

Excitation

The diphtheria toxin is determined by the building (non-toxic building materials) bacterium Corynebacterium diphtheria and triggered from person to person by droplet infection transmitted.

The toxins (poisonous substances) – designated especially after the diphtheria toxin pathogen – the pathogen damage through inhibition of protein biosynthesis Elongation factors. The pathogens form the toxin but only if they are with a bacteria phage infected, the toxin is phagenkodiert. With the blood they will also be removed by the inflammation of body organs are transported, such as heart, liver, kidney. This can lead to the (life) dangerous complications of diphtheria lead.

Abundance and distribution

The physician characterizes the incidence of the disease and Nobel Prize winner Emil von Behring introduced vaccination, which greatly decreased the cases of this disease. The disease however is not, eradicated such as smallpox. Once known as the coverage falls below a specified value decreases, the disease figures considerably. That was in the former Soviet Union, where, after the collapse of the system 1994 48.000 cases occurred.

Symptoms

The severity and form of symptoms, the two to six days after infection occurs, depend on the location of the immune sufferers. It is discriminatory from Pseudo-Krupp and the Epiglottis enclosed.

1. For localized diphtheria (almond, and pharyngeal diphtheria) are beginning to fatigue, nausea and pain on swallowing, often associated with abdominal and limb pain, vomiting is rare. Increasing fever.
2. The preferred nasal diphtheria occurs in infants and small children; disabilities associated with nasal breathing, restlessness and disturbed eating. Serous or purulent, bloody rhinitis occurs, often associated with tissue and crusts on the nasal entrance.
3. As an initial condition is the most laryngeal diphtheria in the wake of revenge on diphtheria. Symptomatic are barking cough, hoarseness and increasing voiceless (Aphonie) summarized as a Real Krupp. Breathing is difficult and associated with Pfeifgeräuschen.
4. Less common forms of diphtheria are occurring with diphtheria skin ulcers and injuries and the conjunctiva with diphtheria-bloody watery secretion and frequent corneal involvement.
5. In advanced stages of Diphtheria spreads the membrane formation rapidly and intensively on the tonsils, the palate and uvula and the nasal mucosa from, local lymph node swelling occurs.

Investigation

The diagnosis by a bacteriological test is at least 12 hours to obtain. Therefore, in case of suspicion, particularly when toxic diphtheria, immediately based on the clinical picture therapy.

Treatment

* Anti-toxin

Treatments will Antikörperseren (anti-toxin) administered. The serum antibody binds the bacterial toxins, so they can be harmless. The anti-toxin is on the medication depots Bundeslaender available for toxicological emergencies.

* Antibiotics

Penicillin is used for at least 10 days are used to kill bacteria.

When occlusion of the airway must be a cut trachea made. Strict bed rest for five to six weeks is necessary to minimize the risk of heart damage to a minimum. With good and proper treatment of diphtheria remains little damage and the fatality rate is low.

Complications

As the toxic complications occur primarily a myocarditis (heart inflammation) and polyneuritis (nerve inflammation) on: For example, during the diphtheria epidemic in 1995 in Kyrgyzstan 656 hospitalized patients, but from those at 22% a heart muscle inflammation, and at 5% a polyneuritis was diagnosed.

* Inflammation of the heart muscle is consistent with the possibility of conduction disturbances, cardiac enlargement and circulatory failure associated; sudden cardiac occurs when so-called “Frühtod” in the first week or illness as a “Spättod” in the convalescence of
* Polyneuritis which manifests itself as a paralysis of various cranial nerves or Hirnnervenäste as the facial nerve or nerve recurrens and can lead to paralysis of the soft palate. The eye muscles or a sip of disability or paralysis, swallowing, so that the recorded food on the nose can be hochgewürgt. The peripheral polyneuritis develop usually one to three months after the onset of the disease.
* Pneumonia occurs in half of the deaths
* Rarer complications are a limitation of nephritis with renal or kidney failure, bacteremia, endocarditis, pulmonary embolism, encephalitis

History of diphtheria

Discovery of the pathogen

* 1826 Pierre Fidele Bretonneau leads the description in the medical linguistic usage
* 1858 to trigger investigations of diphtheria by microorganisms
B. 1884 Friedrich Loeffler identified at Imperial Health Office in Berlin Corynebacterium diphtheria as the agent of diphtheria
* 1896 Group: Coryne bacteria (Coryn greek: “mace”)

Immunization

* 1888 Emile Roux and Alexandre Yersin: Toxin detection
B. 1889 Emil Adolf von Behring: serum carrier immunity
* 1890 & Shibasaburo Kitasato Behring: The discovery of the anti-toxin in the blood of infected animals, anti-toxin is in principle transferable
B. 1894 William H. Park and Anna Wessels Williams develop at the New York City Department of Health an anti-toxin.
B. 1898 Behring & Erich Wernicke: immunity by injection of diphtheria toxin neutralized
B. 1901 Nobel Prize for Physiology or Medicine for von Behring
* 1913 von Behring: toxin-antitoxin mixture for immunization
* 1924 Gaston Ramon (1886-1963) treated with the toxin heat / formal for vaccination.