Diphtheria

Diphtheria is an acute contagious disease caused by specific organism bacillus diphtheria. It is characterized by local inflammation with fibrin formation of the mucous membranes, usually of the upper respiratory tract, with production of a toxin which when absorbed into the blood stream may produce deleterious effects on various parts of the body, especially the heart and peripheral nerves.

The disease exists throughout the world but is more common in temperate zones and during the colder months, autumn and winter. It is commonly spread by direct contact which must be fairly intimate. Dissemination by third objects such as clothes, toys, etc. may also occur and carriage by milk has been reported many times. Healthy carriers may disseminate the disease to susceptible persons and thus constitute a menace to public health. Children appear to be more liable to diphtheria than adults; although the most robust people may be attacked and those whose health is weakened by any cause are especially predisposed.

The incubation period is three to ten days. The disease may be divided into three main forms according to the anatomical distribution of the membrane: a) faucial or pharyngeal; b) laryngeal; c) nasal.

The onset of the disease is insidious with relatively moderate temperature reaction. In general, following an incubation period of about two days, symptoms set in like those commonly accompanying a cold. A slight feeling of uneasiness in the throat is experienced along with some stiffness of the back of the neck. The earliest objective manifestation of the disease is the formation of a thin film of fibrin on the tonsils which increases in thickness to form characteristic yellowish-white or grayish-white pseudomembrane. The throat appears to be reddened and somewhat swollen. If the pseudomembrane is forcibly removed, it is found to separate from the underlying true mucous membrane with difficulty and leaves a raw, bleeding surface on which in the untreated cases a fresh membrane rapidly reforms. The lesion tends to spread over the pillars and onto the soft palate and uvula. Hence any membranous formation on pharyngeal tissues should immediately be regarded as a suspicion of diphtheria.

Myocarditis is the most dreadful of all complications of diphtheria. It is due to direct action of the toxin on the heart muscle. Another severe complication is peripheral neuritis. It occurs in the form of paralysis affecting the soft palate and throat. Other forms of paralysis are paralysis of eye or even respiratory muscles, paralysis of a limb or both legs. These symptoms, however, after continuing for a variable length of time, almost always ultimately disappear.

The outcome of the disease depends mainly on one factor, namely, the early administration of adequate doses of antitoxin. Its employment in any recognized or even suspected case of diphtheria is mandatory and no physician can delay its administration. The second important measure is rest, the patient being kept strictly flat.

Patients suffering from diphtheria should be isolated for at least two weeks after the onset of the disease, and then until three successive cultures from the nose and throat taken not less than 48 hours apart are negative.

POST - TEXT ASSIGNMENT

Exercise 7. Answer the following questions:

1. What is diphtheria caused by?

2. Is it contagious disease?

3. What is the disease characterized by?

4. Where is diphtheria more common?

5. Who is more liable to diphtheria?

6. What is the incubation period of the disease?

7. What are the main forms of diphtheria?

8. What are its main symptoms?

9. What are its main complications?

10.What does the outcome of the disease depend on?

Exercise 8. Translate into English and make up 5 sentences with them:

oстрое инфекционное заболевание, местное воспаление, всасываться кровотоком, слизистая оболочка, вредное воздействие, во всем мире, распространяться при непосредственном контакте, здоровый носитель, быть более подверженным, самые здоровые (крепкие) люди, быть особенно предрасположенным, появляться ненадолго, отложить назначение, по крайней мере, начало заболевания.

Exercise 9. Give English equivalents to the words in braсkets:

1. Diphtheria is an (острое инфекционное) disease.

2. It is characterized by (местным воспалением) with fibrin formation of the (слизистой оболочки) of the (верхних дыхательных путей).

3. The disease exists (по всему миру) but is more common (в умеренных зонах).

4. It is commonly spread (при прямом контакте).

5. Сhildren appear to be (более подвержены) to diphtheria than (взрослые).

6. Most (крепкие) people may be (инфицированы) and those whose health is weakened by any cause are especially (предрасположены).

7. The earliest objective (проявление) of the disease is the formation of (тонкой пленки на миндалинах).

8. If the pseudomembrane is forcibly removed, it leaves (свежую кровоточащую) surface.

9. (Исход заболевания) depends largely on one factor, namely, (назначения соответствующей дозы антитоксина).

10. Patients suffering from diphtheria should be (изолированы) for at least two weeks after (начала заболевания).

Exercise 10. Put the verbs in brackets in the appropriate tense:

1. Whom … the doctor … at the hospital every day? (treat)

2. What … you … now? (study)

3. What … the surgeon already …? (transfuse)

4. What … the surgeon … for two hours? (perform)

5. What … the lecturer … yesterday at 3 o’clock? (report on)

6. What … you … to do before you saw me? (decide)

7. What … the nurse … for an hour before the surgeon began the operation? (sterilize)

8. What … you … tomorrow at 6 o’clock? (do)

9. What … you … tomorrow? (take part in)

10. How many patients … the doctor … tomorrow by 5 p.m.? (hospitalize)

Exercise 11. Speak on following items:

Epidemiology of diphtheria.

Symptomatology.

Treatment.

Complications.

Quarantine.

Exercise 12. Compose a case history using the key words:

To be admitted to the hospital, to complain of, on physical examination, symptoms, to reveal, laboratory findings, antitoxin treatment, the course of the disease, convalescence.

Exercise 13. Give summary of the text.

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