Septic shock
Shock develops as a result of pronounced microcirculatory disorders. They are provoked by the action of the diphtheria toxin itself on tissues, as well as inflammatory mediators and cell breakdown products. The main task of intensive therapy is to neutralize the circulating toxin and eliminate tissue hypoxia.
- Specific therapy: Based on the intravenous administration of antitoxic diphtheria serum (ADS). Strict rule: before starting the infusion, the patient must receive prednisolone at a dose of 90–120 mg intravenously.
- Hormonal support: Subsequently, high doses of glucocorticoids are prescribed (prednisolone at the rate of 5–20 mg/kg or hydrocortisone 20–75 mg/kg per day).
- Hemodynamic correction: Includes the administration of colloidal and crystalloid solutions, the use of catecholamines (dopamine, norepinephrine, adrenaline, dobutamine), as well as oxygen therapy.
- Combating DIC syndrome: Fresh frozen plasma, heparin, protease inhibitors, and activated protein C are used.
For nonspecific detoxification in severe toxic forms, plasmapheresis with the replacement of 70–100% of the plasma volume with cryogenic donor plasma can be used.
Diphtheritic myocarditis
Heart muscle damage requires the patient's immediate transfer to strict bed rest. The duration of bed rest depends on the severity of the disease and in toxic forms can reach 30–45 days. Treatment is aimed at restoring coronary blood flow, stopping arrhythmias, and improving myocardial metabolism.
Comprehensive therapy includes:
- Infusion of a polarizing mixture (glucose, potassium, insulin).
- Preparations to improve myocardial metabolism (ATP, riboxin, cocarboxylase, cytochrome C, antioxidants).
- Anticoagulants and antiplatelet agents to improve microcirculation.
- Glucocorticoids and nonsteroidal anti-inflammatory drugs.
- Symptomatic pain relief for attacks associated with myocardial ischemia.
Respiratory failure and laryngeal stenosis
Acute respiratory failure often accompanies laryngeal diphtheria (croup) or severe toxic forms of oropharyngeal diphtheria. In the latter case, the pharyngeal lumen narrows due to massive soft tissue edema and the accumulation of dense fibrinous membranes.
- Catarrhal stage: Steam inhalations with soda or herbal decoctions, aerosol and systemic glucocorticoids, antihistamines, diuretics, and aminophylline are prescribed.
- Stenosis stage: The patient needs strict dynamic monitoring. With increasing hypoxemia, more frequent and prolonged suffocation attacks, the appearance of motor agitation, pronounced cyanosis, and tachycardia, emergency instrumental or surgical intervention (intubation, tracheostomy, or conicotomy) is indicated.
Polyneuropathy and iatrogenic complications
Severe polyneuropathy is another absolute indication for the immediate prescription of strict bed rest. When nerves regulating the act of swallowing are involved in the process, the patient loses the ability to feed independently — during this period, mandatory tube feeding is indicated.
A separate group consists of immune complications arising from irrational treatment. Unjustified overestimation of the dose or frequency of administration of horse antitoxic diphtheria serum provokes allergic reactions, up to serum sickness. This not only paradoxically aggravates the course of the diphtheria infection itself, but also significantly increases the risk of a fatal outcome.
Briefly: answers to topical questions
What ECG signs are characteristic of diphtheritic myocarditis?
Characteristic ECG signs of diphtheritic myocarditis:
- prolongation of the PR interval;
- changes in the ST–T complex;
- rhythm and conduction disturbances, including blocks of various degrees.
What are the timings for the development of myocarditis in toxic diphtheria?
The timing of myocarditis development determines the severity of the course of toxic diphtheria.
| Type of myocarditis | Onset timing |
|---|---|
| Early | From the 4th day of the disease; a prognostically unfavorable option is development as early as the 1st week of the disease |
| Late | Typical course — 2–3rd week of the disease; the timing of development can stretch to 3–4 weeks |
According to pathological anatomy data, diphtheritic myocarditis develops at the end of the 1st — beginning of the 2nd week of toxic diphtheria.
Which nerves are most often affected in diphtheria polyneuropathy, besides those regulating the act of swallowing?
In addition to the nerves involved in the act of swallowing, the sources indicate damage to other cranial nerves, peripheral nerves, and autonomic ganglia in diphtheria:
- ciliary nerve (n. ciliaris) — accommodation paralysis, development of farsightedness;
- abducens nerve (n. abducens) — strabismus, ptosis, asymmetry;
- sympathetic and phrenic nerves;
- III cervical sympathetic and nodose ganglia.
The sources also indicate that demyelination first affects the cranial nerves, then the rest.
Class and exam questions
Is a positive test for horse protein a contraindication to the administration of serum?
In localized forms, administration is canceled. However, in severe forms (toxic diphtheria, croup), the serum is administered for vital indications intravenously, but strictly under the cover of high doses of glucocorticoids in an intensive care unit.
In what cases with diphtheria is the patient transferred to tube feeding?
Tube feeding is necessary when specific polyneuropathy develops, which is accompanied by muscle paresis and persistent disturbance of the act of swallowing.
What clinical signs indicate the need for emergency tracheostomy or intubation?
Intervention is required for signs of decompensated stenosis: increasing cyanosis, changes in respiratory rhythm, pronounced tachycardia, motor agitation, and prolonged suffocation attacks.
What else to study on this topic
- Technique for conducting skin allergy tests for horse protein
- Principles of serum dosing depending on the form of diphtheria
- Extracorporeal detoxification and plasmapheresis in severe forms
- Stages of diet therapy during the convalescence period (tables No. 4, 13, 15)
Master the complete topic in the «Infectious Diseases» course
This is a summary. The course covers everything tested in classes and exams.
- Full guidelines on the topic "Diphtheria Complications" and 3,312 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 41 video lessons on the subject
Other topics in the "Respiratory Infections" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.