Diphtheria [Ссылки доступны только зарегистрированным пользователям ]
Emergency Department Care
Treatment should be initiated even before confirmatory tests are completed because of the high potential for mortality and morbidity.
Diphtheria
[Ссылки доступны только зарегистрированным пользователям ]
Mortality/Morbidity
Death due to mechanical airway obstruction or cardiac involvement with circulatory collapse occurs in at least 10% of patients with respiratory tract diphtheria. The mortality rate has not improved and was approximately 20% in the outbreak that occurred in the newly independent states of the Soviet Union during the early 1990s.
Prognosis depends on the virulence of the organism (with the gravis strain usually accounting for the most severe disease), the age and immunization status of the patient, the site of involvement, and the speed with which antitoxin is administered.
For patients in whom disease is recognized on day 1 and therapy is initiated promptly, the mortality rate is approximately 1%. If appropriate treatment is withheld until day 4, the mortality rate rises to 20%.
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Measurement of the patient's serum antibodies to diphtheria toxin before administration of antitoxin may help assess the probability of the diagnosis of diphtheria.
If antibody levels are low, diphtheria cannot be excluded, but if levels are high, C diphtheriae is less likely to produce serious illness.
Не дифтерия исключается вообще, а менее вероятна тяжелая дифтерия (если я правильно перевел для себя)
Medical Care
Antitoxin: Specific antitoxin is the mainstay of therapy and should be administered on the basis of clinical diagnosis because it neutralizes free toxin only.
Antitoxin is the mainstay of therapy. Probably of no value for local manifestations of cutaneous diphtheria, but its use is prudent because toxic sequelae can occur, causing rapid deterioration of the patient.
Adult Dose
Pharyngeal or laryngeal ( <48 h): 20,000-40,000 U IV infused over 30-60 min
Nasopharyngeal: 40,000-60,000 U IV infused over 30-60 min
Extensive illness (>3 d) or brawny neck swelling: 80,000-120,000 U IV infused over 30-60 min
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Prognosis
• For respiratory tract diphtheria, the fatality rate can be set at 10-15%. The prognosis depends on multiple factors, including the virulence of the organism, the patient's age and immunization status, the site of infection, and the timing of administration of the antitoxin.
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