Diphtheric encephalitis and brain neuroimaging features.

We report a rare case of paediatric diphtheria complicated with encephalitis. A 6-year-old boy who did not receive his scheduled diptheria-tetanus-pertusis vaccination presented with one episode of generalised convulsive seizure. His illness was preceded by a 3day history of fever associated with enlarged exudative tonsils with a pseudomembrane. He was commenced on intravenous penicillin and oral erythromycin. However, he developed progressive encephalopathy with focal neurological deficit which required intubation on day 5 of illness. Throat swab polymerase chain reaction for diphtheria toxin A and B were positive and diphtheria antitoxin was given. Magnetic resonance imaging (MRI) of brain showed T2-weighted hyperintensities over the anterior cingulate gyri, insular cortex and cerebellum. This is the first reported MRI finding of diphtheric encephalitis. Our report highlights the importance of neuroimaging in diagnosing diphtheric encephalitis particularly in cases with unremarkable cerebrospinal findings.

[Clinic laboratory and integrated ultrasonic study in patients with liquid formation in diphtheria catamnesis].

It has been determined that in 9.3% of patients suffered from diphtheria of fauces in catamnesis till 10 years cysts of renal sinus were revealed by ultrasonic study which should be differentiated with calicopieloectasies. The method of pharmocoechography with introducing diuretics is very informative and reliable way of differential diagnostics. The cysts of renal sinus have been recorded in the indices of the study by ultrasonic study. It has been found that in patients suffered from severe diphtheria are in 1.8-2 times higher in frequency than in patients with slight and intermediate degree of disease. In 57.1% of patients with cysts of renal sinus chronic TIN was diagnosed. Frequency of cysts of renal sinus in patients with diphtheria exceeds frequency by older people in 3-9 times. Patients with renal cysts suffered from diphtheria should be under urological control in long-term regular medical check-up and need ultrasonic study with pharmocoechography and echodoplerography of renal vessels.

[Kidney lesions in a diphtheria catamnesis].

150 persons aged from 16 to 65 years found in a diphtheria catamnesis have been observed. Clinical and laboratory as well as ultrasonic signs of kidney lesions in an acute period of a pharynx diphtheria have been studied. These signs corresponded to tubulo-interstitial nephritis. Obtained data testifies that more severe old form of diphtheria in the acute period is more often symptoms of kidneys lesion in a catamnesis period are revealed and they remain throughout long time. 47.5% of patients in a diphtheria catamnesis had clinical-laboratory and echographic signs of kidneys lesion, 81.3% of them clinically presented pain and edematic syndromes, uropoiesis and urine passage disturbances; depression of renal functions (concentration and depurination), an urinary syndrome; sonographic signs of kidneys lesion were observed and manifested at maximum level 1-3 years after an acute period of a pharynx diphtheria. Perimedullary thickness was revealed in 20-45% of patients depending on severity of the disease, it was combined with single and multiple calcifications and a calcification of pyramids papillas. According to ultrasonic data, the nephrocalcinosis has been found 1.2 times oftener after average degree of severity and 2 times oftener after severe degree of severity of pharynx diphtheria in comparison with mild form of the disease. The calcification of papillas of the pyramids, found out in a diphtheria catamnesis, had been developed in a place of necrosis of papillas of pyramids in patients in an acute period of disease.

[Clinical and structural parallels in changes of the myocardial conduction system in diphtheria patients]. / Klinicheskie i strukturnye paralleli izmenenii provodiashcheisistemy serdtsa i miokarda u bol'nykh difteriei.

AIM: Comparison of the results of clinical device investigations of the heart with morphological autopsy evidence in diphtheria. MATERIAL AND METHODS: Hearts of 309 patients with diphtheria aged 25 to 80 years and 60 hearts of patients who died of diphtheria were investigated using ECG, echo-CG, doppler echo-CG, Holter ECG monitoring, biochemical tests of blood. Structural study of cardiac conduction included examination of the sinus-atrial node, atrioventricular node and bundle regarding the adjacent myocardium. RESULTS: Variants of structural-functional state of the myocardium and conduction system are explained by variability of the pathological processes which arose due to individual features of the conduction system structure and location, relationships with the myocardium. In acute diphtheria (day 1-10) dystrophic, necrobiotic and vascular disorders prevailed followed on days 11-30 by inflammation ending in myocardiosclerosis. Nodes and bundles of the conduction system are affected less frequently than the myocardium. CONCLUSION: A correlation exists between structural state of the cardiac conduction system and variants of clinical affection of the heart in diphtheria.