白喉
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白喉(Diphtheria，来源于希腊语διφθερα dipthera “pair of leather scrolls”)是一种上呼吸道疾病，临床症状为咽炎，低烧and an adherent membrane (a pseudo-membrane) on the 扁桃体, 咽部,或鼻。A milder form of diphtheria can be limited to the skin. 致病菌为白喉棒状杆菌, a facultatively anaerobic[1] Gram-positive bacterium. Diphtheria is a highly contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected individuals. Once quite common, diphtheria has largely been eradicated in developed nations through wide-spread vaccination. In the United States for instance, between 1980 and 2004 there have been 57 reported cases of diptheria[2] as the DPT (Diphtheria-Pertussis-Tetanus) vaccine is given to all school children. Boosters of the vaccine are recommended for adults since the benefits of the vaccine decrease with age; they are particularly recommended for those traveling to areas where the disease has not been eradicated.
[编辑] 历史Diphtheria was named in 1826年 by French physician Pierre Bretonneau. The name alludes to the leathery, sheath-like membrane that grows on the 扁桃体, throat, and in the nose. The pronunciation /ˌdipˈθiɹˌi.ə/ was originally considered incorrect, but has become the most common way of saying the word, and is accepted as a correct form. While many writers today use the spelling "diptheria" which fits the modern pronunciation, this spelling is rarely found in dictionaries.
1920年代美国每天有10-20万患者，死亡人数约1万3千－1万5千人。[2] Children represented a large majority of these cases and fatalities. One of the most famous outbreaks of diphtheria was in Nome, Alaska; the trip made to get the antitoxin is now celebrated by the Iditarod Trail Sled Dog Race. 19世纪晚期，白喉病也袭击了英国王室，导致英国维多利亚女王一个女儿一个孙女去世. Princess Alice of Hesse (维多利亚女王第二个女儿) died of diphtheria after she contracted it from her children in December of 1878 while nursing them. One of Princess Alice's own daughters, Princess May, also died of diphtheria in November of 1878.[4] One of the first effective treatments for diphtheria was discovered in the 1880s by U.S. physician Joseph O'Dwyer (1841-1898). O'Dwyer developed tubes that were inserted into the throat, and prevented victims from suffocating due to the membrane sheath that grows over and obstructs airways.1890年代,德国医师Emil von Behring开发出一种抗生素，并不杀死白喉病毒，而是抑制它释放毒素到患者体内。他因为发现和研制出抗白喉血清获得第一个诺贝尔医学奖。(美国的William H. Park，Anna Wessels Williams和Pasteur Institute的科学家Emile Roux，Martin Chaillou同期也独立研制出白喉抗生素)。首度成功地白喉疫苗于1923年研制成功。但是抗生素并未用于治疗白喉直到二战后开发出磺胺药。
[编辑] 机理白喉病毒促进ADP-核糖基化，阻止eEF-2活性。 这样真核蛋白合成期间抑制传输移动。 [编辑] 标志和症状
The respiratory form has an 潜伏期 of 2-5 days. The onset of disease is usually gradual. Symptoms include fatigue, fever, a mild sore throat and problems swallowing. Children infected have symptoms that include nausea, vomiting, chills, and a high fever, although some do not show symptoms until the infection has progressed further. In 10% of cases, patients experience neck swelling. These cases are associated with a higher risk of death. In addition to symptoms at the site of infection (sore throat), the patient may experience more generalized symptoms, such as listlessness, pallor, and fast heart rate. These symptoms are caused by the 毒素 released by the bacterium. 低血压 may develop in these patients. Longer-term effects of the diphtheria toxin include 心肌症 and 周围神经 (sensory type).[5] 
The cutaneous form of diphtheria is often a 继发性传染 of a preexisting skin disease. Signs of cutaneous diphtheria infection develop an average of seven days after the appearance of the primary skin disease. [编辑] 诊断疾病控制和预防中心(CDC)所使用的白喉确诊基于实验室和临床检测。 [编辑] 实验室标准
[编辑] 临床标准
[编辑] 病例分类
Empirical treatment should generally be started in a patient in whom suspicion of diphtheria is high. [编辑] 处理The disease may remain manageable, but in more severe cases 淋巴结 in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require 插管法 or a 气管切开术. In addition, an increase in heart rate may cause cardiac arrest. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital 加护病房 (ICU) and be given a diphtheria anti-toxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation. Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends[6] either:
[编辑] 流行病学Diphtheria is a serious disease, with fatality rates between 5% and 10%. In children under 5 years and adults over 40 years, the fatality rate may be as much as 20%.[2] Outbreaks, though very rare, still occur worldwide, even in developed nations. After the breakup of the former 苏联 in the late 1980s, vaccination rates in its constituent countries fell so low that there was an explosion of diphtheria cases. In 1991 there were 2,000 cases of diphtheria in the USSR. By 1998, according to 红十字会 estimates, there were as many as 200,000 cases in the 独联体, with 5,000 deaths. This was so great an increase that diphtheria was cited in the 吉尼斯世界纪录 as "most resurgent disease". [编辑] 参考文献
[编辑] 普通参考
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