BIOCHEMICAL SIGNS OF ADJUSTMENT PATTERNS IN TOXIC DIPHTHERIA

Objective. To study the nature of biochemical shifts in toxic oropharyngeal diphtheria in relation to the type of its pathogen — toxigenic Corinebacterium diphtheriae (CBD) mitis or gravis. Subjects and methods. The investigation enrolled 40 patients with severe and moderate toxic oropharyngeal diphtheria. Results. The follow-up established that the patients had biochemical differences in the clinical picture of the disease in relation to the etiological factor toxigenic CBD mitis or gravis. Thus, the disease was more severe; and multiple organ dysfunction (complications) and fatal outcomes (30%) were more frequently recorded in patients with toxic oropharyngeal diphtheria caused by toxigenic CBD gravis. The clinical picture correlated with biochemical shifts both at the onset of the disease and in its acute period. Prognostically poor metabolic disturbances were more commonly recorded in patients with toxic oropharyngeal diphtheria caused by toxigenic CBD gravis; they were detectable just at the onset of the disease and continued to progress during its course. Toxic diphtheria caused by CBD mitis is a clinically and biochemically more favorable disease. The lower load of metabolic systems (AST and ALT) and a higher safety factor (a bloodf ree amino acid pool) offer better promise of recovery in this patient group. The biochemical shifts correspond to the severity of the disease to a greater extent than the well-established criterion — subcutaneous fat edema. Conclusion. Toxic diphtheria caused by toxigenic CBD gravis is characterized by a more severe course than that induced by toxigenic CBD mitis. The clinical picture correlates with quantitative changes in the parameters under study.

oropharyngeal diphtheria, toxigenic Corinebacterium diphtheriae mitis or gravis, adjustment syndrome, biochemistry, enzymemia, hypoproteinemia, gluconeogenesis, thermogenesis, enzymatic homeostasis, hemostasis, polyneuropathy, myocarditis