218
Pathogenesis851601012686155203281351420483561622677715771
Local851839012878148211280320
process1205839012870125194257319373427
(portal1668839012846117186241279349388
of2091839012870109
entry)2236839012862131171225287334
11:2607839012869139186
1.8511080012870106
Adhesion99210800128127197267330383422492562
and15901080012888157228
colonization:18531080012888158197267337376439501539577648717757
bacteria26451080012895158220258321368406469
attach31491080012892131169232294363
to35481080012865134
the37181080012865135197
mucous395010800128136203266336407462
membranes444810800128134195305373420482553616670
of51541080012895142
the53311080012865135196
oropharynx,8511321012870117188257327390436507575646681
nose,15671321012870140194256292
larynx18941321012838101146216284355
(less2284132101284786148203257
commonly25771321012862131241349416487526597
-32071321012849
conjunctiva,32931321012862132203242310381444482520591653688
genitals,40151321012870133202242280343381436470
skin).45201321012855125164234281317
2.8511563012870106
Multiplication99215630128161231270309348417457495558620658698767837
and18651563012899168237
toxin21381563012876145216254324
production:249815630128107154223292363425464502573643681
C.32151562012894129
diphtheriaemultiplies337915620128106146216286325394457510550620682409815630128109177216256295365404443506559
at46931563012899138
the48661563012875146207
site51081563012892130170232
of537515630128107154
entry,8511805012862133172218289322
releasing12081805012846109148210273327367437506
exotoxin.17501805012862131202240311380420489525
3.8512046012870106
Necrotic99220460128146208270317387426465527
action155420460128108170209248317388
of197720460128114162
the21742046012884154216
toxin:24252046012885154224263333372
the28322046012884154217
exotoxin308420460128107179249288358428467537
causes365720460128107169239293356409
coagulative410220460128107177239309379418481519558628690
necrosis482720460128115178241286356410450504
of536620460128116162
epithelial8512287012862133172211280343381420483521
cells.14082287012862124162201255291
4.8512529012870106
Formation9912529012878149196305365404443513584
of16092529012870117
a17612529012862
fibrinous1859252901284685155202240310380449505
membrane:239925290128109169279347394457527590629
Increased8512771012847117180227289350405468537
vascular14222771012870133187249319358421467
permeability19232771012870133179289349411482521560599638708
→266427710128141
exudation28402771012862132203272335374413482553
of34272771012870117
fibrinogen.3579277101284785155202240310381450513582618
Under85130120128101171242304351
the12373012012838108170
action14423012012863125163202272343
of18183012012871118
tissue1971301201283877131186256319
thrombokinase,23253012012839108155224334402472543581652714768831866
fibrinogen3227301201284684154201239309380449512581
is3844301201283992
converted39723012012862131202271334381419481550
to45583012012839108
fibrin.4702301201284786155202240311346
Fibrin8513254012878117188234273343
impregnates12293254012857166234281344414484546584647702
the19663254012856125188
necrotized21893254012888150214261330369408470533602
tissue,2826325401285795149204274337372
forming32333254012863133180290326397468
a37363254012880
dense38513254012887149218274336
membrane424032540128109169278346393456526589
adherent48643254012880150220283329392461500
to54003254012855126
the8513495012839110172
mucous105934950128109176239309379434
membrane.152834950128110169280347395457527589624
Membrane85137370128125187296364411474544607
characteristics:14933737012876145208255317380418480527565619659697760813853
greyish-white,23813737012883130193263300355425474576645684722785820
dense,32363737012883146215270333368
removed36393737012860122231299369432502
with419137370128101138178247
difficulty,44733737012884124170217256318388426465536569
forcible50773737012861131178241279349388450
removal8513978012847109218286357420459
causes13453978012862125194249311365
mucosal174539780128110177240310364427466
bleeding.22453978012870110171234303342412482518
5.8514220012870106
Inflammatory9924220012846116164201264373482541581651698769
edema17944220012862132195304365
of21944220012871117
surrounding23474220012854125172219288358428498536607677
tissues,3059422001283977131185256319372408
most350142200128109177232272
pronounced38084220012870117187256327396466529591660
in45044220012839108
toxic46484220012839112182221283
forms.49674220012846115162271324359
Toxinemia8514461012878148211249320382484521592
and14774461012870139210
systemic17234461012853115170209271372410473
damage22314461012870139241311380443
11:27124461012869139186
The8514702012886155218
exotoxin11044702012863133202241311381420490
enters16304702012862131170232279333
the19994702012837107170
blood22044702012870108178249318
and25584702012862131201
lymph,27954702012837108217285355391
affecting32214702012862108155217280318357427498
various37534702012870132179217287357411
organs42004702012870117186248318373
and46094702012861131201
systems:48454702012855125178217280389442481
Cardiovascular8514945012894156203273311382452514568631700739801848
system:17344945012854125178217280388425
671521409146
Toxic8515186012886155226265327
myocarditis:123251860128109178247309372419489528568606660700
early19675186012881143189228299
(weeks23005186012865166228291361416
1-227515186012889139208
of29955186012889136
illness):3166518601285896135205268322376423462
parenchymal,36645186012887150197259328391460531639699738774
with447451860128120158198268
dystrophy47785186012889160212252299368438508579
of53905186012889136
cardiomyocytes;8515427012862125171242280351461529598661731768831886925
late18125427012839100139202
(weeks20495427012845147208271341395
4-6):24805427012871118187235273
interstitial,27885427012839108148211256311349389427466527566602
with342454270128102140180249
development37075427012871133204265304374444553613683723
of44665427012870117
cardiosclerosis.46185427012862124171240280349403466504567614683738776831867
671569609146
Clinically:8515668012894133172242280343405443483553591
tachycardia14775668012860123185254325386448495565603666
→220056680128140
bradycardia,23755668012891139200270341401464510581619682717
widening312756680128122161232294363402472542
of37055668012891137
heart38775668012892154217262301
borders,42145668012890161208277340387440476
muffled472556680128131199246293332395464
heart52245668012892154216262300
sounds,8515911012855125195265335389425
rhythm13115911012846116187224295404
and17485911012862133203
conduction19875911012862131202271341404443481551621
disturbances,26425911012871110164203273320389452521584645700735
heart34125911012870133194241280
failure.37285911012846109146185255303364399
671618009146
Vascular85161520128101163218281351389452499
damage:13846152012870132242302372435474
Increased18936152012847116179224287349404466536
permeability,24636152012870132179288348411481521560598637708741
capillary32396152012863125195234273312375421491
paresis37646152012870132179242295335389
→418861520128141
tissue4367615201283977131186256319
edema.47216152012862131194303363398
Nervous85163930128101163210280351420475
system:13616393012855125178217280389426
Toxic18236393012885155225264327
polyneuropathy:21856393012870139178248317379450497566637699737807878915
671666309146
Mechanism:85166350128125187249320382452490545655692
demyelination15786635012870133242311372411450521584623661731801
of24136635012871118
nerve25666635012870132178247310
fibers.2911663501284786155218265318353
671690509146
Periods8516877012878140187226296366420
of29616877012870117
development:47676877012870133202265304373443553613683722762
1.8517118012870106
Bulbar99271180128162232271341403450
(week147771180128116217279341412
3-4):192471180128139186256303341
paresis230171180128139202249310365403458
of279571180128138185
the301571180128108178241
soft329071180128124194241279
palate360571180128139202240303341403
(nasal404371180128116185248303365404
voice,448171180128140210249311374409
choking).492571180128131200271341380450519566602
2.8517359012870106
Accommodative122373590128101163225296405513581652715754793863926
(week24157359012847148210272341
4-5):30227359012870119189235274
paresis35637359012870132179241295334388
of42187359012870117
accommodation.46007359012862125187257367475543614676715755824894929