303
67162509146
Mechanism8515990126133194257335405484521576694
of1578599012674121
action:1734599012673136183221291369416
The2186596012886155218
exotoxin2439596012866136206245315384424494
consists2968596012866136205259298353391446
of3450596012872119
two3604596012843145214
fragments:385459601285096159228338398468507562601
B4494596012893
(binding)4622596012850120160230299339408478525
and5182596012866136206
A54265960128102
(active).851839012847109171210249320381428463
Fragment1349839012896143205274384444514553
B19388390128111
binds2083839012888127197266322
to2439839012857126
specific2601839012871141204265304352390452
receptors3088839012864126187249320358429476530
on3653839012887156
the3845839012856126189
membrane40878390128109169279347394457527590
of4712839012886134
target4881839012855118165234296334
cells5251839012880142180218273
(cardiomyocytes,8511080012847109171218288327397506575644706778815878932968
cells18541080012892154193231286
of217610800128100146
nervous235710800128100163209278349419473
tissue,28651080012869108162218287350385
kidneys).328410800128100139210279342412465512547
This386710800128115184224278
facilitates41801080012877139201240279317357420458520574
the47891080012869139201
entry50261080012891162200247318
of537710800128100147
fragment851132101284794156226336396466506
A139513210128102
into15311321012842112151221
the17881321012841111173
cell.19961321012866127166206241
Inside22721321012850119173212282345
the26521321012841111173
cell,28601321012866128166206241
fragment3136132101285096158228338398468507
A368213210128102
catalyzes38181321012866128167229268338399461516
the43701321012842111174
process45791321012872120190252314369423
ofADPribosylation503713210128721205197132401261012022878511565012662101180249304373413483530568639716
of16021565012675122
elongation17591565012666105174253322393440478547626
factor24201565012651120183230299361
228161565012674
(EF-2)29251565012652145231280349396
,33211563012835
which339515630128102171210273343
is3773156301284397
necessary39051563012875137199261315370433478547
for44861563012851121168
translation4689156301284491153223278317379418456527597
and53211563012867136206
protein8511805012870117188226289327396
synthesis.12831805012873144212252321384439477531567
Blocking188518050128112151220283352392461532
EF-2245318050128104182231300
leads27881805012857120182251306
to31291805012857128
the32911805012858129191
cessation35181805012880142197251313351391460530
of40841805012889136
protein42551805012888135204242305344414
synthesis47041805012873143212251322384438476531
and,52711805012881150220255
consequently,8512046012862133202257320389459521591630668739772
to16582046012839110
cell18032046012862125164202
death.20392046012870133195233304339
3.8512292012670106
Immediate9922292012654171287347425464535582644
specific16712292012655133196258296343381443
treatment:21492292012647109172242289406467545591638
671255709146
The8512529012886155218
patient110425290128124187226264327396435
urgently157425290128124171241303373412451521
needs,212825290128125188250320376411
without257325290128156194233303373443482
waiting309025290128156217259299337407477
for360225290128102171218
laboratory38552529012893155224295342403442512559628
confirmation,451725290128117187258305344390499559598638708779814
to53652529012893162
receivediphtheria851277101284710917123427334340512912773012678116194272319397460521560629
antitoxin19562773012670147194233280349420458537
serum25282773012655116178256373
(DAT)29352773012646148248342389
.33262771012835
671304109146
Justification:8513015012670149203249288336373436505552592661740786
The16733012012886154217
serum19253012012883146191262371
neutralizes232930120128100163233272319381420458521584637
the30023012012867137199
exotoxin32363012012891161231270340411449519
circulating37903012012892130177240309348410449488558628
in44533012012868138
the46263012012869138201
blood.48623012012899137208277347382
The528030120128115184246
effectiveness8513254012862109156218281319358428490559622677731
of16173254012895142
treatment17943254012864111173235273382443513553
directly23823254012895134181243306344383454
depends28693254012895158228290360430485
on33893254012894165
the35893254012863133196
timing38203254012863102212249319389
of42443254012895142
administration:44223254012885156265302373412466506553615653692762832870
the53283254012864133196
earlier8513495012862125171210249312359
the12453495012841110173
serum14533495012857120166236346
is1832349501284297
given,19643495012873112182244313349
the23483495012842112174
less25563495012843105159213
toxin28043495012841112182221291
will313334950128102139177217
have33843495012874137206269
time3686349501284381191251
to39723495012842113
bind41203495012872111182251
to44073495012841110
target45533495012841104150219282321
organ49093495012873119190251322
cells52653495012866128166205259
and8513737012862133202
cause10893737012886148217272335
irreversible14593737012861109155218287350396450488559597659
damage21533737012894157266326396459
(to26473737012871110179
the28623737012862132195
myocardium,309237370128133202270333395442512552621731764
nerves,38913737012893156203273336391426
kidneys).43523737012893131202271334404457504539
Treatment492737370128109155217279319428488558598
begins8513978012870133202241311366
upon125339780128110180250320
clinical160939780128103141181250289352414452
suspicion20963978012896166220291329392430500570
of270239780128110158
diphtheria,289539780128110150219289328398461508546608643
as357339780128104159
delay376739780128111174212274345
is41453978012881136
fatal.43163978012888150189251289325
The467639780128127197259
serum49703978012896158205274384
is53863978012881136
administered8514220012862133242279350389443483545592653723
using16094220012870125163233304
the19484220012838108170
Bezredka21534220012894156218265329398469530
method271942200128109168208278349419
to31744220012837108
prevent33174220012870116179248311381420
anaphylactic37724220012862131194263334404442504567606644707
shock.45134220012854125195257327362
4.8514466012670106
Laboratory9914466012694164243312374443491560622693
diagnostics:17194466012678116185256335403458506544606660707
671473009146
Bacteriological8514704012694164227273336397436506545615684724786856894
method178147040126164225272350420499
("gold23154704012694172242312350429
standard"):277947040126102149218297375444506584662708755
Culture35714702012894163202241311358420
of402647020128117165
material422647020128157216257319366404467506
on476747020128117188
selective499047020128102164203266327366405475537
media85149450128109170241280343
(e.g.,12294945012864127162231266301
Clauberg's156549450128111150212282351414461530556610
medium).222849450128110170240279349459503538
The280149450128103173236
material309149450128109170209272319356419457
is35844945012856110
taken37304945012856118188250320
with408649450128119156196265
a43874945012878
sterile45014945012872111173220259297360
swab48964945012871173235305
from52364945012864111180289
under8515186012870141210273320
the12065186012842113175
membrane,142051860128109169280348395457527590625
from2080518601285198168278
the23915186012843114176
border26025186012875146196265328373
of30105186012875122
healthy31675186012874135198237275346416
and36175186012866137207
affected38605186012867113159221284322384455
tissue,4350518601284382136191261324359
and47445186012866135206
also49855186012867105160230
from5250518601285198167277
the8515427012839110172
nose.10595427012886156211274309
After140354270128118165203265312
isolating17505427012857111181220283321359430499
a22855427012880
pure24005427012888157205266
culture27015427012880150189228298345407
ofC.3143542701288713433145427012894129
diphtheriae34785427012887127196267305375438493531601663
,41425427012835
a42125427012880
mandatory434554270128109170240310372412481528599
step49775427012872112174243
is52565427012857111
to54025427012857126
determine8515668012870133172234281390426497560
its1446566801284382136
toxigenicity16175668012844113183222292355424462525564603673
(using23245668012851121176214284355
gel27145668012874136174
precipitation29245668012873120183245283353392431494531571641710
reaction36705668012851113175237276314385455
or41605668012874121
PCR43195668012878170264
for46185668012851121168
the48215668012843113175
presence50305668012875122183238301370433495
of8515911012870117
the10035911012840109172
toxgene).1209591001283911017314155911012870133202265312347
671618009146
Molecular85161540126133202242304366444483552615
biological15036154012678116187225295365404467536576
method211661540126117178224302373451
(PCR):26026154012649135236336383429
Allows306761520128101140179250352406
rapid35086152012849111180219290
detection38336152012871134172234297335374444513
(within43826152012849149187227296336405
a48236152012864
few49226152012849111213
hours)51696152012871142212259312359
of8516393012870117
the10036393012840109172
pathogen's12086393012871133172242312382444514540593
DNA183763930128101202303
and21746393012862133203
the24136393012837108171
toxin26196393012837108178216287
gene29406393012870133202265
directly32386393012870110157218281320358429
in37006393012839109
the38456393012839108171
clinical40516393012862100140209249310373412
sample.44976393012855117227295334397432
671666309146
Serological8516637012678140203273311382452490553622661
method155466370126117177224302372451
(RPHA,20406637012651152238346448482
ELISA):25626637012694188242321422468515
Examination31146635012886155217328364435498535575645715
of38656635012874121
paired40226635012875137176223285355
blood44126635012875113184254323
sera47706635012860123170231
to50376635012845114
detect51876635012876138176239301339
an8516877012862133
increase10196877012847118180226289351405467
in15226877012847117
the16746877012848118180
titer1889687701284787125188234
of21586877012879126
antitoxic23206877012870140179218257326397435498
antibodies.28536877012870141179219288358428470533587623
It3511687701285594
has36406877012879141195
retrospective38706877012856119156204273328397460522560599669731
significance46366877012863102172242281328366429491560623686
for53556877012856127173
confirming8517118012862133202249288336445481552622
the15087118012839108171
diagnosis.17147118012871109171241311381436474529565
5.8517364012670106
Assessment99173640126102156211273327381498559637684
of17107364012670117
vaccination18627364012670140203264303381450497536606685
status25827364012654100170218295349
and29657364012670149227
further32277364012646123186232310373435
tactics:36977364012647116178225263326381427