白喉

原中文條目：https://zh.wikipedia.org/wiki/%E7%99%BD%E5%96%89

英文條目：https://en.wikipedia.org/wiki/Diphtheria

白喉（Diphtheria，來源於希臘語διφθερα（dipthera），意思是「隱藏的皮革」）是一種由白喉桿菌引起的急性呼吸道傳染病，多見於秋冬季。

臨床症狀為咽炎，低燒及黏附在扁桃體、咽部，或鼻上的黏膜（屬假黏膜）。另一種比較輕度的白喉只會病發於皮膚上。致病菌為白喉棒狀桿菌（Corynebacterium diphtheriae，兼厭氧性）^[1] 革蘭氏陽性細菌。但要注意的，雖然中文及英文上名稱相似，但病發於皮膚上的白喉（白喉棒狀桿菌）跟其中一款會引致暗瘡的類白喉（Diphtheroid）痤瘡丙酸桿菌是不同的。

白喉擁有極高的傳染性；它能透過直接身體接觸或呼吸帶菌者的氣體分泌物而散播。白喉曾是相當普遍的疾病。近年由於大力推行免疫注射，在發達國家已甚為少見。以美國為例，1980年至2004年總共只有57宗白喉病例。^[2]現時美國所有學童都必需接受白喉、百日咳、破傷風三合一疫苗注射。而成人方面，疫苗需要與促升劑量並用，因為隨著年齡的增長，疫苗的效力會逐漸下降。對於需要前往一些白喉病源未被根除的地區的人，三合一疫苗更被建議需要注射。白喉對化學殺菌劑抵抗力較弱，在60°C以上加熱十分鐘白喉菌便死亡。

Diphtheria is an infection(感染) caused by the bacterium(细菌)Corynebacterium diphtheriae.^[1] Signs and symptoms may vary from mild to severe.^[2] They usually start two to five days after exposure.^[1] Symptoms often come on fairly gradually beginning with a sore throat and fever(发热).^[2] In severe cases a grey or white patch develops in the throat.^[1][2] This can block the airway and create a barking cough as in croup(义膜性喉炎).^[2]The neck may swell in part due to large lymph nodes(淋巴結).^[1] A form of diphtheria that involves the skin, eyes, or genitals also exists.^[1][2]Complications may include myocarditis, inflammation of nerves(神经病 (神经系统疾病)), kidney problems(蛋白尿), and bleeding problems due to low blood platelets. Myocarditis may result in an abnormal heart rate(心律不整)and inflammation of the nerves may result in paralysis(瘫痪).^[1]

’’’白喉’’’是由一種稱為[[白喉棒狀桿菌]]的[[細菌]]造成的[[感染]]<ref name=CDC2012Pink/>。症狀可以從輕微到嚴重<ref name=WHO2006/>，且通常是於接觸到致病菌二到五天後開始出現症狀<ref name=CDC2012Pink/>。剛開始出現的症狀通常進展的較和緩，伴隨有喉嚨痛和[[發熱]]。而嚴重的病人其喉嚨會出現灰色或白色的斑塊<ref name=CDC2012Pink/><ref name=WHO2006/> ，這些斑塊可以阻塞呼吸道並且讓患者在咳嗽時產生如同狗吠一樣的叫聲，稱為[[義膜性喉炎]]<ref name=WHO2006/>。脖子會因為腫脹的[[淋巴結]]而部分腫大<ref name=CDC2012Pink/>。另外也有一種形式的白喉會感染皮膚、眼睛或是生殖器官<ref name=CDC2012Pink/><ref name=WHO2006/>。併發症包含有[[心肌炎]]、[[神經發炎]]、[[蛋白尿]]，還有因為[[血小板低下]]而造成的流血不止的狀況。心肌炎可能會導致[[心律不整]]，而神經發炎則可能導致[[癱瘓]]<ref name=CDC2012Pink/>。

Diphtheria is usually spread between people by direct contact or through the air.^[1][3] It may also be spread by contaminated objects. Some people carry the bacteria without having symptoms, but can still spread the disease to others. There are three main types of C. diphtheriae causing different severities of disease.^[1] The symptoms are due to a toxin(外毒素) produced by the bacteria. Diagnosis can often be made based on the appearance of the throat with confirmation by culture. Previous infection may not prevent against future infection.^[2]

白喉通常是經由直接接觸或是[[飛沫傳染]]<ref name=CDC2012Pink/><ref>{{cite book|last1=Kowalski|first1=Wladyslaw|title=Hospital airborne infection control|date=2012|publisher=CRC Press|location=Boca Raton, Florida|isbn=9781439821961|page=54|url=https://books.google.ca/books?id=rGS7fCcloBQC&pg=PA54}}</ref>。也可以經由受到汙染的物品而擴散出去。有些白喉帶原的人可能沒有症狀，但仍舊有能力傳播疾病給其他人。白喉桿菌有三種分型，分別能造成不同嚴重度的疾病。感染後的症狀通常是由細菌所製造的[[外毒素]]所引起的。觀察喉嚨的外觀並透過喉頭取樣[[培養]]可以幫助建立診斷。過去曾被感染過者未來仍舊有感染的機會<ref name=WHO2006>{{cite journal|title=Diphtheria vaccine|journal=Wkly Epidemiol Rec|date=Jan 20, 2006|volume=81|issue=3|pages=24–32|pmid=16671240|url=http://www.who.int/wer/2006/wer8103.pdf}}</ref>。

A vaccine(疫苗), known as diphtheria toxoid, is effective for prevention and available in a number of formulations. Three or four doses, given along with tetanus toxoid(破傷風疫苗) and acellular pertussis vaccine, are recommended during childhood. Further doses are recommended every ten years. Protection can be verified by measuring the antitoxin level in the blood. Treatment is with the antibiotic(抗细菌药) erythromycin(红霉素) orpenicillin G(青霉素). These antibiotics may also be used for prevention in those who have been exposed to the infection.^[1] A surgical procedure known as a tracheostomy(氣管切開術) is sometimes needed to open the airway in severe cases.^[2]

白喉[[疫苗]](即所謂的[[白喉類毒素]])，對於預防感染是相當有效的，並且以不同的配方製成<ref name=CDC2012Pink/>。白喉疫苗會和[[破傷風類毒素]]、[[百日咳死菌疫苗]]共同施打，在孩童時期施打約三或四劑<ref name=CDC2012Pink/>。每隔十年會再建議施打。施打後是否已具有免疫力會藉由抽血檢驗抗毒素抗體的量來確認<ref name=CDC2012Pink/>。治療包括使用[[抗生素]][[紅黴素]]和[[青黴素]]。對於那些已經暴露在感染源的人<ref name=CDC2012Pink/>，這些抗生素或許也能用來預防感染<ref name=CDC2012Pink/>。嚴重感染的病患有時也需要接受[[氣管切開術]]<ref name=WHO2006/>。

In 2013, 4,700 cases were officially reported, down from nearly 100,000 in 1980.^[4] It is believed, however, that about a million cases occurred per year before the 1980s.^[2] It currently occurs most often in Sub-Saharan Africa(撒哈拉以南非洲), India, and Indonesia.^[2][5] In 2013, it resulted in 3,300 deaths down from 8,000 deaths in 1990.^[6] In areas where it is still common, children are most affected. It is rare in the developed world(已開發國家) due to widespread vaccination(疫苗接種).^[2] In the United States 57 cases were reported between 1980 and 2004. Death occurs in between 5% and 10% of those affected. The disease was first described in the 5th century BC by Hippocrates(希波克拉底). The bacterium was discovered in 1882 by Edwin Klebs.^[1]

2013年官方正式報導有4,700個案例，相較於1980年將近100,000個案例已大幅下降<ref>{{cite web|title=Diphtheria|url=http://www.who.int/immunization/monitoring_surveillance/burden/diphtheria/en/|website=who.int|accessdate=27 March 2015|date=3 September 2014}}</ref> 。然而據傳在1980年代，每年仍舊有將近一百萬的病例產生。目前的案例大多發生在[[撒哈拉以南的非洲]]、印度和印尼<ref name=WHO2006/><ref>{{cite book|title=Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases|date=2014|publisher=Elsevier Health Sciences|isbn=9780323263733|page=2372|edition=8|url=https://books.google.ca/books?id=73pYBAAAQBAJ&pg=PA2372}}</ref>。在2013年，死亡人數已從1990年的8,000名減少至3,330名<ref name=GDB2013>{{cite journal|last1=GBD 2013 Mortality and Causes of Death|first1=Collaborators|title=Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=17 December 2014|pmid=25530442|doi=10.1016/S0140-6736(14)61682-2|pmc=4340604|volume=385|pages=117–71}}</ref>。在百喉流行的區域，主要感染者為孩童。因為廣泛的[[疫苗施打]]讓[[已開發國家]]中的白喉案例變得非常稀少 。在1980到2004年之間在美國只有57名案例被報導。被感染後死亡率大約在5%到10%之間。這種疾病早在西元五世紀就由[[希波克拉底]]所記載過。而白喉桿菌是在1882年由[[愛德恩·克雷伯]]發現<ref name=CDC2012Pink>{{cite book|last1=Atkinson|first1=William|title=Diphtheria Epidemiology and Prevention of Vaccine-Preventable Diseases|date=May 2012|publisher=Public Health Foundation|isbn=9780983263135|pages=215–230|edition=12|url=http://www.cdc.

gov/vaccines/pubs/pinkbook/dip.html}}</ref>。