Diphtheria

What is diphtheria?

Diphtheria is an illness caused by infection with Corynebacterium diphtheriae bacteria. The bacteria infect and multiply in the airways, releasing a dangerous toxin that may cause damage to major organs of the body.

Diphtheria is a dangerous condition and can be fatal in about 5-10% of cases. ^{[1] [2] [3]} An effective vaccine against diphtheria has dramatically reduced infection and death rates from the disease since its introduction, making diphtheria a rare disease in many countries.

Causes

Diphtheria is caused by infection with Corynebacterium diphtheriae bacteria, which are spread via millions of tiny droplets, each containing many bacteria, that are sneezed or coughed into the air by an infected person. If a droplet enters your nose or mouth, you may then become infected with the bacteria.

The bacteria infect the airways and multiply there, forming a grey-colored membrane that grows from the tonsils to the throat, and sometimes reaches the nose. The bacteria also release a dangerous toxin.

Signs and symptoms

Some people show little or no symptoms after being infected. When diphtheria symptoms do show up, they usually begin 2-5 days after the infection, and can include:

• Fever and chills;
• Bluish skin color;
• Breathing difficulties;
• Barking cough;
• Drooling;
• Hoarseness;
• Swollen lymph nodes;
• Sore throat and painful swallowing;
• Runny nose, and;
• A grey-colored membrane at the back of the throat and tongue.

Cutaneous diphtheria

Diphtheria bacteria can also infect the skin, causing red, inflamed sores with patches of greyish skin around them. This condition, known as cutaneous diphtheria, is more common in warm, tropical climates.

Methods for diagnosis

Your doctor will make an initial diagnosis of diphtheria based on your symptoms. They will also take samples from your nose or throat (swab sample) and/or from any skin lesions you may have, and send the samples off for laboratory testing.

Types of treatment

Treatment of diphtheria needs to be immediate. Because the diphtheria toxin can cause damage quickly, treatment will often start before a final diagnosis is made.

Diphtheria antitoxin

If your doctor suspects diphtheria, you will be given a shot of antitoxin, a substance that can neutralize the diphtheria toxin and make it harmless.

Antibiotics

In order to treat the diphtheria bacteria, you will be given a course of antibiotics.

Supportive treatment

In order to help the body recuperate and keep it out of danger, you may receive supportive treatment that can include:

• Removal of the grey membrane from the throat;
• Intubation - insertion of a breathing tube to prevent blocking of the airways, and;
• Electrocardiography of the heart to detect any irregularities in heart function.

People suspected of having diphtheria are placed in isolation for a few weeks until there is no danger of them infecting other people.

Potential complications

The main complications of diphtheria are inflammation of the heart muscle (myocarditis) and the grey membrane in the throat growing and blocking the airways, both of which can be fatal. The diphtheria toxin can also cause brain damage.

Other complications of diphtheria can include:

• Inflammation of lungs (pneumonia);
• Kidney damage, and;
• Nerve damage, which may lead to paralysis.

Prognosis

Diphtheria can be a mild disease, but it can also turn severe. Death can occur in one in five of untreated cases and in up to one in 10 of treated cases. ^{[1] [2] [3]}

Prevention

Vaccination

There is an effective diphtheria vaccine. It is a part of the regular immunization schedule in many countries and is often given as part of the diphtheria, tetanus and acellular pertussis (DTaP) combined vaccine.

Adults over 50 years of age are encouraged to receive another dose to boost waning immunity to the disease.

Preventative antibiotics

People who have been exposed to a person infected with diphtheria may receive antibiotic treatment to prevent being infected themselves.

References

1. Diphtheria. Centers for Disease Control and Prevention. Accessed 25 July 2014 from link here
2. Anima H. Malay M. Santanu H. et al. (2008) A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID & BG Hospital of Kolkata. The Journal of Communicable Diseases 40:53–58.
3. Shetty N. Tang J.W. and Andrews J. (eds) (2009) Infectious disease: pathogenesis prevention and case studies (1st edition). London: Wiley-Blackwell.
4. Anima H. Malay M. Santanu H. et al. (2008). A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID & BG Hospital of Kolkata. The Journal of Communicable Diseases 40: 5358.
5. Better Health Channel Site Search. Accessed 24 July 2014 from link here
6. Choices N.H.S. (2013 December 19). Diphtheria - NHS Choices. Accessed 24 July 2014 from link here
7. Diagnosis and treatment of diphtheria. Accessed 24 July 2014 from link here
8. Diphtheria. Accessed 24 July 2014 from link here
9. Diphtheria - Blue Book - Department of Health Victoria Australia. instructional. Accessed 24 July 2014 from link here
10. Diphtheria - dip.pdf. Accessed 25 July 2014 from link here
11. Diphtheria: MedlinePlus Medical Encyclopedia. Accessed 24 July 2014 from link here
12. Nandini Shetty Julian W Tang Julie Andrews. (2009). Infectious Disease: Pathogenesis Prevention and Case Studies (1st ed.). Wiley-Blackwell.

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