Diphtheria




Introduction

Diphtheria (dif-THEER-e-uh) is a serious bacterial infection, usually affecting the mucous membranes of your nose and throat. The disease typically causes a bad sore throat, fever, swollen glands and weakness. But the hallmark sign is a thick, gray covering in the back of your throat that can make breathing difficult. Diphtheria can also infect your skin.

Years ago, diphtheria was a leading cause of death among children. Today, diphtheria is rare in the United States and other developed countries thanks to widespread vaccination against the disease.

Medications are available to treat diphtheria. However, in advanced stages, diphtheria can cause damage to your heart, kidneys and nervous system. Nearly one out of every 10 people who get diphtheria die of it.

Signs and Symptoms

Signs and symptoms of diphtheria may include:
  • A sore throat and hoarseness
  • Painful swallowing
  • Swollen glands (enlarged lymph nodes) in your neck
  • A thick, gray membrane covering your throat and tonsils
  • Difficulty breathing or rapid breathing
  • Nasal discharge
  • Fever and chills
  • Malaise
Signs and symptoms usually begin two to five days after a person becomes infected, but they may take as many as 10 days to appear. You may mistake diphtheria in its initial stages for a bad viral sore throat. Other early symptoms include a mild fever and swollen glands in the neck — signs and symptoms of other, much more common types of infection such as strep throat or mononucleosis.



The bacterium that causes diphtheria attacks mucous membranes that line the nose and throat and cover the tonsils. The throat becomes inflamed. The inflammation may spread to the voice box (larynx) and may make your throat swell, narrowing your airway.

A hallmark sign
The bacteria may produce a toxin that can lead to a thick, gray covering in your nose, throat or airway — a marker of diphtheria that separates it from other respiratory illnesses. This covering is usually fuzzy gray or black and causes breathing difficulties and painful swallowing.

In more advanced stages, a person with diphtheria may have severe difficulty breathing and may show signs of respiratory distress such as rapid breathing, a rapid heartbeat and cold, clammy skin.

Some people become infected with diphtheria-causing bacteria, but they develop only a mild case of the illness and show no signs or symptoms of the disease. They're said to be carriers of the disease, because they may be contagious without showing signs or symptoms of illness.

Skin (cutaneous) diphtheria
Diphtheria occurs in two types. One type involves the mucous membranes of your nose and throat, and the other involves the skin. A wound infected with bacteria is typically red, painful and swollen. A wound infected with diphtheria-causing bacteria also may have patches of a sticky, gray material.

Although it's more common in tropical climates, cutaneous diphtheria also occurs in the United States, particularly among people with poor hygiene who live in crowded conditions.

In rare instances, diphtheria affects the eye.

Causes

The bacterium Corynebacterium diphtheriae causes diphtheria. Usually the bacteria multiply on or near the surface of the mucous membranes of the throat, where they cause inflammation. Some types of C. diphtheriae release a toxin, a poison, which can damage the heart, the brain and the nerves.

You contract diphtheria by inhaling airborne droplets exhaled by a person with the disease or by a carrier who has no symptoms. Diphtheria passes from an infected person to others through:
  • Sneezing and coughing, especially in crowded living conditions (easily)
  • Contaminated personal items, such as tissues or drinking glasses that have been used by an infected person (occasionally)
  • Contaminated household items, such as towels or toys (rarely)
You can also come in contact with diphtheria-causing bacteria by touching an infected wound.

People who have been infected by the diphtheria bacteria and who haven't been treated can infect nonimmunized people for up to six weeks — even if they don't show any symptoms.



Treatment

Diphtheria is a serious illness. Doctors treat it immediately and aggressively with these medications:
  • An antitoxin. After doctors confirm that a person has diphtheria, the infected child or adult receives a special antitoxin. The antitoxin neutralizes the diphtheria toxin already circulating in your body. The antitoxin is injected into a vein (intravenously) or into a muscle (intramuscular injection). But first, doctors may perform skin allergy tests to make sure that the infected person doesn't have an allergy to the antitoxin. Persons who are allergic must first be desensitized to the antitoxin. Doctors accomplish this by initially giving small doses of the antitoxin and then gradually increasing the dosage.
  • Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious.
Children and adults who have diphtheria often need to be in the hospital for treatment. They may be isolated in an intensive care unit because diphtheria can spread easily to anyone not immunized against the disease.

Doctors may remove some of the thick, gray covering in the throat if the covering is obstructing breathing.

There may be other complications of diphtheria that need treatment. Inflammation of the heart (myocarditis) is treated with medications. In advanced cases, a person with diphtheria may need the assistance of a machine that helps them breathe (ventilator) until the infection is successfully treated.

Preventive treatments
If you've been exposed to a person infected with diphtheria, see a doctor for testing and possible treatment. Your doctor may give you a prescription for antibiotics to help prevent you from getting the infection. You may also need a booster dose of the diphtheria vaccine.

Doctors treat people who are found to be carriers of diphtheria with antibiotics to clear their systems of the bacteria, as well.

Prevention

Before antibiotics were available, diphtheria was a common illness in young children. Today, the disease is not only treatable but also preventable with a vaccine.

The diphtheria vaccine is usually combined with vaccines for tetanus and whooping cough (pertussis). Tetanus is a bacterial infection that leads to stiffness of the jaw and other muscles. Whooping cough is a bacterial infection of the respiratory tract. The three-in-one vaccine is known as the diphtheria, tetanus and pertussis, or DTP, vaccine. The latest version of this immunization is known as the DTaP vaccine.

The diphtheria, tetanus and pertussis vaccine is one of the childhood immunizations that doctors in the United States recommend begin during infancy. The vaccine consists of a series of five shots, typically administered in the arm or thigh, and is given to children at ages:
  • 2 months
  • 4 months
  • 6 months
  • 15 to 18 months
  • 4 to 6 years
The diphtheria vaccine is very effective at preventing diphtheria. But there may be some side effects. Some children may experience a mild fever, fussiness, drowsiness or tenderness at the site of the injection after a diphtheria, tetanus and pertussis shot. Ask your doctor what you can do for your child to minimize or relieve these effects.

Rarely, the diphtheria, tetanus and pertussis vaccine causes serious complications in a child, such as an allergic reaction (hives or a rash develops within minutes of the injection), seizures or shock — complications which are treatable.

Some children — such as those with progressive brain disorders — may not be candidates for the diphtheria, tetanus and pertussis vaccine. But, the number of children to whom these restrictions apply is small.

You can't get diphtheria from the vaccine.

Booster shots
After the initial series of immunizations in childhood, booster shots of the diphtheria vaccine are needed to help you maintain immunity. That's because immunity to diphtheria fades with time.

The first booster shot is needed around age 12, and then every 10 years after that — especially if you travel to an area where diphtheria is common. Ask your doctor whether you're up-to-date on your immunizations. Be sure your child is as up-to-date as possible on childhood vaccinations before starting child care or school.

A booster shot of the diphtheria vaccine is given in combination with a booster shot of the tetanus vaccine. The tetanus-diphtheria (Td) vaccine is given by injection, usually into the arm or thigh.

Doctors recommend that anyone older than age of 7 who has never been vaccinated against diphtheria receive three doses of the Td vaccine.

Informations obtained from National Institute of Health.
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