Learn about diphtheria, its symptoms, and prevention. Stay informed and protect yourself from this infectious disease with Meri Sehat.

Diphtheria

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Iqra Mazhar

Overview

Diphtheria is a serious infection caused by Corynebacterium diphtheria. This bacterium produces toxins that can cause heart failure, breathing difficulties, paralysis, and even death. Vaccination against diphtheria is necessary for children, adults, and infants.

Diphtheria usually spreads from one person to the other through respiratory droplets produced by coughing or sneezing. It can also spread through touch.&nbsp;&nbsp;

Diphtheria was a major cause of death in childhood, before the invention of vaccines across the world. Due to the successful vaccination programs in the USA, diphtheria is no more a cause of death in the USA and developed countries. But in other parts of the world, outbreaks of diphtheria are still occurring. According to the World Health Organization, many countries have reported about 16,000 cases of diphtheria, and there may likely be many more unregistered cases.

Diphtheria is a bacterial infection that usually affects the mucous membranes of the throat and nose at the start of the infection. Countries with limited health care and/or limited vaccination options still experience high rates of diphtheria.&nbsp;

However, diphtheria can be easily treated with medicines. In the advanced stages of the disease, diphtheria can damage the kidneys, nervous system, and heart. Even with treatment, diphtheria can be deadly, especially in children<a href="#">[4]</a>.

In Pakistan, the prevalence of diphtheria was 46.61% in 2018 and 76.01 % in 2019. However, in 2020, these cases were reduced by 89.89%<a href="#accordion">[3]</a>. 
&nbsp;

These include:

&nbsp;

<ul>
	<li>
	<h5>Respiratory Diphtheria</h5>
	</li>
</ul>

This type of diphtheria is the most common. In the beginning stages of the infection, the bacteria affects the respiratory system. At this point, the infected person exhibits symptoms of fever and weakness.&nbsp;

The bacterium produces a toxin that can kill the healthy tissues of the respiratory system. After 2-3 days, a grey coating appears on the nose or throat and if left untreated, can affect non-respiratory organs as well. 
&nbsp;

<ul>
	<li>
	<h5>Skin (Cutaneous) Diphtheria</h5>
	</li>
</ul>

This is a relatively rare type of diphtheria and can affect the skin of the patient, causing swelling, redness, and pain. The redness and skin infections are similar to that caused by other bacteria. The cutaneous manifestations due to diphtheria may be covered by a grey membrane.

It is important to mention that while cutaneous diphtheria is common in tropical climates, cases have been reported in the USA as well. People with poor hygiene and living in crowded conditions mostly suffer from this skin infection. 
&nbsp;

Signs And Symptoms

The bacteria primarily infect the respiratory system and other parts of the body which are involved in breathing and respiration. When bacteria penetrate or attach to the lining of the respiratory system, they cause<a href="#accordion">[1]</a>:&nbsp;

<ul>
	<li>Mild fever</li>
	<li>Weakness</li>
	<li>Sore throat</li>
	<li>Swollen neck glands</li>
</ul>

Other signs and symptoms of diphtheria appear after 2-5 days after the infection, which are as follows:&nbsp;&nbsp;

<ul>
	<li>Nasal discharge</li>
	<li>Hoarseness and a sore throat&nbsp;</li>
	<li>Rapid and difficult breathing&nbsp;</li>
	<li>Glands or lymph nodes in the neck swell up and are enlarged.&nbsp;&nbsp;</li>
	<li>A thick grey membrane covers the throat and tonsils.</li>
	<li>The bacteria causing diphtheria can also cause a skin infection, resulting in sores or ulcers but cutaneous involvement is rare.&nbsp;</li>
</ul>

In some cases, diphtheria causes a mild illness or may not have any obvious signs and symptoms. In such cases, people are unaware of an infection. These people are called carriers and can be a source of spread. 
&nbsp;

<h5>Time To See Your Doctor</h5>

Contact your physician immediately after the onset of symptoms. Please update your children and your vaccinations against diphtheria<a href="#accordion">[4]</a>. 
&nbsp;

Causes

Corynebacterium diphtheriae causes diphtheria. The bacterium multiplies on or near the surface of the skin or throat, and spreads through: 
&nbsp;

<ul>
	<li>Airborne Droplets.&nbsp;Tiny air-borne droplets are produced when an infected person sneezes or coughs. These drops may be inhaled by healthy people nearby. Hence, it can be easily spread in crowded areas. 
	&nbsp;</li>
	<li>Direct Contact With Contaminated People Or Other Related Items. People often get this infection&nbsp;by taking care of the infected person or handling their things, e.g., towels, tissues, and utensils. The germs can also infect the person who touches the ulcers due to diphtheria.&nbsp;</li>
</ul>

Diphtheria can spread silently and affects huge masses. Asymptomatic diphtheria patients can spread the infection to healthy people who are not vaccinated<a href="#accordion">[4]</a>. 
&nbsp;

Diagnosis

Diphtheria can be diagnosed by<a href="#accordion">[1][2]</a>:

<ul>
	<li>A&nbsp;physical exam&nbsp;to check for swollen lymph nodes.&nbsp;</li>
	<li>Signs and symptoms as mentioned earlier.&nbsp;</li>
	<li>Medical history (including traveling to areas prone to diphtheria outbreaks).&nbsp;&nbsp;</li>
	<li>A grey coating on the throat, tonsils, or skin will confirm the diphtheria.&nbsp;</li>
	<li>Histology of a piece of the affected part is also very helpful to confirm diphtheria.</li>
	<li>In the case of skin, diphtheria&nbsp;throat culture&nbsp;can be done to study the level (early, advanced) of disease. 
	&nbsp;</li>
</ul>

Treatment

Diphtheria is a serious condition. Hence, it is necessary to treat it quickly. In the first step, doctors check the airways. If airways are partially or completely blocked, a breathing tube is placed to keep the airways open in the throat until the inflammation is controlled or reduced.

The doctor may treat diphtheria with: 
&nbsp;

<ul>
	<li>Antitoxins to counteract the toxins produced by the bacterium. It is necessary to inform your doctor immediately about an <a href="https://merisehat.pk/disease/allergies">allergic</a> reaction to the antitoxin. Your physician will revise the administration dose i.e. start from a low dose and gradually increase the dose.</li>
	<li>Antibiotics e.g. erythromycin or penicillin are administered to help clear up the infection.</li>
</ul>

The infected person must be hospitalized to prevent the spread and often doctors can prescribe antibiotics for the attendants of the patient as well.

&nbsp;

Untreated, diphtheria can cause:

<ul>
	<li>Breathing Problems.&nbsp;The bacterium that causes diphtheria often produces toxins. These toxins damage tissues in the area of infection, usually in the nose and throat. At the site of the infection, the formation of a grey, tough membrane, consisting of dead bacteria, cells, and other substances can be seen. Breathing is obstructed due to this membrane.</li>
	<li>Heart Damage.&nbsp;The toxins produced by the bacterium spread to other areas of the body through the bloodstream. These toxins can damage healthy parts of the body. They can also damage <a href="https://merisehat.pk/disease/myocardial-infarction">heart muscles</a> and cause inflammation (myocarditis). In severe cases, it causes <a href="http://merisehat.pk/disease/congenital-heart-diseases">h</a><a href="https://merisehat.pk/disease/congenital-heart-diseases">eart failure</a> and death.</li>
	<li>Nerve Damage.&nbsp;These toxins can damage nerves. Typically, they target the nerves in the throat, which causes difficulty in swallowing due to poor nerve conduction. Other nerves in the legs and arms may also be weakened due to inflammation caused by the infection.&nbsp;Similarly, the diphtheria toxin can damage the nerves and cause paralysis of the breathing muscles. At that stage, the patient needs mechanical assistance to breathe. 
	&nbsp;</li>
</ul>

People with complications can often survive with proper medication. However, their recovery is often a slow process. The fatality rate of diphtheria is about 5-10% at any given time. Death rates are often higher in children below 5 years and adults older than 40<a href="#accordion">[4]</a>. 
&nbsp;

Recovery from diphtheria requires many lifestyle modifications and home remedies.

<ul>
	<li>A lot of bed rest is required for recovery. Physical exertion must be avoided particularly when the heart is affected by the infection. If the patient is suffering from pain and difficulty in swallowing, introduce a liquid and soft food diet e.g. soups.&nbsp;&nbsp;</li>
	<li>Strict isolation is recommended. It will prevent the spread of the infection and any outbreaks.&nbsp;</li>
	<li>All members of the patient&rsquo;s family should wash their hands regularly and with care using sufficient water and soap. This is a vital step in preventing the spread of infection.</li>
	<li>After complete recovery, a course of diphtheria vaccine is recommended to prevent a recurrence. Contrary to other infections, having diphtheria doesn&#39;t mean you have lifetime immunity. Any person can get diphtheria more than once if he/she is not fully vaccinated against it. 
	&nbsp;</li>
</ul>

Following people at a higher risk of being infected:&nbsp;&nbsp; 
&nbsp;

<ul>
	<li>Weak/low immunity e.g.,&nbsp;<a href="https://www.merisehat.pk/disease/aids" target="_blank">AIDS</a></li>
	<li>Travelling to an area that is under a diphtheria outbreak</li>
	<li>Visiting a country that doesn&rsquo;t provide immunizations</li>
	<li>People who are living in overcrowded areas or unsanitary conditions</li>
	<li>Children and adults without any immunization</li>
</ul>

Diphtheria has a rare occurrence in the United States and Western Europe due to regular vaccination. Unfortunately, it is still present in other parts of the world where vaccination is not done regularly<a href="#accordion">[4]</a>. 
&nbsp;

Diphtheria was a common illness in young children before antibiotics were available. However, today the disease is preventable with vaccination and can be easily treated with antibiotics.&nbsp;

The vaccines for diphtheria and whooping cough (pertussis) are combined with the vaccine for tetanus. This combined vaccine is known as tetanus, diphtheria, and pertussis vaccine. The latest vaccine is called the DTaP or vaccine for children, and the vaccine for adults is termed as Tdap vaccine.

The pertussis, diphtheria, and tetanus vaccine is recommended during infancy by doctors in the United States. Vaccination is primarily administered in the arm or thigh of the infant and consists of five shots. The vaccination is administered to children at the ages of: 
&nbsp;

<ul>
	<li>Two months</li>
	<li>Four months</li>
	<li>Six months</li>
	<li>Fifteen to eighteen months</li>
	<li>Four to six years 
	&nbsp;</li>
</ul>

Although this diphtheria vaccine is sufficient for prevention, children can experience some side effects e.g. drowsiness, mild fever, fussiness, or tenderness at the injection site. Consult and discuss with your doctor to find ways to manage these effects.&nbsp;Severe complications of the vaccine are rare. These include an allergic reaction (rash develops or hives within minutes of the injection).

Note: The DTaP&nbsp;vaccine is contraindicated in epileptic children or children suffering from any nervous system disorders.&nbsp;&nbsp; 
&nbsp;

<h5>Booster Shots</h5>

The immunity of the body against diphtheria decreases with time. Therefore, the initial series of child vaccination must be followed by booster shots, to help the body in maintaining immunity. The child who has been administered the vaccine before 7 years should receive a booster shot at 11 or 12 years. The next booster is to be repeated after 10 years.&nbsp;

Booster shots are also important if somebody is traveling to an area where diphtheria cases are common. A booster shot of diphtheria is also a combined vaccine, containing the tetanus booster (the tetanus-diphtheria (Td) vaccine).&nbsp;

Tdap is an alternative vaccine for adults between the ages of 11-18. One booster dose is also recommended during pregnancy.&nbsp;

Consult your physician about vaccines and booster shots if you&#39;re not sure about your vaccination status. The&nbsp;Tdap&nbsp;vaccine can be recommended as part of the&nbsp;Td&nbsp;series for children 7-10 years<a href="#accordion">[2][4]</a>. 
&nbsp;

Key Points

<ul>
	<li>Diphtheria is a priority notification disease in Pakistan, and any presenting cases must be reported to the Ministry of Health or concerned department for corresponding necessary arrangements to prevent an outbreak.</li>
	<li>Diphtheria is an infectious disease that can be spread among masses through tiny droplets from infected people.&nbsp;&nbsp;</li>
	<li>It mainly affects the respiratory system and skin.</li>
	<li>Its presentation ranges from mild to severe. Often, presenting with a sore throat and a thick grey lining in epithelial tissues of the nose and throat.</li>
	<li>Proper and updated vaccination can prevent diphtheria, and proper use of antibiotics can cure it without any harmful effect on the infected individual.&nbsp;&nbsp;</li>
	<li>Complete bed rest and a soft diet, composed of liquids and purees, can expedite the recovery process. Complete isolation of the patient is highly recommended to prevent transmission of infection. 
	&nbsp;</li>
</ul>