Diphtheria

What is diphtheria?

Diphtheria is an acute bacterial disease that can infect the throat, nose, or tonsils (respiratory and/or skin (skin or cutaneous diphtheria). A common childhood disease in the 1930s, a vaccine against diphtheria has made it very rare in the US and other developing countries today.

How is diphtheria transmitted?

The diphtheria bacterium can enter the body through the nose and mouth. However, it can also enter through a break in the skin. It is transmitted from person to person by breathing in respiratory secretions or droplets that contain diphtheria bacteria from an infected person coughing, sneezing, or laughing. After being exposed to the bacterium, it usually takes 2 to 4 days for symptoms to develop.

What are the symptoms of diphtheria?

The following are the most common symptoms of diphtheria. However, each individual may experience symptoms differently. Symptoms may include:

• respiratory diphtheria
  When a person is infected with diphtheria, the bacterium usually multiplies in the throat, leading to the respiratory version of diphtheria. A membrane may form over the throat and tonsils, causing a sore throat. Other common symptoms of respiratory diphtheria may include:
  • breathing difficulty
  • husky voice
  • enlarged lymph glands
  • increased heart rate
  • stridor (a shrill breathing sound heard on inspiration)
  • nasal drainage
  • swelling of the palate (roof of the mouth)
  • sore throat
  • low-grade fever
  • malaise

  Persons may die from asphyxiation when the membrane obstructs breathing. Other complications of respiratory diphtheria are caused by the diphtheria toxin released in the blood, leading to heart failure.

• skin (cutaneous) diphtheria
  With this type of diphtheria, the symptoms are usually milder and may include yellow spots or sores (similar to impetigo) on the skin.

The symptoms of diphtheria may resemble other medical conditions. Always consult your physician for a diagnosis.

Treatment of diphtheria:

Specific treatment for diphtheria will be determined by your physician based on:

• your overall health and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Penicillin is usually effective in treating respiratory diphtheria before it releases toxins in the blood. An antitoxin can be given in combination with the penicillin, if diphtheria is suspected. Sometimes a tracheostomy (a breathing tube surgically inserted in the windpipe) is necessary if the patient has severe breathing difficulties.

Prevention of diphtheria:

Children in the US are routinely given a triple vaccine that includes diphtheria in their first year. Because diphtheria still prevails in underdeveloped countries, the vaccine remains necessary in case of exposure to a carrier visiting from abroad.

The Centers for Disease Control and Prevention recommends that children need five DTaP shots. A DTaP shot is a combination vaccine that protects against three diseases: diphtheria, tetanus, and pertussis. The first three shots are given at two, four, and six months of age. Between 15 and 18 months of age, the fourth shot is given, and a fifth shot when a child enters school at four to six years of age. At regular check-ups for 11 or 12 year olds, a pre-teen should get a dose of Tdap. The Tdap booster contains tetanus, diphtheria, and pertussis. If an adult did not get a Tdap as a pre-teen or teen, then he should get a dose of Tdap instead of the Td booster. Adults should get a Td booster every ten  years, but it can be given before the ten-year mark. Always consult your physician for advice.

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