What Is Diphtheria

What Is Diphtheria ?

Diphtheria is a bacterial infection caused by Corynebacterium diphtheria. This highly contagious disease affects the upper respiratory tract, and can be fatal in some cases.

  • Fever, sore throat, and a feeling of illness are the first symptoms. Lymph nodes may be swollen and a typical pseudo membrane can be seen in the throat.
  • Serious diphtheria disease mainly occurs in children, but it has become rare in developed countries.
  • The typical symptoms, especially the pseudo membrane and the inflammation in the throat, help diagnose the disease.
  • An infected child is admitted in the hospital and treated in isolation until the infection is completely eliminated.
  • Infection of the diphtheria bacteria can be prevented by vaccination.

Diphtheria used to be one of the major causes of childhood mortality in the past. Vaccination against the disease has been very effective, and diphtheria has become a rare occurrence among children in the developed countries like the US, where less than 5 cases are reported in a year. However, the bacteria causing diphtheria have not been completely wiped out, and if vaccinations are not continued, an outbreak of this highly contagious disease can occur anytime.

The diphtheria bacteria are present in the mouth as well as the throat of the infected person. They are spread into the surrounding air through coughing. These bacteria named Corynebacterium diphtheriae can multiply in the mouth, usually on the mucous membranes lining the mouth and the throat, causing inflammation and sore throat. Some types produce a toxin that can affect the nervous system, the heart, and the kidneys, and cause severe damage. Another type of diphtheria, mainly occurring in adults with poor personal hygiene, affects the skin, but it is milder. It’s common among the poor and the homeless.

Symptoms and Diagnosis

One to four days after the child is exposed to the bacteria, the disease may begin with symptoms such as high fever and sore throat. Malaise, or a feeling of being ill, may be present. The temperature may be as high as 103° F (39.4° C), and the fever may be accompanied by headache and chills.  Nausea and vomiting may be present. Heart rate becomes fast, and the lymph nodes in the neck may become swollen and painful to touch. Inflammation in the throat may cause the narrowing of the airway, which results in severe breathing difficulty.

A typical characteristic of diphtheria is the formation of a tough membrane in the throat. This grayish skin is made up of remnants of the white blood cells and the bacteria among other substances, and is referred to as pseudo membrane. It may cover the tonsils as well as the throat, and makes the airway narrow. It can completely block the airway if it gets detached, suffocating the child. The diphtheria toxin can affect the nerves, particularly the nerves which control the muscles of the throat and the face causing difficulty in swallowing. Eye movements also can be affected. Arm and leg muscles may be affected too. If the toxin affects the cardiac muscles, a condition called myocarditis results, which may lead to abnormalities in the heart rhythm and heart failure. It can have a fatal outcome also.

When the doctor finds the pseudo membrane when examining a child with sore throat, diphtheria is suspected. If there are signs of paralysis of the muscles in the face or the throat, and the child had not received diphtheria vaccine, the diagnosis of diphtheria is given. A throat swab culture is done to confirm the diagnosis.

Prevention and Treatment

Routine vaccination against diphtheria is administered to children to prevent this disease. Usually, a combined vaccine called DPT against diphtheria, tetanus, and whooping cough or pertussis, is given.

When a child is diagnosed with diphtheria, immediate hospitalization is necessary. The child is admitted to the intensive care unit, and is isolated from other patients to prevent the spread of the disease. The treatment involves antibiotic therapy as well as the administration of antibodies or antitoxins which can neutralize the toxin produced by the diphtheria bacteria. Erythromycin and penicillin are the antibiotics usually given, and they are continued for 14 days to ensure that the bacteria are completely destroyed. After the completion of the antibiotic therapy, two mouth and throat samples are taken and cultured to confirm the absence of the bacteria before the child is released from isolation.

Watch this very interesting historical video about Diphtheria and why Vaccinaion is important:

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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