Diphtheria

1 What is Diphtheria?

Diphtheria is a serious bacterial infection that mostly affects the mucous linings of the nose and throat.

Signs and symptoms include:

The hallmark sign of diphtheria is a sheet of thick, grey material covering the back of the throat. This material can block the airway leading to trouble breathing.

Diphtheria is rare in the United States and other developing countries due to wide spread vaccination against the disease. Medications are available for the treatment of diphtheria. In advanced cases diphtheria can affect other organs, such as:

  • The heart
  • Kidneys and
  • Nervous system

Diphtheria is a deadly disease with a death rate of up to 3 percent despite treatment. Te rate is higher for children younger than 15.

2 Symptoms

Some people with diphtheria may only experience a mild illness or no obvious signs and symptoms at all. People who are unaware of having diphtheria are known as carriers. These individuals can spread the infection without being sick themselves.

The signs and symptoms of diphtheria usually begin two to five days after infection has occurred. They may include:

  • A thick, gray membrane covering the back of the throat and tonsils
  • A sore throat and hoarseness
  • Enlarged lymph nodes of the neck
  • Difficulty breathing or rapid breathing
  • Nasal discharge
  • Fever and chills
  • Malaise Another type of diphtheria known as skin or cutaneous diphtheria affects the skin and can cause pain, redness and swelling of the skin. Ulcers covered by a gray membrane may also develop in this disease.

Cutaneous diphtheria tends to occur mostly among people with poor hygiene living in crowded conditions.

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3 Causes

Diphtheria is caused by a bacteria known as Corynebacterium diphtheriae. This bacteria can be bread via air borne droplets, such as an infected person's sneeze or cough, contaminated personal items and contaminated household items.

Touching an infected wound can also lead to diphtheria. Once the bacteria is on or near the surface of the mucous membranes on the throat it begins to multiply. Infected people who haven't been treated can infect nonimmunized people for up to six weeks, even if they don't show any signs and symptoms.

4 Making a Diagnosis

Diphtheria is usually diagnosed by inspection of the mucous membranes of the throat. A thick, gray membrane on the back of the throat is indicative of diphtheria.

Lab tests are required to confirm the diagnosis. Doctors may notify the lab that they suspect diphtheria because special media are needed for the growth of C. diphtheriae cultures.

Samples from an infected wound can be taken if doctors suspect cutaneous diphtheria. If a doctor suspects diphtheria, treatment begins immediately, even before the results of the bacterial tests are available.

5 Treatment

Treatments for diptheria include:

  • Diphtheria anatoxin which helps to neutralize the diphtheria toxin already circulating in the body. An allergy test is usually performed before this anatoxin is injected. People who are allergic to this anatoxin must first be desensitized. This can be done by giving small doses of the anatoxin and then gradually increasing the dose.
  • Antibiotics, such as penicillin and erythromycin which kill bacteria and help to clear up infection. Antibiotics reduce the period of time a person with diphtheria is contagious to just a few days.
  • Removing the thick, gray membrane lining the throat if the airway is obstructed. People with diphtheria usually need to be in a hospital for treatment. They may also be placed in isolated wards to prevent the spread of diphtheria to other people, especially those who are not immunized.

6 Prevention

Diphtheria can be prevented by administering a diphtheria vaccine to people who are not immunized. This vaccine is usually given in combination with vaccines for tetanus and whooping cough (pertussis), known as the diphtheria, tetanus and pertussis vaccine. The latest version of this vaccine is known as the DTaP vaccine for children and the DTap vaccine for adolescents and adults.

The diphtheria vaccine for children is one of the childhood immunizations that are recommended during infancy. Vaccinations consist of a series of five shots, typically administered in the arm or thigh at the ages of:

  • 2 months
  • 4 months
  • 6 months
  • 12 to 18 months
  • 4 to 6 years

Some side effects of diphtheria vaccine include:

  • Fever
  • Fussiness
  • Drowsiness and
  • Tenderness at the site of injection

In rare cases this vaccine may cause treatable complications, such as:

  • Allergic reactions
  • Seizures or shock

Children with certain conditions, such as epilepsy or other nervous system disorders shouldn't be given this vaccine. Because immunity to diphtheria fades with time, several booster shots are required after the initial immunizations in childhood. Children need their first booster shot at the age of 12. The next booster shot is recommended 10 years later, then repeated at 10-year intervals.

Booster shots are important particularly for people travelling to endemic regions. The diphtheria booster is combine with the tetanus booster in one vaccine making the tetanus-diphtheria (Td) vaccine.

Anyone who is older than 7 who has never been vaccinated against diphtheria should receive three doses of the Td vaccine. A one-time combined tetanus toxoid, reduced diphtheria and acellular pertusis (Tdap) vaccine is recommended for adolescents around the age of 12, anyone older who doesn't remember being vaccinated in the past or pregnant women regardless of previous vaccination status.

7 Lifestyle and Coping

There are different ways to adapt your lifestyle in coping with diphtheria.

The following can help patients with diphtheria to recover rapidly:

  • Taking enough bed rest for a few weeks or until full recovery
  • Avoiding any physical exertion especially if the heart is affected
  • Nutrition comprising mostly of liquids and soft foods because of pain and difficulty swallowing.

A full course of diphtheria vaccine is recommended after full recovery to prevent a recurrence.

8 Risks and Complications

People who are at a high risk of contracting diphtheria include:

  • People who don't have up-to-date immunizations
  • People living in crowded places with poor sanitary conditions
  • People traveling to places where diphtheria is endemic Complications associated with diphtheria include:
    • Breathing problems- due to the thick, gray membrane which may obstruct the airway
    • Heart damage, caused when the diphtheria toxin travels through the blood to damage heart muscle. This can cause severe heart damage which can lead to congestive heart failure and death.
    • Damage of nerves especially those of the throat. This can make swallowing difficult. Nerves of the arms can also be affected leading to muscle weakness and nerves supplying the respiratory muscles. Weakness of the respiratory muscles can make breathing impossible without the help of a respirator or any other device that can assist with breathing. Most people can survive these complications if proper treatment is provided although recovery can be a very slow process.
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