A vaccine preventable infection

Identification & Definition

Diphtheria comes from the Greek word diphtheria, meaning leather hide. The naming becomes apparent once the disease takes hold. Once a serious threat to the lives of children, antitoxins and vaccinations have virtually diminished the risk of contracting Diphtheria in industrialized countries. About 4,000 cases are reported around the world each year, but many more cases are thought to go unreported.

History of Diphtheria

Diphtheria is an ancient disease, dating back as early as the 5th century. In the 1930s, diphtheria was among the top 3 causes of death in children up to age 15 in the United Kingdom. About one half of all people who contracted the infection died from it. The prevalence of diphtheria reduced dramatically in the industrialized world when the vaccine was routinely administered in the 1940s.

Signs & Symptoms of Diphtheria

The incubation period for this infection ranges from 1-10 days, but is typically about 2-5 days.

Diphtheria symptoms start out similar to the common cold or sore throat. These symptoms include:

  • Weakness
  • Fever
  • Sore throat
  • Swollen glands in the neck
  • Fever

Within two to three days, a thick, grayish membrane will appear on the back of the throat or nose, making it very difficult to breath. This membrane can build up on many wet, mucous membranes of the body, including:

  • Nasal tissues
  • Tonsils
  • Voice box
  • Throat

Transmission of Diphtheria

The diphtheria infection is caused by a bacteria, Corynebacterium diphtheria. Only strains of this bacteria infected by a specific virus carrying the genetic information for the toxin will cause sever infections. This infectious bacteria is usually spread from person to person through droplets from sneezing and coughing or touching an object that has the droplets on it. There have been very few cases of transmission through coming into contact will discharges from an infected person's skin lesions.

Complications of Diphtheria

The complications suffered from contracting diphtheria are caused by the toxin that the bacteria produces. When this toxin is absorbed into the bloodstream, it can affect organs and tissues far away from the actual site of the infection. Complications may include:

  • Blocking of airway
  • Skin lesions
  • Damage to the heart muscle (myocarditis - presented as abnormal cardiac rhythms)
  • Inflammation of nerves, which may cause nerve damage (polyneuropathy)
  • Paralysis
  • Lung infection (respiratory failure or pneumonia)
  • Death - about 1 in 10 people who get diphtheria will die from the infection or complications

Myocarditis may occur during the illness, but it is important to note that it can also occur weeks after the infection has been cleared up. Myocarditis is usually fatal if it occurs early in the illness.

Around the third week of illness, paralysis of the soft palate is usually seen. After the fifth week, paralysis of the eye muscles, limbs, and diaphragm can occur. If there is diaphragmatic paralysis, secondary pneumonia and respiratory failure may also be seen.

Recommended Control Measures for Diphtheria

The current method for treating a suspected case of diphtheria is to immediately start taking the specific antitoxin developed to combat the toxin produced by the bacteria, while also starting antibiotics to kill the diphtheria bacteria, and isolate the patient for 48 hours once the first doses have been taken. These treatments are started before the lab results come back testing the swabs taken from the suspected infectious patient. Thankfully, most people in developed countries do not experience treating the infection because they have been vaccinated with the four vaccinations combos that protect them from diphtheria. This illness is still common in tropical climates around the world, including Indonesia, Thailand, and Laos.