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Diphtheria
Respiratory diphtheria; Pharyngeal diphtheria; Diphtheric cardiomyopathy; Diphtheric polyneuropathy
Diphtheria is an acute infection caused by the bacteria Corynebacterium diphtheriae .
Acute
Acute means sudden or severe. Acute symptoms appear, change, or worsen rapidly. It is the opposite of chronic.
Causes
The bacteria that cause diphtheria spread through respiratory droplets (such as from a cough or sneeze) of an infected person or someone who carries the bacteria but has no symptoms.
The bacteria most commonly infects your nose and throat. The throat infection causes a gray to black, tough, fiber-like covering, which can block your airways. In some cases, diphtheria infects your skin first and causes skin lesions .
Skin lesions
Rashes involve changes in the color, feeling or texture of your skin.
Once you are infected, the bacteria make dangerous substances called toxins. The toxins spread through your bloodstream to other organs, such as the heart and brain, and cause damage.
Because of widespread vaccination (immunization) of children, diphtheria is now rare in many parts of the world.
Risk factors for diphtheria include crowded environments, poor hygiene, and lack of immunization.
Symptoms
Symptoms usually occur 1 to 7 days after the bacteria enter your body:
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Fever
and chills
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Sore throat,
hoarseness
Hoarseness
Hoarseness refers to a difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or qualit...
ImageRead Article Now Book Mark Article - Painful swallowing
- Croup-like (barking) cough
- Drooling (suggests airway blockage is about to occur)
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Bluish coloration of the skin
Bluish coloration of the skin
Cyanosis is a bluish color to the skin or mucous membrane that is usually due to a lack of oxygen in the blood.
ImageRead Article Now Book Mark Article - Bloody, watery drainage from nose
- Breathing problems, including difficulty breathing, fast breathing, high-pitched breathing sound (stridor)
- Skin sores (usually seen in tropical areas)
Sometimes there are no symptoms.
Exams and Tests
The health care provider will perform a physical exam and look inside your mouth. This may reveal a gray to black covering (pseudomembrane) in the throat, enlarged lymph glands , and swelling of the neck or vocal cords.
Enlarged lymph glands
Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...
Tests used may include:
-
Gram stain or
throat culture
to identify the diphtheria bacteria
Throat culture
A throat swab culture is a laboratory test that is done to identify germs that may cause infection in the throat. It is most often used to diagnose ...
ImageRead Article Now Book Mark Article - Toxin assay (to detect the presence of the toxin made by the bacteria)
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Electrocardiogram (
ECG
)
ECG
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Treatment
If the provider thinks you have diphtheria, treatment will likely be started right away, even before test results come back.
Diphtheria antitoxin is given as a shot into a muscle or through an IV (intravenous line). The infection is then treated with antibiotics, such as penicillin and erythromycin.
You may need to stay in the hospital while getting the antitoxin. Other treatments may include:
- Fluids by IV
- Oxygen
- Bed rest
- Heart monitoring
- Insertion of a breathing tube
- Correction of airway blockages
People without symptoms who carry diphtheria should be treated with antibiotics.
Outlook (Prognosis)
Diphtheria may be mild or severe. Some people do not have symptoms. In others, the disease can slowly get worse. Recovery from the illness is slow.
People may die, especially when the disease affects the heart.
Possible Complications
The most common complication is inflammation of the heart muscle ( myocarditis ). The nervous system is also frequently and severely affected, which may result in temporary paralysis .
Myocarditis
Myocarditis is inflammation of the heart muscle. The condition is called pediatric myocarditis when it occurs in children.
Paralysis
Muscle function loss is when a muscle does not work or move normally. The medical term for complete loss of muscle function is paralysis.
The diphtheria toxin can also damage the kidneys.
There can also be an allergic response to the antitoxin.
When to Contact a Medical Professional
Contact your provider right away if you have come in contact with a person who has diphtheria.
Diphtheria is a rare disease. It is also a reportable disease , and any cases are often publicized in the newspaper or on television. This helps you to know if diphtheria is present in your area.
Reportable disease
Reportable diseases are diseases considered to be of great public health importance. Local, state, and national agencies (for example, county and st...
Prevention
Routine childhood immunizations and adult boosters prevent the disease.
Anyone who has come into contact with an infected person should get an immunization or booster shot against diphtheria, if they have not already received it. Protection from the vaccine lasts only 10 years. So it is important for adults to get a booster vaccine every 10 years. The booster is called tetanus-diphtheria ( Td ). (The shot also has vaccine medicine for an infection called tetanus .)
Immunization
All content below is taken in its entirety from the CDC Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine Information Statement (VIS): www. cdc. gov/...
Td
All content below is taken in its entirety from the CDC Td Vaccine Information Statement (VIS): www. cdc. gov/vaccines/hcp/vis/vis-statements/td. pdf...
Tetanus
Tetanus is an infection of the nervous system with a type of bacteria that is potentially deadly, called Clostridium tetani (C tetani).
If you have been in close contact with a person who has diphtheria, contact your provider right away. Ask whether you need antibiotics to prevent getting diphtheria.
References
MacGregor RR. Corynebacterium diphtheriae. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 206.
Stechenberg BW. Diphtheria. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases . 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 90.
Tiwari TSP, Wharton M. Diphtheria toxoid. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines . 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 12.
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Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
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Antibodies - illustration
Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.
Antibodies
illustration
Review Date: 12/10/2015
Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
