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A contagious bacterial disease that causes upper respiratory tract infection is diphtheria. This infection can lead to life-threatening consequences, if not treated early on. Today, there are vaccines available that can protect children from this dangerous disease.

What is Diphtheria?

Diphtheria is an acute, contagious disease that affects the nose, throat and trachea (windpipe). It spreads through direct contact or by breathing droplets containing the bacteria in the air after an infected person sneezes, coughs or talks. This disease was wide-spread long time ago, before the development of vaccines. It caused the deaths of many children who fell prey to the toxins secreted by the bacteria. It is one of the most successfully studied diseases affecting humans. Today, most children are vaccinated against this disease by the age of two months as a part of their regular vaccination program.

Cause of Diphtheria

Diphtheria is caused by a Gram-positive, facultative anaerobic bacteria called Cornynebacterim diphtheriae. This bacteria spreads through respiratory droplets of an infected person or a carrier of the bacteria. It can also spread by touching contaminated objects like doorknobs, toys, etc. or through infected unpasteurized milk. The bacteria produces a pseudomembrane that grows on the throat, nasal cavity as well as the pharynx. This increases the risk of suffocation in the infected person.

An infected person remains contagious for about 4 weeks, if no antibiotic treatment is received. At times, certain people carry the bacteria in their system longer and are known as carriers. The bacteria lives in the mouth, nose, throat and skin of these infected people or carriers. Thus, direct contact with these carriers can lead to the spread of the disease to susceptible individuals.

Who Are At Risk of Diphtheria Infection?

There are many factors that increase the risk of diphtheria infection. These factors include:

  • Those who are not vaccinated against the disease
  • Malnourished or people with a weak immune system
  • People who live in crowded, unsanitary environments
  • Those who are residents of an epidemic area

Symptoms of Diphtheria

On gaining entry into the body, the bacteria are very quick to grow in multiply. It starts killing the cells in the throat as well as nasal cavity, leading to the development of a gray-colored membrane. The signs and symptoms of diphtheria usually begin about 2 to 7 days of infection. Some of the symptoms include:

  • Sore throat
  • Low grade fever
  • Chills
  • Breathing difficulty
  • Stridor
  • Croup-like cough (barking cough)
  • Hoarseness
  • Pain when swallowing
  • Blue skin coloration
  • Headache
  • Nasal discharge that has a foul smell as well as blood stained

In a few cases, the neck becomes swollen to such an extent, that it is referred to as bull neck. This condition indicates severe infection and increase in the risk of death.

When diphtheria starts affecting the skin, it is called as cutaneous diphtheria. This leads to:

  • Formation of pus-filled lesions on skin, especially of the hands, legs and feet
  • The lesions develop into a large ulcer with a discolored gray skin patch
  • The lesion will heal in a few months, but leave a scar

Complications of Diphtheria

If left untreated, the infection can lead to many complications. Some of the complications include:

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  • The growth of abnormal membrane in throat increases the risk of suffocation as it affects breathing. Any attempt to cut the membrane will lead to bleeding.
  • The bacteria can spread to other organs through the blood and lead to inflammation of the heart (myocarditis) or congestive heart failure.
  • Cranial or peripheral nerve damage depending on the nerve affected.
  • Damage to the kidneys leading other complications.

Diagnosis of Diphtheria

Diagnosis is usually made on physical examination of the patient. Observation of a gray-colored membrane covering the throat and complains of a sore throat indicate diphtheria. Other than physical examination, the doctor may take throat, nose or skin lesion swab and isolate the bacteria in the lab for confirmation of Cornynebacterium diphtheriae.

Treatment for Diphtheria

The treatment for diphtheria begins immediately, even before the lab results are back. This is because this is an extremely high-risk infection. The patient is hospitalized and isolated to keep the infection from spreading. Antibiotics like metronidazole are given through an intravenous (IV) line or as an injection into the muscles. Other than that, the patient is given fluids through an IV and kept on oxygen. The patient may also require a breathing tube and correction of the airway to open up the blockages due to the abnormal membrane growth. Diphtheria antitoxins are given and the patient is advised at least 6 weeks or more of bed rest.

Prevention of Diphtheria

The best way to prevent diphtheria is vaccination. Other than that:

  • Wash hands with soap or disinfectant every time before eating, drinking or cooking food.
  • Maintain proper hygiene
  • Avoid sharing towels, napkins, clothes and other personal items.

Vaccination for Diphtheria

The diphtheria vaccine is a part of normal childhood vaccination program. One needs to be given about 5 doses of diphtheria vaccine. These vaccines are given in combination with other vaccines. These include polio, whooping cough, tetanus, Haemophilus influenzae type b (Hib) vaccine. A booster dose is recommended for children who are 3 to 4 months old. A final dose is to be given when children are about 13 to 18 years of age.

Diphtheria is a serious infection which should be prevented at all cost. Treatment is possible today, but it leads to many complications. Speak to your family physican, if you have any doubts regarding this infection.

Written by: Saptakee sengupta
Date last updated: February 4, 2015

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