Diphtheria: Symptoms, Causes, Diagnosis, Risk factors, Treatment & Prevention

A serious bacterial infection, diphtheria (dif-THEER-e-uh) typically affects the mucous membranes of the throat and nose. Because of widespread vaccination against the disease, diphtheria is rare in the United States and other wealthy nations. Nonetheless, significant incidences of diphtheria are still seen in many countries with inadequate access to healthcare and immunization programs.

Medication is a treatment option for diphtheria. However, when diphtheria progresses, it can harm the kidneys, heart, and neurological system. Diphtheria can be deadly even with treatment, especially in children.

 Corynebacterium diphtheriae is the source of the highly infectious disease diphtheria. In addition to having severe breathing and swallowing problems, diphtheria patients may get skin sores. 

What is diphtheria?

A bacteria known as Corynebacterium diphtheriae is the source of the infectious disease diphtheria. The bacterium produces a toxin that builds up in your throat, making it difficult for you to breathe and swallow.

A person suffering from diphtheria in warmer climates may also have non-healing skin lesions that may become coated in gray tissue. 

Symptoms:

Signs and symptoms of diphtheria often appear two to five days after infection. Among the symptoms and indicators are:

• A substantial, gray membrane covering the tonsils and throat

• A sore throat and hoarseness

• Enlarged lymph nodes, or swollen glands, in the neck

• Breathing rapidly or difficultly

• Nasal discharge

• Chills and a fever

• Tiredness

Causes:

The bacteria Corynebacterium diphtheriae is the cause of diphtheria. Usually, the bacteria grow on or close to the skin's or throat's surface. C. diphtheriae spreads through:

Droplets in the air. People in the vicinity may breathe in C. diphtheriae when an infected individual sneezes or coughs and generates a mist of contaminated droplets. This is how diphtheria spreads quickly, particularly in crowded areas.
contaminated household or personal items. Diphtheria can occasionally be contracted by handling an infected person's objects, such as hand towels or used tissues, which may be contaminated with the bacterium.

Bacteria that cause diphtheria can also be transmitted by touching an infected wound.

Even if they don't exhibit any symptoms, those who have been infected with the diphtheria germs and have not received treatment can still infect others who have not received the vaccine.

Also Read: Mumps: Symptoms, Causes, Treatment & Prevention

Diagnosis:

A lab test and your symptoms will be used by your healthcare professional to reach a diagnosis. They will obtain a sample from a sore or the back of your throat using a swab. After that, a lab receives this swab for diagnosis.

Risk factors:

The following individuals have a higher chance of contracting diphtheria:

• People who are not up to date with their vaccines

• People who live in unsanitary or crowded environments

• Anyone traveling to area where cases of diphtheria are more prevalent

• In Western Europe and the United States, where children have been immunized against diphtheria for decades, the illness rarely occurs. Nonetheless, in developing nations with inadequate immunization rates, diphtheria is still widespread.

In areas where immunization against diphtheria is mandatory, the illness mostly poses a risk to those who are not vaccinated or who have not received enough vaccinations, and who travel abroad or interact with individuals from developing nations.

Complications:

If diphtheria is not treated, it can cause:

• Breathing issues. Bacteria that cause diphtheria may produce a toxin. This toxin usually affects the nose and throat, but it also damages tissue in the local area of infection. A tough, gray membrane consisting of bacteria, dead cells, and other materials is produced at that location by the infection. Breathing may be hindered by this membrane.

• Damage to the heart.  The diphtheria toxin can enter the bloodstream and damage other body tissues. For instance, it may harm the heart muscle, leading to issues like myocarditis, or inflammation of the heart muscle. Myocarditis may cause mild or serious heart damage. Myocarditis can, in its severe case, result in heart failure and sudden death.

• Damage to nerves. There's a chance that the toxins damage nerves. Nerves in the throat are often the focus because impaired neural conduction can make swallowing difficult. Muscle weakness may also result from inflammation of the nerves that supply the arms and legs.

How does one treat diphtheria?

Treatment for diphtheria begins immediately, often even before the results of the lab test are confirmed. To prevent organ damage, your healthcare professional will prescribe diphtheria antitoxin.  To combat infection, they will also give antibiotics, usually erythromycin or penicillin.

To stop others from getting sick, people who have diphtheria are kept isolated. Approximately 48 hours after starting antibiotics, an infected person is no longer contagious. Tests will be repeated after the course of treatment to ensure the bacteria is gone. You will receive a vaccination that prevents infections when the bacteria have been gone.

Prevention:

Yes. In the United States, there are many vaccines designed for stopping diphtheria. Many of them offer simultaneous protection against multiple infections including diphtheria, tetanus, and pertussis (whooping cough). Different schedules for receiving the series of shots—which include booster shots after the first ones—are given.

In general, fever, soreness or redness at the injection site, and rare cases, an allergic reaction to the vaccine itself are possible side effects of vaccinations.

References:

• Centers for Disease Control and Prevention. Travel-Related Infectious Diseases: Diphtheria (https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/diphtheriahttps:/wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/diphtheria). Accessed 2/7/2022.

• Diphtheria. Merck Manual Professional Version. https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-bacilli/diphtheria. Accessed Aug. 19, 2021.

• Elsevier Point of Care. Clinical Overview: Diphtheria. https://www.clinicalkey.com. Accessed Aug. 19, 2021.

• Recommended child and adolescent immunization schedule. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Accessed Aug. 19, 2021.

• Tdap (tetanus, diphtheria, pertussis) vaccine information statement. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html. Accessed Aug. 19, 2021.

• AskMayoExpert. Tetanus, diphtheria, and pertussis (Tdap) vaccination. Mayo Clinic; 2021.

• Lamichhane A, Radhakrishnan S. Diphtheria (https://www.ncbi.nlm.nih.gov/books/NBK560911/). [Updated 2021 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 2/7/2022.

• National Library of Medicine. Diphtheria (https://medlineplus.gov/diphtheria.html). Accessed 2/7/2022.

• Barroso LF, et al. Clinical manifestations, diagnosis, and treatment of diphtheria. https://www.uptodate/com/search. Accessed Aug.19, 2021.

• Kim DK, et al. Recommended adult immunization schedule, United States, 2019. Annals of Internal Medicine. 2019; doi:10.7326/M18-3600.