Diphtheria is a life-threatening bacterial infection that mainly affects the nose and throat, and sometimes the skin.
Diphtheria is highly contagious. It is caused by a bacteria called Corynebacterium diphtheriae.
The infection is usually acquired after being in close or prolonged contact with someone who has the condition or is carrying the infection.
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The bacteria produce toxins that cause the development of a thick, gray membrane that covers the throat and tonsils, which can lead to suffocation.
Other dangerous complications include paralysis and heart failure if the toxins spread throughout the body.
In advanced stages, diphtheria can damage the heart, kidneys, and nervous system.
Even with treatment, diphtheria can be fatal – up to 10 percent of people with diphtheria die from it.
Mortality is highest in children under 15 years of age.
In October 2020, the Peruvian Ministry of Health confirmed the first case of diphtheria in 20 years. The patient is a 5-year-old girl who lives in a very poor area in the center of Lima. The girl had only received vaccines at birth, but not the subsequent booster doses necessary to maintain immunity to this disease.
Causes of diphtheria
Diphtheria is an infection caused by the bacteria Corynebacterium diphtheriae.
Diphtheria is spread from person to person, usually through respiratory droplets, such as coughing or sneezing.
In rare cases, people can get sick from touching open sores or clothing that touched the sores of someone sick with diphtheria.
A person can also get diphtheria by coming into contact with an object, such as a toy, that is contaminated with the bacteria that cause diphtheria.
Diphtheria symptoms
The signs and symptoms of diphtheria usually begin two to five days after a person is infected and can include:
- A thick, gray membrane that covers the throat and tonsils
- Sore throat and hoarseness
- Enlarged lymph nodes in the neck
- Shortness of breath or rapid breathing
- Runny nose
- Fever and chills
- Discomfort
In some people, infection caused by diphtheria bacteria causes only mild illness, or has no obvious signs and symptoms.
Infected people who remain unaware of their disease are known as carriers, as they can spread the infection without being sick.
Diphtheria of the skin (cutaneous)
A second type of diphtheria can affect the skin, causing the typical pain, redness, and swelling associated with other bacterial skin infections.
Ulcers covered by a gray membrane can also develop in cutaneous diphtheria.
Although more common in tropical climates, cutaneous diphtheria also occurs in other countries, particularly among people with poor hygiene who live in crowded conditions.
Diphtheria complications
Respiratory problems
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The bacteria that cause diphtheria produce a toxin that damages tissue in the immediate area of infection – usually the nose and throat.
At that site, the infection produces a hard gray membrane made up of dead cells, bacteria, and other substances.
This membrane can obstruct breathing.
Heart damage
Diphtheria toxin can spread through the bloodstream and damage other tissues in the body, such as the heart muscle, causing complications such as inflammation of the heart muscle (myocarditis).
Heart damage from myocarditis can be mild, presenting as minor abnormalities on an EKG, or severe, leading to congestive heart failure and sudden death.
Nerve damage
The toxin can also cause nerve damage.
Typical targets are the nerves in the throat, where poor nerve conduction can cause difficulty swallowing.
The nerves in the arms and legs can also become inflamed, causing muscle weakness.
If the C. diphtheria toxin damages the nerves that help control the muscles used in breathing, these muscles can become paralyzed.
Breathing may then be impossible without a respirator or other device to assist with breathing.
Diphtheria treatment
If diphtheria is suspected, you will be admitted immediately to an isolation room at the hospital to stop the spread of the infection to others.
If the gray-white membrane is making breathing difficult, some or all of it will be removed.
A diphtheria infection is treated with two types of medications:
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- Antibiotics to kill diphtheria bacteria. Penicillin or erythromycin is used to treat diphtheria.
- Diphtheria antitoxins to neutralize the effects of the toxin produced by the bacteria.
Most people with diphtheria require a 14-day course of antibiotics.
After this time, they will do tests to find out if all the bacteria are gone.
If diphtheria bacteria are still present, you may need to continue taking antibiotics for another 10 days.
Once you have completed the treatment, it will not be infectious to other people.
However, you will not be able to leave the isolation room until tests show that you are completely free of infection.
The patient should be vaccinated against diphtheria after they have been treated, because having diphtheria does not always prevent you from getting the infection again.
Cutaneous diphtheria
Cutaneous diphtheria is diphtheria that affects the skin more than the throat.
It is treated by thoroughly washing infected wounds with soap and water.
You will be examined two weeks later to make sure all bacteria are gone.
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Testing and treating close contacts
Anyone who has had close contact with the patient, such as family or household members, visitors, and anyone who has kissed or had sex with the patient, should see their doctor immediately for signs of diphtheria.
The diphtheria test involves taking a sample of cells from the nose to test for diphtheria bacteria.
Close contacts of the patient will be prescribed antibiotics.
It is very important that they complete the entire treatment plan.
If needed, they will also be given a booster dose of diphtheria vaccine.
Any healthcare worker who has cared for someone with diphtheria may also need to be investigated and treated.
The risk of getting diphtheria from co-workers or friends at school is very low.
Diphtheria vaccination
All children should be vaccinated against diphtheria as part of the routine childhood immunization program.
Adults should consider getting a booster shot when traveling to parts of the world where diphtheria is widespread.
