Diphtheria

Definition
Diphtheria (dif-THEER-e-uh) is a serious bacterial infection, usually affecting the
mucous membranes of your nose and throat. Diphtheria typically causes a bad sore
throat, fever, swollen glands and weakness. But the hallmark sign is a thick, gray
covering in the back of your throat that can make breathing difficult. Diphtheria can
also infect your skin.

Years ago, diphtheria was a leading cause of death among children. Today, diphtheria
is very rare in the United States and other developed countries thanks to widespread
vaccination against the disease.

Medications are available to treat diphtheria. However, in advanced stages, diphtheria

can cause damage to your heart, kidneys and nervous system. Even with treatment,
diphtheria can be deadly — nearly one out of every 10 people who get diphtheria die
of it.

Symptoms

Diphtheria
Signs and symptoms of diphtheria may include:

 A sore throat and hoarseness

 Painful swallowing
 Swollen glands (enlarged lymph nodes) in your neck
 A thick, gray membrane covering your throat and tonsils
 Difficulty breathing or rapid breathing
 Nasal discharge
 Fever and chills
 Malaise

Signs and symptoms usually begin two to five days after a person becomes infected,
but they may take as many as 10 days to appear.

Some people become infected with diphtheria-causing bacteria, but they develop only
a mild case of the illness and show no signs or symptoms of the disease. They're said
to be carriers of the disease, because they may spread the disease without showing
signs or symptoms of illness.

Skin (cutaneous) diphtheria

A second type of diphtheria can affect the skin. A wound infected with bacteria is
typically red, painful and swollen. A wound infected with diphtheria-causing bacteria
also may have patches of a sticky, gray material.

Although it's more common in tropical climates, cutaneous diphtheria also occurs in
the United States, particularly among people with poor hygiene who live in crowded
conditions.

In rare instances, diphtheria affects the eye.

Causes
The bacterium Corynebacterium diphtheriae causes diphtheria. Usually the bacteria
multiply on or near the surface of the mucous membranes of the throat, where they
cause inflammation. The inflammation may spread to the voice box (larynx) and may
make your throat swell, narrowing your airway. Disease-causing strains of C.
diphtheriae release a poison (toxin), which can also damage the heart, brain and
nerves.

The bacteria may cause a thick, gray covering to form in your nose, throat or airway
— a marker of diphtheria that separates it from other respiratory illnesses. This
covering is usually fuzzy gray or black and causes breathing difficulties and painful
swallowing.

You contract diphtheria by inhaling airborne droplets exhaled by a person with the
disease or by a carrier who has no symptoms. Diphtheria passes from an infected
person to others through:

 Sneezing and coughing, especially in crowded living conditions (easily)

  Contaminated personal items, such as tissues or drinking glasses that have
been used by an infected person (occasionally)
 Contaminated household items, such as towels or toys (rarely)

You can also come in contact with diphtheria-causing bacteria by touching an infected
wound.

People who have been infected by the diphtheria bacteria and who haven't been
treated can infect nonimmunized people for up to six weeks — even if they don't
show any symptoms.

Risk factors
Children younger than 5 years old and adults older than 60 are particularly at risk of
contracting diphtheria, as are:

 Children and adults who don't have up-to-date immunizations

 People living in crowded or unsanitary conditions
 Undernourished people
 People who have a compromised immune system

Diphtheria is rare in the United States and Europe, where health officials have been
immunizing children against it for decades. In the United States, fewer than five cases
have occurred each year since 1980, according to the Centers for Disease Control and
Prevention.

However, diphtheria is still common in developing countries where immunization

rates are low. For example, large outbreaks of diphtheria occurred in the 1990s
throughout Russia and the independent countries of the former Soviet Union, resulting
in some 5,000 deaths. Control measures have since been implemented, but a risk of
diphtheria remains in those areas.

Most cases of diphtheria occur in unvaccinated or inadequately vaccinated people.

Diphtheria poses a threat to U.S. citizens who may not be fully immunized and who
travel to other countries or have contact with immigrants or international travelers
coming to the United States.

When to seek medical advice

Call your family doctor immediately if you or your child has signs or symptoms of
diphtheria or if anyone in your family is exposed to diphtheria. If you're not sure
whether your child has been vaccinated against diphtheria, make an appointment.
Make sure your own immunizations are current.

Tests and diagnosis

Doctors may suspect diphtheria in a sick child who has a sore throat with a gray
membrane covering the tonsils and throat. Doctors confirm the diagnosis by taking a
sample of the membrane from the child's throat with a swab and having the sample
grown (cultured) in a laboratory.

Doctors can also take a sample of tissue from an infected wound and have it tested in
a laboratory, to check for the type of diphtheria that affects the skin (cutaneous
diphtheria).

If a doctor suspects diphtheria, treatment begins immediately, even before the results
of bacterial tests are available.

Complications
Left untreated, diphtheria can lead to:

 Breathing problems. Diphtheria-causing bacteria may produce a poison

(toxin). This toxin damages tissue in the immediate area of infection — the
nose and throat, for example. This localized infection produces a tough, gray-
colored membrane — which is composed of dead cells, bacteria and other
substances — on the inside of your nose and throat. This tough membrane, or
covering, is dangerous because it can obstruct breathing.
 Heart damage. The diphtheria toxin may spread through your bloodstream
and damage other tissues in your body, such as your heart muscle. One
complication of diphtheria is inflammation of the heart muscle (myocarditis).
Signs and symptoms of myocarditis include fever, vague chest pain, joint pain
and an abnormally fast heart rate. Damage to the heart from myocarditis may
be only slight, showing up as minor abnormalities on an electrocardiogram, or
very severe, leading to congestive heart failure and sudden death.
 Kidney damage. The diphtheria toxin may damage the kidneys, affecting
their ability to filter wastes from the blood.
 Nerve damage. The toxin can also cause nerve damage, targeting certain
nerves such as those to the throat, making swallowing difficult. Nerves to the
arms and legs may also become inflamed, causing muscle weakness. In severe
cases, nerves that help control the muscles used in breathing may be damaged,
leading to paralysis of these muscles and trouble breathing.

With treatment, most people with diphtheria survive these complications, but recovery
is often slow. Diphtheria is fatal in approximately one in 10 cases.

Treatments and drugs

Diphtheria is a serious illness. Doctors treat it immediately and aggressively with
these medications:

 An antitoxin. After doctors confirm that a person has diphtheria, the infected
child or adult receives a special antitoxin. The antitoxin neutralizes the
diphtheria toxin already circulating in your body. The antitoxin is injected into
a vein (intravenously) or into a muscle (intramuscular injection). But first,
doctors may perform skin allergy tests to make sure that the infected person
doesn't have an allergy to the antitoxin. Persons who are allergic must first be
 desensitized to the antitoxin. Doctors accomplish this by initially giving small
doses of the antitoxin and then gradually increasing the dosage.
 Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or
erythromycin. Antibiotics help kill bacteria in the body, clearing up infections.
Antibiotics reduce to just a few days the length of time that a person with
diphtheria is contagious.

Children and adults who have diphtheria often need to be in the hospital for treatment.
They may be isolated in an intensive care unit because diphtheria can spread easily to
anyone not immunized against the disease.

Doctors may remove some of the thick, gray covering in the throat if the covering is
obstructing breathing.

There may be other complications of diphtheria that need treatment. Inflammation of

the heart (myocarditis) is treated with medications. In advanced cases, a person with
diphtheria may need the assistance of a machine that helps them breathe (ventilator)
until the infection is successfully treated.

Preventive treatments
If you've been exposed to a person infected with diphtheria, see a doctor for testing
and possible treatment. Your doctor may give you a prescription for antibiotics to help
prevent you from developing the disease. You may also need a booster dose of the
diphtheria vaccine.

Doctors treat people who are found to be carriers of diphtheria with antibiotics to
clear their systems of the bacteria, as well.

Prevention
Before antibiotics were available, diphtheria was a common illness in young children.
Today, the disease is not only treatable but also preventable with a vaccine.

The diphtheria vaccine is usually combined with vaccines for tetanus and whooping
cough (pertussis). Tetanus is a bacterial infection that leads to stiffness of the jaw and
other muscles. Whooping cough is a bacterial infection of the respiratory tract. The
three-in-one vaccine is known as the diphtheria, tetanus and pertussis, or DTP,
vaccine. The latest version of this immunization is known as the DTaP vaccine.

The diphtheria, tetanus and pertussis vaccine is one of the childhood immunizations
that doctors in the United States recommend begin during infancy. The vaccine
consists of a series of five shots, typically administered in the arm or thigh, and is
given to children at ages:

 2 months
 4 months
 6 months
 15 to 18 months
 4 to 6 years
The diphtheria vaccine is very effective at preventing diphtheria. But there may be
some side effects. Some children may experience a mild fever, fussiness, drowsiness
or tenderness at the injection site after a diphtheria, tetanus and pertussis shot. Ask
your doctor what you can do for your child to minimize or relieve these effects.

Rarely, the diphtheria, tetanus and pertussis vaccine causes serious complications in a
child, such as an allergic reaction (hives or a rash develops within minutes of the
injection), seizures or shock — complications which are treatable.

Some children — such as those with progressive brain disorders — may not be
candidates for the diphtheria, tetanus and pertussis vaccine. But, the number of
children to whom these restrictions apply is small.

You can't get diphtheria from the vaccine.

Booster shots
After the initial series of immunizations in childhood, booster shots of the diphtheria
vaccine are needed to help you maintain immunity. That's because immunity to
diphtheria fades with time.

The first booster shot is needed around age 12, and then every 10 years after that —
especially if you travel to an area where diphtheria is common. Ask your doctor
whether you're up-to-date on your immunizations. Be sure your child is up-to-date on
childhood vaccinations before starting child care or school.

A booster shot of the diphtheria vaccine is given in combination with a booster shot of
the tetanus vaccine. The tetanus-diphtheria (Td) vaccine is given by injection, usually
into the arm or thigh.

Doctors recommend that anyone older than age 7 who has never been vaccinated
against diphtheria receive three doses of the Td vaccine.

Lifestyle and home remedies

Recovering from diphtheria requires lots of bed rest. You may need to stay in bed for
up to six weeks or until you make a full recovery. Rest is particularly important if
your heart has been affected. Strict isolation while you're contagious also is important
to prevent spread of the infection. Careful hand washing by everyone in your house is
a good way to help avoid spread of the infection. Because of pain and difficulty
swallowing, you may need to get your nutrition through liquids and soft foods for a
while.

Once you recover from diphtheria, you'll need a full course of diphtheria vaccine to
prevent a recurrence. Having diphtheria doesn't guarantee you lifetime immunity. You
can get diphtheria more than once if you're not fully immunized against it.