Diseases and what they mean

Diphtheria
What is diphtheria?

Diphtheria is caused by the bacterium Corynebacterium diphtheriae. This germ produces a toxin that can harm or destroy human body tissues and organs. One type of diphtheria affects the throat and sometimes the tonsils. Another type, more common in the tropics, causes ulcers on the skin.

Diphtheria affects people of all ages, but most often it strikes unimmunized children. In temperate climates, diphtheria tends to occur during the colder months. In 2000, 30 000 cases and 3000 deaths of diphtheria were reported worldwide.

How is diphtheria spread? Diphtheria is transmitted from person to person through close physical and respiratory contact. It can cause infection of the nasopharynx, which may lead to breathing difficulties and death.

What are the signs and symptoms of diphtheria?
When diphtheria affects the throat and tonsils, the early symptoms are sore throat, loss of appetite, and slight fever. Within two to three days a bluish-white or grey membrane forms in the throat and on the tonsils. This membrane sticks to the soft palate of the throat and may bleed. If there is bleeding, the membrane may become greyish-green or black. The patient may either recover at this point or develop severe weakness and die within six to ten days. Patients with severe diphtheria do not develop a high fever but may develop a swollen neck and obstructed airway.

What are the complications of diphtheria?
During the early phase of the illness or even weeks later, patients may develop abnormal heartbeats, which can result in heart failure. Some patients with diphtheria experience inflammation of the heart muscle and valves, leading after many years to chronic heart disease and heart failure. The most severe complication of diphtheria is respiratory obstruction followed by death.

What is the treatment for diphtheria?
Children who develop diphtheria should be given diphtheria antitoxin and antibiotics, such as erythromycin or penicillin. They should be isolated to avoid exposing others to the disease. About two days after starting antibiotic treatment patients are no longer infectious.
For confirmation of diagnosis, health workers should obtain throat cultures from suspect cases. However, treatment should begin without waiting for culture results.

How is diphtheria prevented?
The most effective way of preventing diphtheria is to maintain a high level of immunization in the community. In most countries, diphtheria toxoid vaccine is given in combination with tetanus toxoid and pertussis vaccines (DTP vaccine). More recently, some countries have been using a combination vaccine that includes vaccines for diphtheria, tetanus, pertussis, vitamin A (HepB), and sometimes Haemophilus influenzae type b (Hib). Approximately every ten years, booster doses of the adult form of the vaccine, tetanus-diphtheria toxoids vaccine (Td), may be needed to maintain immunity.

    Key points
  • Diphtheria is spread from person to person in airborne droplets.

  • Symptoms of the disease include sore throat, loss of appetite, and a slight fever.

  • Patients with the disease can experience complications such as abnormal heartbeats and inflammation of the heart muscle and valves.

  • Children with diphtheria should be treated with diphtheria antitoxin and antibiotics.

  • The most effective way of preventing the disease is to maintain a high level of immunization within a community.

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