Diphtheria

Medical Term:
Diphtheria

Common Name: None Specified

Description: Diphtheria is an acute, highly contagious infection caused by a bacteria Corynebacterium diphtheriae, that usually attacks the respiratory tract but may involve any mucous membrane or skin wound. The diphtheria bacteria are spread by droplets of moisture coughed into the air. Rarely, the bacteria can be spread by contaminated household article, such as clothing or toys.

Years ago, diphtheria was one of the leading causes of death in children. As a result of widespread immunization against the disease, diphtheria is very rare in developed countries. Since 1980 , fewer than 5 cases a year have been reported in the United States. However, diphtheria bacteria still exist and outbreaks can still occur if immunization is not kept up to date.

Causes: Diphtheria is caused by Corynebacterium diphtheriae.

Usually infects the throat and sometimes the skin. Some types of Corynebacterium diphtheriae release a toxin, which is distributed via the blood causing severe potential damage to the heart, central nervous system and kidneys.

Incubation period for 2-5 days.

Prevention: Immunization with diphtheria vaccine. This is part of active childhood immunization. Booster immunization should be given every ten years. Susceptible individuals exposed to diphtheria should receive a booster dose of toxoid, plus active immunization, if not previously immunized, and a course of penicillin.

Signs & Symptoms

Infection begins 1-4 days after exposure. Symptoms begin with a mild sore throat

  • Low grade fever;
  • Swollen neck glands;
  • Typically, the bacteria form a pseudomembrane – a sheet of gray colored material composed of dead white blood cells and bacteria and other substances. Pseudomembane usually forms around the tonsils or other parts of the throat and may cause narrowing of the airway or may suddenly get detached and lead to airway obstruction and breathing difficulty;
  • Double vision, slurred speech and difficulty in swallowing;
  • Shock (low blood pressure; rapid heartbeat; paleness; cold skin; sweating; anxious appearance).

Risk Factors

  • Outbreak in the community;
  • Adults over 60, children under 5 years;
  • Poor nutrition;
  • Crowded or unsanitary living conditions;
  • Lack of up-to-date immunizations.

Diagnosis & Treatment

Diphtheria is suspected ,if a sick child presents with a sore throat and pseudomembrane. Diagnosis can be confirmed by taking a throat swab from the membrane and sending it to the laboratory for culture.

General Measures:

Hospitalization and isolation of the patient until fully recovered. Protect susceptible individuals (the non-immunized, very young or elderly) from exposure
Patient with diphtheria must be admitted to hospital, in the intensive care unit, and should be observed for any breathing difficulty and to make sure that the heart is functioning properly. In case of breathing difficulty, patients may require tracheotomy and mechanical assistance for breathing. Sometimes, removal of the pseudomembrane by direct laryngoscopy or bronchoscopy may be necessary to alleviate airway obstruction

Dispose of all secretions (nose and mouth) and excretions (urine and feces) in an acceptable manner. Call the local health department for instructions.

Medications:

Diphtheria antitoxin to neutralize the diphtheria toxin should be given as soon as possible. However, the physician must first make sure that the child is not allergic to the antitoxin by performing a skin test. In case of allergy, the patient has to be desensitized by being given very small doses initially and progressively larger doses are administered.

Antibiotics to fight remaining diphtheria germs. Both Penicillin and Erythromycin are effective.

Activity:

Prolonged bed rest (3 weeks or until fully recovered), especially if the heart is involved. This is very important, as even minor activity may cause harm to the patient recovering from myocarditis (inflammation of the heart).

Diet:

Liquid to soft diet as tolerated.

Possible Complications:

  • Heart inflammation and heart failure;
  • Suffocation due to upper airway and bronchial obstruction;
  • Nerve inflammation, usually causing double vision, slurred speech and difficulty swallowing;
  • Misdiagnosis as a less serious infection, resulting in dangerous delay of treatment.

Prognosis

Usually curable in 10 days if treatment is begun promptly, followed by slow recovery for several weeks. A delay in treatment may result in death or long-term heart disease.

Other

Nothing Specified.

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