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Diphtheria

Definition


Disease: Diphtheria Diphtheria
Category: Infectious diseases

Disease Definition:

Usually affecting the mucous membranes of the nose and throat, diphtheria is a serious bacterial infection. Diphtheria, which may additionally infect the skin, commonly results in a sore throat, swollen glands, weakness and fever. But the hallmark sign is a thick, gray covering in the back of the throat that could cause difficulty breathing.

 

Diphtheria used to be a leading cause of death among children many years ago but thanks to the widespread vaccination against the disease, it is quite rare in developed countries. Diphtheria can be treated with medications, but when it progresses, it could result in damage to the heart, nervous system and kidneys. Diphtheria could be deadly even with treatment; between 5% to 10% of people suffering from this condition end up dying.
 

Work Group:


Symptoms, Causes

Symptoms:

Diphtheria may cause some of these signs and symptoms:

  • Painful swallowing
  • Malaise, which is a general feeling of not being well
  • Nasal discharge
  • Swollen glands (enlarged lymph nodes) in the neck
  • A sore throat and hoarseness
  • Fever and chills
  • A thick, gray membrane covering the throat and tonsils
  • Rapid breathing or difficulty breathing

 

Signs and symptoms often start two to five days after the infection. Certain people become infected with diphtheria-causing bacteria but grow only a mild case of the disease, or they might not even show any signs or symptoms. These people are considered carriers of the disease since they might spread it without showing signs or symptoms.

 

Skin (cutaneous) diphtheria:

A second kind of diphtheria could affect the skin, resulting in the typical pain, redness and swelling related to other bacterial skin infections. In this type, ulcers covered by a gray membrane may also develop.

 

Diphtheria may affect the eye in some rare cases. In case one is exposed to someone suffering from diphtheria, a doctor should be consulted immediately.
 

Causes:

Diphtheria is caused by the bacterium called Corynebacterium diphtheriae. The bacteria often multiply on or near the surface of the mucous membranes of the throat resulting in inflammation in that area that might spread to the voice box (larynx) and might cause swelling of the throat and narrowing of the airway. Disease-causing strains of C. diphtheriae release a damaging substance (toxin) that could additionally involve the heart, brain and nerves.

 

A thick, gray covering might form in the nose, throat or airway due to the bacteria, indicating that diphtheria has occurred and not any other respiratory disease. This covering is often fuzzy gray or black and results in painful swallowing and breathing difficulties. Inhaling airborne droplets exhaled through a person with the disease or by a carrier who has no symptoms is how diphtheria is contracted. Diphtheria is passed from an infected person to a health one through:

 

  • Sneezing and coughing, particularly in crowded living conditions
  • Contaminated personal items, like tissues or drinking glasses that have been used by an infected person
  • Contaminated household items, like towels or toys

 

Touching an infected wound may also result in contracting diphtheria. When someone is infected by the diphtheria bacteria, even if he/she doesn’t show any signs or symptoms, could infect nonimmunized people for up to six weeks.
 

Complications

Complications:

Diphtheria could contribute to the following complications in case it isn’t promptly treated:

 

Breathing problems:

A toxin that damages tissue in the immediate place of infection, for instance, the nose and throat is caused by the diphtheria-causing bacteria. This localized infection produces a hard, gray-colored membrane that is composed of dead cells, bacteria and other substances on the inside of the nose and throat. Because this tough membrane or covering could obstruct breathing, it is considered dangerous.

 

Heart damage:

The heart muscle for instance might be damaged due to the diphtheria toxin that spreads through the bloodstream damaging tissues in the body. Inflammation of the heart muscle (myocarditis) is a complication resulting from diphtheria. Fever, vague chest pain, an abnormally fast heart rate and joint pain are all among the signs and symptoms of myocarditis. There might only be a slight damage resulting from myocarditis apparent as minor abnormalities on an electrocardiogram, or very severe ones contributing to congestive heart failure even sudden death.

 

Nerve damage:

The toxin could additionally result in nerve damage, targeting some nerves like those to the throat, causing difficulty swallowing. Nerves to the arms and legs can be additionally inflamed, weakening the muscles. Diphtheria may also lead to difficulty breathing and paralysis of the muscles that are used in breathing in case it damages those muscles. Diphtheria is fatal in as many as 10% of the cases, and although treatment usually helps people survive its complications, but their recovery is usually slow.
 

Treatments:

Diphtheria is a serious disease; it is treated right away in an aggressive way with the following medications:

 

An antitoxin:

After being diagnosed with diphtheria, the infected child or adult receives a special antitoxin that neutralizes the diphtheria toxin already circulating in the body. The antitoxin is injected intravenously or into a muscle (intramuscular injection). However, skin allergy tests may be done first to ascertain that the patient doesn’t have an allergy to the antitoxin. Allergic people should initially be desensitized to the antitoxin, which is performed by doctors through administering small doses of the antitoxin first and then raising the dosage slowly.

 

Antibiotics:

Additionally, diphtheria might be treated with antibiotics like penicillin or erythromycin that aid in killing bacteria in the body, clearing up infections. The length of time that a person with diphtheria is contagious is decreased with the help of antibiotics.

 

Hospitalization of children and adults who suffer from diphtheria might be necessary, in addition to being isolated in an intensive care unit since diphtheria could spread easily to anyone not immunized against the disease. Certain thick, gray covering in the throat might be cleared away in case it is preventing the patient from breathing.

 

Other complications of diphtheria might require treatment as well. Inflammation of the heart (myocarditis) is treated with medications. When the condition progresses, assistance of a machine helping the patient breathe (ventilator) might be recommended until the infection is treated successfully.

 

PREVENTIVE TREATMENTS:

A doctor should be seen for testing and possible treatment in case someone has been exposed to an infected person with diphtheria. A prescription for antibiotics might be given to help prevent that person from developing the disease. A booster dose of the diphtheria vaccine might additionally be required in such cases. Additionally, people who are discovered as being carriers of diphtheria are treated with antibiotics clearing their systems of the bacteria.
 

Prognosis:

Not available

Expert's opinion

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Consultants Corner

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery
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