Diphtheria

diphtheria doses

Last Updated December 20th, 2021

Overview of diphtheria

Microbial infections are common in the tropics and the subtropics. These regions have climatic and environmental conditions that are optimum for microbial growth. In due course of time, these diseases turn into epidemics and result in millions of fatalities. Diphtheria is one such disease caused by the bacterial species Corynebacterium diphtheriae. It is mainly observed in people who lack immunity due to nutritional deficits or for not being immunized in childhood.  In the year 2013, nearly 4700 cases of diphtheria were reported, with 3300 cases leading to death. Although the mortality rates have been brought down by a significant percentage, the current global burden is still quite high and needs to be addressed seriously.

 

What is diphtheria?

Diphtheria is a type of contagious disease triggered by the bacterium Corynebacterium diphtheria. It derives its name from the Greek term “diphthera” which means “leather hide”. The onset of the disease is marked by a sore throat and fever. In the more advanced stages, greyish or whitish patches appear in the throat. This partially blocks the air passage and produces a hoarse cough. It is preventable by means of adequate vaccinations.

 

How does the disease occur?

Diphtheria in kidsThe pathogenesis of diphtheria is complex. The immunosuppressed people acquire the diphtheria bacilli in the nasopharynx. This pathogen then produces a particular toxin that impedes cellular protein synthesis. This is then followed by the destruction of the local tissues and the formation of pseudomembrane. The toxin generated at the site of this membrane is henceforth absorbed into the bloodstream and is circulated to the important tissues of the body. This toxin leads to certain serious complications such as- low platelet count (thrombocytopenia) and presence of protein in the urine (proteinuria). Another non-toxic variant of this pathogen can lead to mild pharyngitis, but do not give rise to the formation of pseudomembrane.

 

How does the disease spread?

Diphtheria is a highly communicable disease and spreads via human to human transmission. The disease mainly spreads via respiratory droplets discharged when the infected person coughs or sneezes. These droplets when inhaled by a healthy person cause infection. A direct contact with the skin lesions can also transmit the infection. Indirect infections may also take place if the patient uses any object which is later used by a healthy person. Sharing of common items of use such as towels, bed-sheets and utensils with the patient can also cause infection. Zoonotic transmission (animal to human transmission) is also possible, but rare.

 

What are the main signs and symptoms of the disease?

The symptoms of Diphtheria begin around 2-7 days (incubation period) after the infection. The disease mainly manifests through the following signs and symptoms-

  • Low-grade fever (100.4oF)
  • Occasional chills
  • Fatigue and general malaise
  • Bluish discoloration of the skin (cyanosis)
  • A sore throat
  • Formation of a thick coating at the back of the throat
  • Unusual hoarseness of the voice
  • Barking cough
  • A constant headache
  • Problems in swallowing
  • Difficulty breathing
  • Smelly nasal discharge with blood
  • Lymphadenopathy
  • Increased heart rate
  • Myocarditis
  • Cranial and peripheral nerve palsies

 

What are the different types of diphtheria?

diphtheria dosesBased on the pathophysiology and the site affected, the following classification of the disease is done-

  • Anterior nasal diphtheria: The onset of this type mimics common cold and flu. The patients tend to have a mucopurulent nasal discharge which may even contain blood. Clinical examination reveals the formation of a white membrane on the nasal septum. The comparatively low absorption of the toxins makes the symptoms mild.
  • Pharyngeal and tonsillar diphtheria: The pharynx and the tonsils are the commonly affected sites in diphtheria. The systemic absorption of toxin is quite high in this case. The early symptoms of the disease include but are not limited to- mild fever, soreness of throat, general malaise and eating disorders (anorexia). Within 2-3 days, a bluish-white membrane develops on the tonsil and extends to cover a part of the soft palate. As the disease progresses, this membrane turns greenish, greyish or blackish along with bleeding. Mild to moderate mucosal erythema occurs in the vicinity of the membrane. Obstruction of the respiratory passage may occur at a later stage due to excessive pseudomembrane formation.
  • Laryngeal diphtheria: It involves the larynx and often occurs as a progression of the pharyngeal type. The patients have fever, hoarseness of voice and a barking cough. Here also a membrane forms on the tonsil and the palate, which may lead to respiratory blockage. In the end stage, these patients may suffer from coma and death. In laryngeal diphtheria, the patients are often found to have swollen neck and throat, also known as “bull neck”. It is accompanied by a characteristic barking cough and hoarseness of voice. All these symptoms are collectively known as diphtheritic croup.
  • Cutaneous diphtheria: It is also known as skin diphtheria. It mainly affects the inhabitants of the tropical zone. Rashes and ulcers form on the skin. These eruptions are usually very scaly with prominent borders and membrane. Microbes other than the Corynebacterium diphtheria may also be present at the site of infection. Some of the commonly affected sites in this type are the vulvovaginal area, the mucous membranes of the conjunctiva and the external auditory canal.

 

What are the main diagnostic criteria?

Diphtheria cultureCDC has devised the following diagnostic criteria for the disease-

  • Laboratory criteria: Includes throat culture and histopathologic diagnosis
  • Clinical criteria: Upper respiratory tract illness, sore throat, low-grade fever, a sticky, dense grey pseudomembrane.

 

How can you treat and prevent the disease?

CDC recommends the following medications for diphtheria-

  • Metronidazole
  • Erythromycin: Given orally or injected
  • Procaine Penicillin G: Intramuscular injection

The best prevention against this disease is to get vaccinated. The available vaccines are DTaP, Tdap, DT, and Td. These provide immunity from diphtheria and tetanus. DTap and DT are administered to children younger than 7 years of age. Diphtheria is a life-threatening disease that can lead to a number of serious complications and even death. Studies have shown that the overall case-fatality rate for diphtheria is as high as 20% in people less than 5 years or greater than 40 years of age. Timely immunizations along with booster doses can help minimize this burden to a considerable extent.

Facts

  • In 1921, there were 206,000 cases of diphtheria diagnosed in the USA. By widespread use of vaccinations, this was reduced to just 2 cases from 2004 to 2015.
  • The worldwide prevalence of this disease is around 7,321 as per a 2014 report.

Facts

  • The bacterium responsible for diphtheria (Corynebacterium diphtheria) causes the inflammation of cardiac muscles and nerves which can cause paralysis and is highly fatal.

Facts

  • The microbes generally spread with contact with an infected person but can also occur by ingestion of unpasteurized milk.
  • Living in crowded and poorly sanitized areas and having lower immunity levels can act as risk factors in acquiring diphtheria.

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Dos and Don'ts

Dos
  • One time immunization against the disease doesn’t guarantee lifelong protection from the infection. The effect of vaccine wanes with time and one should get routine vaccines once every 10 years.
  • Provide your child the complete DTP vaccine for protection against diphtheria, tetanus, and pertussis (whooping cough).
  • The patient with diphtheria should be kept in isolation for at least the 1st 48 hours after he/she has been administered the antibiotic dose for treating the infection.
Don'ts
  • Consume oily and spicy food In case one gets infected with diphtheria, and include more of fluids and soft foods in the diet.
  • Swallow harmful secretions in the nose and oral cavity; the patient should avoid sleeping on the back.

 

 

 

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Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
AUTOIMMUNE HEPATITIS liver
Hepatitis Profile A hepatitis profile or a hepatitis panel is a blood test that checks for markers of hepatitis infection…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Squid-ink-spaghetti
Squid Ink: A unique food coloring and flavoring agent Want to add a unique black color to your pasta, noodles and ice-creams? How can you use squid…
Hepatitis A virus infected liver
Hepatitis A Virus (HAV) Total Blood test to look for IgM antibodies to know if you are infected with Hepatitis A virus (HAV),…
carrageenan seaweed
Carrageenan: How a simple seaweed extract could better your gut health & immunity Eat more ice cream to prevent cold and flu? –With carrageenan you get one simple seaweed extract that…
dance health benefits
5 unbelievable effects of dance on your overall health! You enjoy dancing, but did you know what else it does to your body? Dancing is not only…
improve digestion weight loss
Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
How seitan proved to be a blessing in disguise for vegans worldwide Can only meat-eaters enjoy delicious juicy steaks and burgers? With seitan, the best meat substitute available today,even vegans…
BRAT Diet: What is the right way to follow this diarrhea-relieving diet? BRAT diet, a simple diet consisting of just bananas, rice, applesauce, and toast, can help you combat the…
Epley maneuver: Why is this the best protection from the symptoms of vertigo? Epley maneuver is an exercise that can treat the symptoms of benign paroxysmal positional vertigo (BPPV).  It was…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Appendix pain: Recent findings on this not-so vestigial organ The exact function of the appendix is still not clear. Some consider it as an organ that once…
shakeology woman
Meal replacement or protein drink? Learn all about Shakeology and its claims Shakeology from Beachbody claims to be the most suitable shake that can aid in weight loss, regulate blood…
Strep throat pain
Anti-Streptolysin-O Test The ASO or Anti-Streptolysin-O is a blood test designed to check for the presence of streptococcus bacterial infection…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
AHBC Igm
Anti-Hepatitis B Core Antigen (AHBc) IgM Anti-hepatitis B core antigen (AHBC) IgM is an investigative procedure to detect the presence of IgM antibodies in…
ureteroscopy
Ureteroscopy Ureteroscopy is the diagnostic procedure which is used for the detection of the kidney stones in addition to…
Unbelievable health benefits of gooseberries (and a few tasty recipes) Gooseberries are antioxidant-rich tasty fruits that can be easily added in daily diet to improve overall health and…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…