Diphtheria

diphtheria doses

Last Updated February 20th, 2019

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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Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
immunoglobulin M
Immunoglobulin M Test Immunoglobulin M is the largest and the first produced antibody which helps in the prevention or fighting of…
ureteroscopy
Ureteroscopy Ureteroscopy is the diagnostic procedure which is used for the detection of the kidney stones in addition to…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
Find all the instant ways to get rid of blackheads Blackheads - Not only are they aesthetically unappealing but if left untreated these can cause bacterial overgrowth on…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
Oxalates: How healthy greens can sometimes be bad news for your kidneys Oxalates are compounds present in a majority of healthy foods. However, at times an overconsumption of these could…
SIBO Diet: The important dos and don’ts of this gut-healing diet A SIBO diet is a diet that works by eliminating certain sugars from your diet and adding fibers…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
lp-pla2
LP-PLA2 Test The LP-PLA2 test is a test which is carried out to assess the levels of Lipoprotein-Associated Phospholipase A2…
quinoa salad
Quinoa : A prodigious superfood you need to include in your diet today! Quinoa - what is so special about this native South American grain that has taken the world by…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
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?…
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
bananas exercise
10 health reasons why you should go “bananas” over bananas! Bananas:The world's most popular fruit comes with a host of unbelievable health benefits. Find out how you can…
ashwagandha brain
Ashwagandha: The best-kept secret of Ayurveda now revealed! Ashwagandha literally means "smell of horse". Don't get bogged down by that one tiny detail because this ayurveduic…
Salt dangers
Sodium chloride: The wonders and dangers of the simple table salt Sodium chloride is a salt containing sodium and chlorine ions at a 1:1 ratio. It is edible and…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
The right way to prepare Alfalfa sprouts at home Alfalfa or lusan ghas is not just a nutritious animal fodder. This flavonoid-rich herb has some amazing health…
How to scrub away stress and fatigue with an Epsom salt bath? Epsom salt is a popular home remedy for many skin ailments. Though there is a lack of scientific…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
thyroid_scan
Thyroid Scan Thyroid scan is a diagnostic procedure that aims to view the thyroid gland and detect any growths or…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
shoudler exercises
Keep your shoulders pain-free with these shoulder exercises Shoulder exercises are important in order to prevent chronic back and neck pain. Learn more about how you…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…