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Diphtheria

Diphtheria is an acute, highly contagious, toxin­mediated infection. It usually infects the respiratory tract, primarily involving the tonsils, nasopharynx, and larynx. Cutaneous, stool, and wound diphtheria are the most common types in the United States, often resulting from nontoxigenic strains. The GI and urinary tracts, conjunctivae, and ears seldom are involved.

Because of effective immunization, diphtheria has become rare in many parts of the world, including the United States. A massive and expanding epidemic of diphtheria in the former Soviet Union has been on going since 1990, especially in individuals age 15 and older. In the tropics, cutaneous diphtheria is more common than respiratory diphtheria. It's most likely to strike in areas where crowding and poor hygienic conditions prevail.

Causes

The bacteria live in an infected person's nose, throat, skin, or eye discharges, and are passed to others in close contact through coughing or sneezing. You can also catch diphtheria from touching the open sores on someone with skin diphtheria, a condition that occurs in tropical countries and in any area with crowded conditions and inadequate hygiene. Skin diphtheria causes a rash that is hard to distinguish from impetigo. Very rarely, food contaminated with the diphtheria bacterium can infect others. Diphtheria outbreaks have occurred recently in the former Soviet Union.

Symptoms and Signs

Signs and symptoms of diphtheria may include:

  • A sore throat and hoarseness
  • Painful swallowing
  • Swollen glands (enlarged lymph nodes) in your neck
  • A thick, gray membrane covering your throat and tonsils
  • Difficulty breathing or rapid breathing
  • Nasal discharge
  • Fever and chills
  • Malaise

Diagnostic tests

Culture of throat swabs or of specimens taken from suspicious lesions that show C. diphtheriae confirms the diagnosis. Electrocardiogram abnormalities may indicate myocardium involvement.

Treatment

Initial therapy is based on clinical findings and doesn't wait for a confirmed diagnosis based on culture. Standard treatment includes diphtheria antitoxin administered by I.M. or I.V. infusion. Antibiotics, such as penicillin and erythromycin, eliminate organisms from the upper respiratory tract and else­where so that the patient doesn't remain a carrier.

Prevention

There is a vaccine for diphtheria. The diphtheria vaccine is usually given in a combination shot with tetanus and pertussis vaccines, known as DTP vaccine. A child should have received four DTP shots by 18 months of age, with a booster shot at age 4 years to 6 years. After that, diphtheria and tetanus boosters should be given every 10 years to provide continued protection.

As is the case with all immunizations, there are important exceptions and special circumstances. Health-care providers should have the most current information on recommendations about diphtheria vaccination.

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