Overview
Diphtheria is a bacterial infection that spreads easily and occurs quickly. It mainly affects the nose and throat. Children under 5 and adults over 60 years old are particularly at risk for contracting the infection. People living in crowded or unclean conditions, those who aren't well nourished, and children and adults who don't have up-to-date immunizations are also at risk.
Signs And Symptoms
In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms.
The toxin, or poison, caused by the bacteria can lead to a thick coating in the nose, throat, or airway. This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing. The formation of this coating (or membrane) in the nose, throat, or airway makes a diphtheria infection different from other more common infections (such as strep throat) that cause sore throat.
As the infection progresses, the person may:
- Have difficulty breathing or swallowing
- Complain of double vision
- Have slurred speech
- Even show signs of going into shock (skin that's pale and cold, rapid heartbeat, sweating, and an anxious appearance)
Causes
The bacterium Corynebacterium diphtheriae causes diphtheria. Usually the bacteria multiply on or near the surface of the mucous membranes of the throat, where they cause inflammation. The inflammation may spread to the voice box (larynx) and may make your throat swell, narrowing your airway. Disease-causing strains of C. diphtheriae release a damaging substance (toxin), which can also involve the heart, brain and nerves.
The bacteria may cause a thick, gray covering to form in your nose, throat or airway — a marker of diphtheria that separates it from other respiratory illnesses. This covering is usually fuzzy gray or black and causes breathing difficulties and painful swallowing.
You contract diphtheria by inhaling airborne droplets exhaled by a person with the disease or by a carrier who has no symptoms. Diphtheria passes from an infected person to others through
- Sneezing and coughing, especially in crowded living conditions (easily)
- Contaminated personal items, such as tissues or drinking glasses that have been used by an infected person (occasionally)
- Contaminated household items, such as towels or toys (rarely)
You can also come in contact with diphtheria-causing bacteria by touching an infected wound.
People who have been infected by the diphtheria bacteria and who haven't been treated can infect nonimmunized people for up to six weeks — even if they don't show any symptoms.
Test And Diagnosis :
Doctors may suspect diphtheria in a sick child who has a sore throat with a gray membrane covering the tonsils and throat. Doctors confirm the diagnosis by taking a sample of the membrane from the child's throat with a swab and having the sample grown (cultured) in a laboratory. Your doctor should notify the laboratory that diphtheria is suspected.
Doctors can also take a sample of tissue from an infected wound and have it tested in a laboratory, to check for the type of diphtheria that affects the skin (cutaneous diphtheria).
If a doctor suspects diphtheria, treatment begins immediately, even before the results of bacterial tests are available.
Complications
Left untreated, diphtheria can lead to:
- Breathing problems. Diphtheria-causing bacteria may produce a toxin. This toxin damages tissue in the immediate area of infection — the nose and throat, for example. This localized infection produces a tough, gray-colored membrane — which is composed of dead cells, bacteria and other substances — on the inside of your nose and throat. This tough membrane, or covering, is dangerous because it can obstruct breathing.
- Heart damage. The diphtheria toxin may spread through your bloodstream and damage other tissues in your body, such as your heart muscle. One complication of diphtheria is inflammation of the heart muscle (myocarditis). Signs and symptoms of myocarditis include fever, vague chest pain, joint pain and an abnormally fast heart rate. Damage to the heart from myocarditis may be only slight, showing up as minor abnormalities on an electrocardiogram, or very severe, leading to congestive heart failure and sudden death.
- Nerve damage. The toxin can also cause nerve damage, targeting certain nerves such as those to the throat, making swallowing difficult. Nerves to the arms and legs also may become inflamed, causing muscle weakness. In severe cases, nerves that help control the muscles used in breathing may be damaged, leading to paralysis of these muscles and trouble breathing.
Treatment
Diphtheria is a serious illness. Doctors treat it immediately and aggressively with these medications:
- An Antitoxin. After doctors confirm that a person has diphtheria, the infected child or adult receives a special antitoxin. The antitoxin neutralizes the diphtheria toxin already circulating in your body. The antitoxin is injected into a vein (intravenously) or into a muscle (intramuscular injection). But first, doctors may perform skin allergy tests to make sure that the infected person doesn't have an allergy to the antitoxin. People who are allergic must first be desensitized to the antitoxin. Doctors accomplish this by initially giving small doses of the antitoxin and then gradually increasing the dosage.
- Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill bacteria in the body, clearing up infections. Antibiotics reduce to just a few days the length of time that a person with diphtheria is contagious.
Children and adults who have diphtheria often need to be in the hospital for treatment. They may be isolated in an intensive care unit because diphtheria can spread easily to anyone not immunized against the disease.
Doctors may remove some of the thick, gray covering in the throat if the covering is obstructing breathing.
There may be other complications of diphtheria that need treatment. Inflammation of the heart (myocarditis) is treated with medications. In advanced cases, a person with diphtheria may need the assistance of a machine that helps them breathe (ventilator) until the infection is successfully treated.
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