Diphteria

Cause

Diphtheria is caused by the bacterium Corynebacterium diphtheriae. This bacterium produces particular toxins, which cause damage to tissues (heart, kidneys and nerves). Diphtheria is contagious. People come into contact with the bacterium via coughing, wound discharge, contaminated milk and contaminated food. After infection with the bacterium, it generally takes two to five days before the first symptoms occur. If a person is infected with this bacterium, the disease can be transferred to others for up to four weeks after infection. If someone is carrier, this is even much longer. A person is carrier when he or she carries the bacterium itself, but doesn’t have any symptoms of diphtheria. Infants and the elderly are among the groups at risk.

Symptoms

In the beginning, people usually suffer from the following signs and symptoms:

• Difficulty swallowing.
• Sore throat.
• Nausea.
• Vomiting.
• Mild fever.
• Rapid heartbeat.
• Headache.

As the disease progresses, the symptoms increase. Patients can also get affected by:

• Tough, gray deposit on the tonsils (pseudo-membrane).
• Swollen throat, making breathing difficult.
• Runny nose.
• Damage to airway, heart muscle and nervous system.

Diagnosis

A doctor will suspect diphtheria in a patient with a sore throat and a pseudo-membrane, especially if the muscles of the face or throat are paralyzed and if the person has not been vaccinated. The diagnosis is confirmed by putting material from the patient’s throat on culture.

Treatment

Treatment of diphtheria is required, otherwise it can be fatal. Immediately after the diagnosis has been made, the patient will be hospitalized to start treatment. Because of the contagious nature of the disease, the patient is nursed in isolation.
Diphtheria is treated with the following medications:

• Diphtheria antitoxin. This drug will neutralize the bacterial toxins.
• Antibiotics. This combats the bacterium itself.

Recovery of diphtheria generally takes a long time. The body has been hit and should be able to slowly restore. Recovery will take longer if the heart muscle or nervous system are infected. In those cases, diphtheria can be fatal.
Children are vaccinated as standard against diphtheria. The diphtheria vaccine is usually combined with vaccines against pertussis, tetanus and polio, into the DTaP-IPV vaccine. When a person has received all these vaccinations, he or she is in principle protected against diphtheria for ten years. The vaccine is very effective.

Prognosis

With proper treatment and if no complications occur, the prognosis is good. The existence of a gray diphtheria membrane can be dangerous, because this membrane can overgrow the vocal cords and thus may cause choking hazard. The diphtheria bacteria can also cause an infection of the heart muscle (myocarditis) or damage the nervous system. A patient may be choking very much, looking cross-eyed or seeing less well. Then there may be muscle weakness of the limbs. These complications can be fatal.
In some cases of diphtheria, the bacterium can affect the cranial nerves, causing nasal voice, giving up food and making swallowing impossible. If also paralysis of the respiratory muscles occurs, this is fatal. When the patient survives the complications, he or she will cure gradually but completely.

Considerations

• When a person wants to travel to an area where diphtheria is still prevalent, he or she needs to be vaccinated again if the last vaccination was more than ten years ago.

Facts

• In 1826, the French doctor Pierre Bretonneau gave the name ‘diphteria’ to this disease.
• The vaccine against diphtheria became available in the fifties of the last century.
• The term ‘diphteria’ is derived from the Greek word diphthérā, diphtherís (skin, membrane, leather).
• In contrast to African countries, diphtheria is rare in most Western countries. This is due to the vaccination.
• The disease is most common in temperate regions during the winter months.