Several decades ago, a highly infectious disease that affected the nose and throat was one of the highest cause of death in children. Because of immunization drives against the disease in the 1930’s, it has been all but totally wiped out today.
This infectious disease is called diphtheria, which is a contagion caused by the Corynebacterium Diphtheriae bacteria. It is passed from an infected person through coughing and sneezing, sending droplets from the nose and mouth into the air. Sometimes contaminated food, drink or contact with an infected person’s personal items can also spread the disease.
Diphtheria affects the mucous membranes of the nose and throat. It also infects the tonsils, pharynx, larynx, and sometimes the skin, as well. In its advanced stages, diphtheria can even damage the heart, kidneys and nervous system. It is considered a potentially fatal illness that kills 5% to 10% of infected persons.
The bacteria will multiply in the throat’s mucous membranes, causing inflammation. It takes 2 to 10 days for diphtheria to incubate inside a person before breaking out into symptoms. Signs of the disease begin with a sore throat, fever and chills, pain when swallowing, hoarseness of voice, excessive saliva, a barking cough, blood in the mucus discharges, swollen glands, body weakness, and sometimes even paralysis.
Diphtheria will also cause an infection of the nasopharynx, the upper part of the pharynx that connects to the nasal passages. The infected person will have difficulty in breathing because of a narrowing of the air passages and a thick, grayish, fuzzy membrane that coats the throat (pseudomembrane). This coating is what differentiates diphtheria from other respiratory illnesses. In some tropical countries where diphtheria occurs, a person with the disease will break out in skin lesions.
The bacteria that cause diphtheria can produce dangerous toxins that travel through the bloodstream. When this happens, complications occur, such as toxic damage to the heart muscles (diptheric myocarditis), and toxic damage to the peripheral nerves (neuritis). The kidneys can also become inflamed (nephritis), affecting their ability to filter toxins from the blood. Even when properly treated, one out of 10 patients eventually dies from Diphtheria.
DIPHTHERIA SIGNS AND SYMPTOMS
Sometimes an infected person will show little or no signs of the disease and instead become carriers of diphtheria. They are able to spread the infection around through nose and mouth discharges that spread the bacteria into the air.
Another type of secondary diphtheria affects the skin. This happens when an existing open wound is infected by the Corynebacterium Diphtheriae, the same bacteria which cause primary diphtheria. The wound turns red, painful and becomes swollen (cutaneous diphtheria). Like the tough, gray fiber-like covering that coats the throat in the respiratory form of the disease, the wound will grow spots of a sticky gray substance. There are some rare instances where diphtheria can also affect the eye.
DIPHTHERIA RISK FACTOR
Risk factors for contracting the disease include children younger than 5 years old and adults who are older than 60 who have not been immunized against the disease. Without immunization, repeat infections may occur. People who have weak immune systems or are undernourished are also liable to get this infectious disease. Diphtheria is usually rampant in crowded areas that have unsanitary conditions.
Diphtheria commonly occurs in tropical climates, particularly in developing countries with a low immunization rate. There have been cases of the disease in the United States, especially with tourists who travel to tropical countries without complete immunization, or from immigrants coming from tropical countries.
Consult your physician immediately if you start to exhibit symptoms of the disease or are exposed to anyone with diphtheria. This is especially important if children start showing symptoms and you are not sure whether they have been vaccinated against the disease.
Your doctor will subject you to a thorough physical exam which will include inspection of your mouth and throat. The doctor will be looking for the tell-tale gray membrane, distended lymph glands or a swelling of the neck and larynx. You may be ordered to take several tests like a Gram stain or throat culture to find traces of the Corynebacterium Diphtheriae bacteria, or an electrocardiogram (ECG) to see whether the bacteria has spread its toxins to your heart.
If it is a child who may have the disease, the doctor will confirm the diagnosis through a sample of fluid or membrane taken from a child’s throat using a cotton swab. This sample will be further examined in a laboratory. If you have an infected wound, your doctor may also take tissue samples for testing to check if you do have diphtheria of the skin.
Since diphtheria is a potentially fatal infection, your doctor will most likely recommend aggressive treatment. An infected child will be given an injection of an antitoxin to counteract the toxins secreted by the diphtheria bacteria. Your doctor will also give you an antibiotic prescription, like penicillin or erythromycin to prevent the disease from further developing and spreading. These antibiotics help stop the infection by eradicating the bacteria in your body. They will also lessen the length of time you spend being contagious. If you are a diphtheria carrier, you will also need antibiotics to rid your system of any traces of the disease.
To prevent the disease from returning, your doctor may recommend a booster shot of the diphtheria vaccine.
Hospital confinement will most likely occur during treatment for diphtheria. Your doctor will even require you to be isolated in intensive care to prevent the further spread of the disease. If you may already have complications, you will need separate treatment. One such complication is an inflammation of the heart, or myocarditis. Patients who have reached an advanced stage of the infection may be placed on a ventilator, a machine that aids in breathing, until the disease has been treated successfully and they can breathe properly on their own.
Although treatment methods are effective, recovery from diphtheria is a long and slow process. You are likely to need fluids through an IV line, bed rest for up to 6 weeks, heart monitoring, and even oxygen and breathing tubes. Frequent hand washing is required to avoid potential spreading of the infection. Because of throat pain and difficulty in swallowing, a soft diet and lots of liquids may be needed.
To control an epidemic of diphtheria, it will be best to undertake a mass immunization of the whole population in the area. If you have had contact with an infected person, seek medical advice immediately and get a prescription for antibiotic treatment.
Decades ago, before the discovery of antibiotics, diphtheria caused a high mortality rate in young children. Today, the disease can be prevented with a vaccine or treated with antibiotics.
Vaccinations against diphtheria are usually combined with tetanus and whooping cough (pertussis) vaccines, a three-in-one vaccine called DTP. There is a newer version of this vaccine available called the DTaP. This vaccine is normally administered to children in the arm or thigh, and is given at different stages of childhood: 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years old. It is also recommended to keep children up-to-date on their immunizations, especially before they start day care or school.
Fortunately, because DPT immunizations for children are common and routine in the United States, the Centers for Disease Control and Prevention (CDDP) report less than 5 cases of diphtheria diagnosed in the country each year. Booster shots against diphtheria are recommended every 10 years (the lifespan of its protective effect) to guard against any potential infection.
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