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.
Diphtheria is rare in the United States and Europe, where health
officials have been immunizing children against it for decades.
However, it's still common in developing countries where
immunizations aren't given routinely. In 1993 and 1994, more
than 50,000 cases were reported during a serious outbreak of
diphtheria in countries of the former Soviet Union.
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)
In cases that progress beyond a throat infection, diphtheria
toxin spreads through the bloodstream and can lead to potentially
life-threatening complications that affect other organs of the
body, such as the heart and kidneys. The toxin can cause damage to
the heart that affects its ability to pump blood or the
kidneys' ability to clear wastes. It can also cause nerve
damage, eventually leading to paralysis. Up to 40% to 50% of those
who don't get treated can die.
Prevention
Preventing diphtheria depends almost completely on immunizing
children with the
diphtheria/tetanus/pertussis (DTP or DTaP)
vaccine and non-immunized adults with the diphtheria/tetanus
vaccine (DT). Most cases of diphtheria occur in people who
haven't received the vaccine at all or haven't received the
entire course.
The immunization schedule calls for:
- DTaP vaccines at 2, 4, and 6 months of age
- booster dose given at 12 to 18 months
- booster dose given again at 4 to 6 years
- booster shots given every 10 years after that to maintain
protection
Although most children tolerate it well, the vaccine sometimes
causes mild side effects such as redness or tenderness at the
injection site, a low-grade fever, or general fussiness or
crankiness. Severe complications, such as an allergic reaction, are
rare.
Contagiousness
Diphtheria is highly contagious. It's easily passed from the
infected person to others through sneezing, coughing, or even
laughing. It can also be spread to others who pick up tissues or
drinking glasses that have been used by the infected person.
People who have been infected by the diphtheria bacteria can
infect others for up to 4 weeks, even if they don't have any
symptoms. The incubation period (the time it takes for a person to
become infected after being exposed) for diphtheria is 2 to 4 days,
although it can range from 1 to 6 days.
Treatment
Children and adults with diphtheria are treated in a hospital.
After a doctor confirms the diagnosis through a
throat culture
, the infected person receives a special anti-toxin, given through
injections or through an IV, to neutralize the diphtheria toxin
already circulating in the body, as well as antibiotics to kill the
remaining diphtheria bacteria.
If the infection is advanced, people with diphtheria may need a
ventilator to help them breathe. In cases in which the toxins may
have spread to the heart, kidneys, or central nervous system,
patients may need intravenous fluids, oxygen, or heart
medications.
A person with diphtheria must also be isolated. Family members
(as well as others who spend a lot of time with the person with
diphtheria) who haven't been immunized, or who are very young
or elderly, must be protected from contact with the patient.
When someone is diagnosed with diphtheria, the doctor will
notify the local health department and will take steps to treat
everyone in the household who may have been exposed to the
bacteria. This will include assessment of immune status, throat
cultures, and booster doses of the diphtheria vaccine. They will
also receive antibiotics as a precaution.
Immediate hospitalization and early intervention allow most
patients to recover from diphtheria. After the antibiotics and
anti-toxin have taken effect, someone with diphtheria will need bed
rest for a while (4 to 6 weeks, or until full recovery). Bed rest
is particularly important if the person's heart has been
affected by the disease. Myocarditis, or inflammation of the heart
muscle, can be a complication of diphtheria.
Those who have recovered should still receive a full course of
the diphtheria vaccine to prevent a recurrence because contracting
the disease doesn't guarantee lifetime immunity.
When to Call the Doctor
Call your doctor immediately if you or your child has symptoms
of diphtheria, if you observe symptoms in someone else, if anyone
in your family is exposed to diphtheria, or if you think that you
or a family member is at risk. It's important to remember,
though, that most throat infections are
not
diphtheria, especially in countries that have routine immunizations
against it.
If you're not sure if your child has been vaccinated against
diphtheria, make an appointment. Also make sure your own booster
immunizations are current. International studies have shown that a
significant percentage of adults over 40 years of age aren't
adequately protected against diphtheria and
tetanus
.
Reviewed by:
Joel Klein, MD
Date reviewed: October 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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