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Diphtheria: Symptoms, Causes and Treatment

Diphtheria is a serious bacterial infection caused by Corynebacterium diphtheriae that primarily affects the upper respiratory tract and can be life-threatening if untreated.

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Things worth knowing about "Diphtheria"

Diphtheria is a serious bacterial infection caused by Corynebacterium diphtheriae that primarily affects the upper respiratory tract and can be life-threatening if untreated.

What is Diphtheria?

Diphtheria is a severe, potentially life-threatening bacterial disease that mainly affects the upper respiratory tract, including the throat, larynx, and nasal passages. It is caused by the bacterium Corynebacterium diphtheriae, which produces a powerful toxin capable of destroying local tissue and damaging vital organs such as the heart and nervous system. Due to widespread vaccination programs, diphtheria is now rare in many countries but remains a public health concern globally.

Causes and Transmission

Diphtheria is caused by the bacterium Corynebacterium diphtheriae. Transmission occurs mainly through:

Droplet infection: Coughing, sneezing, or close contact with an infected person.
Direct contact: Touching infected wounds or contaminated objects.
Asymptomatic carriers: People without symptoms can still spread the bacterium.

The diphtheria toxin produced by the bacteria is responsible for the most serious complications. It inhibits protein synthesis in cells, leading to tissue damage in the heart, nerves, and kidneys.

Symptoms

The incubation period is typically 2 to 5 days. Common symptoms include:

Sore throat and difficulty swallowing
Hoarseness and a characteristic barking cough
Formation of a gray-white, firmly adhering pseudomembrane in the throat or on the tonsils
Swelling of the neck, sometimes referred to as a bull neck appearance
Fever and general malaise
Difficulty breathing, potentially leading to life-threatening airway obstruction

In severe cases, the toxin can cause inflammation of the heart muscle (myocarditis), nerve damage (polyneuropathy), and kidney injury.

Diagnosis

Diagnosis of diphtheria is established through:

Clinical examination: Assessment of the characteristic pseudomembrane and neck swelling.
Throat swab and culture: Microbiological identification of the causative bacterium in a laboratory.
Toxin detection: Confirmation of diphtheria toxin production via PCR or the Elek test.
Blood tests: To assess inflammatory markers and organ function.

Suspected diphtheria cases must be reported to the relevant public health authorities without delay.

Treatment

Treatment must begin immediately and is carried out in a hospital setting:

Diphtheria antitoxin: A specific antidote that neutralizes circulating toxin. Early administration is critical to prevent organ damage.
Antibiotics: Penicillin or erythromycin are used to eliminate the bacteria and reduce the risk of transmission.
Intensive monitoring: Patients with airway obstruction may require mechanical ventilation or a tracheotomy.
Isolation: Infected individuals are isolated to prevent further spread of the disease.

Prevention and Vaccination

The most effective protection against diphtheria is vaccination. The diphtheria vaccine is typically given as part of a combination vaccine (e.g., with tetanus and pertussis). Recommended schedules include:

Primary immunization series starting at 2 months of age
Booster doses during childhood and adolescence
Booster doses for adults every 10 years

Vaccination provides highly effective protection and reliably prevents severe disease progression.

References

World Health Organization (WHO): Diphtheria. Immunization, Vaccines and Biologicals. Available at: https://www.who.int
Centers for Disease Control and Prevention (CDC): Diphtheria. Available at: https://www.cdc.gov
Loscalzo J, Fauci A, Kasper D et al.: Harrison's Principles of Internal Medicine. 21st edition. McGraw Hill, 2022.

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