Diphtheria

Overview

What is diphtheria?

Diphtheria is a contagious infection caused by a bacterium called Corynebacterium diphtheriae. The bacterium releases a toxin that causes the accumulation of gray tissue in the throat, leading to problems with swallowing and breathing.

In warmer climates, someone with diphtheria might also develop skin sores that will not heal and may be covered with the gray tissue. This type of diphtheria (called cutaneous diphtheria) also happens sometimes in the U.S. when people live in crowded and unhealthy conditions.

How common is diphtheria?

It is not common in the U.S. because living conditions have improved, and children are routinely given DPT vaccine (diphtheria/pertussis/tetanus). In the past, a large number of people died from diphtheria in the US. In other countries where vaccinations are not given, the disease still exists. Therefore, there is still a potential for diphtheria to cause problems in the U.S.

How does a person get diphtheria?

A person is infected with diphtheria through airborne spread of the bacteria (spread by sneezing, coughing and spitting) or by touching something that has bacteria on it. It is also possible that an infected person could transmit the disease through an open sore touched by someone else, or touching clothes that someone else touches. It is possible to get diphtheria more than once.

Symptoms and Causes

What causes diphtheria?

Diphtheria is caused by bacteria adhering to the lining of the respiratory system. These bacteria generate a toxin which damages tissue cells of the respiratory system. Within two or three days, the tissue left behind forms a bulky, gray coating. This coating has the potential to cover tissues in the voice box, throat, nose and tonsils. For the infected person, breathing and swallowing become hard to do.

What are the symptoms of diphtheria?

Symptoms of diphtheria include:

  • Having throat pain
  • Becoming weak
  • Having a fever
  • Having very swollen neck glands
  • Problems breathing due to tissues obstructing the nose and throat
  • Problems swallowing

An infected person typically shows signs of diphtheria around two to five days after exposure. The length of time for symptoms to show can be anywhere from 1 to 10 days after exposure.

In addition, the toxin can harm the nerves, kidneys or heart if bacteria enter the bloodstream,

Diagnosis and Tests

How is diphtheria diagnosed?

Your healthcare provider will make a diagnosis based on symptoms and a lab test. The provider uses a swab to take a sample from the back of the throat or from a sore. This swab then goes to the lab.

Management and Treatment

How is diphtheria treated?

If you are diagnosed with, or suspected of having diphtheria, the doctor will start treatment right away. Treatment can start even before the lab test results are confirmed. Your doctor will prescribe diphtheria antitoxin to stop damage to organs and antibiotics, typically penicillin or erythromycin, to fight the infection.

People with diphtheria are kept in isolation to prevent others from becoming infected. An infected person is no longer contagious around 48 hours after taking antibiotics. When treatment ends, tests will be run again to make sure the bacteria are gone. Once the bacteria are gone, you will get a vaccine to prevent future infections.

What are the complications associated with diphtheria?

Complications of the infection include:

  • Blockage of the air passages
  • Injury to heart muscle
  • Injury to nerves
  • Sluggishness or lethargy
  • Paralysis (being unable to move)
  • Lung infection or loss of lung function

Prevention

Who is at risk of developing diphtheria?

Anyone who is not protected by the vaccine and comes in close contact with an infected person can develop diphtheria.

Can diphtheria be prevented?

There are 11 different types of combination vaccines in the U.S. that are designed to stop diphtheria and tetanus. Protection against whooping cough (pertussis) is included in 8 of these vaccines. There are different schedules for getting the series of shots, including booster shots after the first ones are given.

In general, the side effects from the vaccines might include fever, pain or redness at the needle site, and rarely, an allergic reaction to the vaccine itself.

Outlook / Prognosis

What is the outlook for patients who have diphtheria?

Vaccination is the best choice. Treatment for diphtheria is effective, but even with treatment, roughly 1 out of 10 people might die. For those without treatment, 1 out of 2 patients may die.

Last reviewed by a Cleveland Clinic medical professional on 08/16/2018.

References

  • Immunization Action Coalition. Handouts: Vaccine Index. (http://www.immunize.org/diphtheria/) Accessed 8/20/2018.
  • Centers for Disease Control and Prevention. About Diphtheria. (https://www.cdc.gov/diphtheria/about/) Accessed 8/20/2018.
  • World Health Organization. Diptheria. (http://www.who.int/immunization/diseases/diphtheria/en/) Accessed 8/20/2018.
  • European Centre for Disease Prevention and Control. Diptheria. (https://ecdc.europa.eu/en/diphtheria) Accessed 8/20/2018.
  • BMJ Publishing Group. BMJ Best Practice. Diphtheria. (https://bestpractice.bmj.com/topics/en-us/738) Accessed 8/20/2018.

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