Diphtheria

Diphtheria is a contagious bacterial infection that typically affects your throat and nose. The bacterium releases a toxin that causes a buildup of grey tissue in your throat. This leads to problems with swallowing and breathing. It can affect other parts of your body, as well.

Diphtheria is treatable, but it can be life-threatening.

Diphtheria is very rare in the U.S. because of widespread use of the diphtheria (Tdap) vaccine and cleaner living conditions. The diphtheria epidemic peaked in 1921 in the U.S. with 206,000 cases.

In other countries with limited or no vaccines, the disease still exists. Diphtheria is endemic (an outbreak that’s limited to a certain region) in Southeast Asia, India and other parts of the world.

Types

There are two main types of diphtheria:

• Classical respiratory diphtheria: It may affect your nose, throat, tonsils or larynx (voice box). It’s the most common type.
• Skin (cutaneous) diphtheria: It causes a skin rash, sores or blisters. They can appear anywhere on your body. Cutaneous diphtheria is more common in tropical climates. Overall, it’s rare.

Symptoms of diphtheria

Common diphtheria symptoms include:

• Throat pain
• Weakness or fatigue
• Mild fever
• Swollen lymph nodes in your neck
• A thick, greyish coating on the back of your throat
• Problems breathing and/or swallowing

Symptoms of skin diphtheria can include:

• Painful open sore or ulcer
• Rash with scales or peeling skin
• Swelling and discoloration near the sore or rash

Signs of diphtheria usually show up around two to five days after exposure. But this can range from one to 10 days. Some people don’t have symptoms or have mild symptoms. But they can still spread the bacteria.

See a healthcare provider immediately if you have these symptoms or have been near someone with diphtheria.

Diphtheria causes

A bacterium called Corynebacterium diphtheriae causes diphtheria. The bacteria stick to the lining of your airways. They then make a toxin that damages your respiratory tissue cells.

Within a few days, a bulky, grey coating forms. It can cover tissues in your voice box, throat, nose and tonsils. Breathing and swallowing may become difficult. The toxins can damage other parts of your body, too.

If you don’t have the diphtheria vaccine and come in close contact with an infected person, you can develop the infection. You can get it through:

• Droplets in the air that contain bacteria (spread by sneezing, coughing and spitting)
• By touching something that has bacteria on it
• By touching an open sore on an infected person

Without vaccination, you can get diphtheria more than once.

Risk factors

A lack of the diphtheria vaccine and/or not having a booster shot are the main risk factors for having severe diphtheria symptoms. Other risk factors for severe disease include:

• Having a weakened immune system
• Being under age 5 or over 40

Risk factors for exposure include:

• Low herd immunity
• Traveling to endemic areas or those with outbreaks
• Living or working in overcrowded places

Complications of this condition

Diphtheria can lead to complications, like:

• Airway blockage, which can cause suffocation
• Heart muscle damage and heart failure
• Nerve damage
• Kidney failure

These complications can result in death.

How doctors diagnose this condition

Healthcare providers diagnose diphtheria based on your symptoms and the results of a lab test. They’ll use a swab to take a sample from the back of your throat (or a sore). A lab then tests the sample for the bacterium that causes diphtheria.

How is it treated?

Diphtheria treatment begins immediately — sometimes even before the lab test results come back. You may get diphtheria antitoxin to stop damage to your organs. You’ll also need antibiotics to fight the infection.

During treatment, you’ll stay in a hospital room by yourself (in isolation) to prevent others from getting sick. In most cases, you’re no longer contagious about 48 hours after starting antibiotics. But it takes about two to three weeks for treatment to be effective. Skin ulcers can take months to heal.

When treatment ends, your provider will run more tests to make sure the bacteria are gone.

When should I see my healthcare provider?

See your healthcare provider if you:

• Have questions about vaccination
• Were exposed to diphtheria
• Have symptoms of the infection
• Develop new or unexplained symptoms

What is the outlook for someone with diphtheria?

Treatment for diphtheria can be effective. But, even with treatment, it can still cause death.

One study estimates that the fatality rate of diphtheria is around 30% for people without vaccination and treatment. Children under 5 years old are at a higher risk of dying without vaccination and treatment.

Can this be prevented?

Yes. Vaccination is highly effective at preventing symptomatic diphtheria. The prevention rate is over 87% with three doses of the vaccine.

The U.S. uses three types of combination vaccines that include protection against diphtheria. They include DTaP, Tdap and Td. They protect you against multiple infections at once, like pertussis (whooping cough) and tetanus, too.

Talk to your healthcare provider about diphtheria immunization schedules. They can vary based on your age. Immunity can wear off over time, so you’ll need a booster about every 10 years if you’re an adult.

Many people have questions about vaccines. Healthcare providers welcome those conversations. They want you to feel confident in the decision you make.