Diphtheria is a serious bacterial infection that primarily affects the throat and respiratory system. Although rare in developed countries due to widespread vaccination, it remains a concern in certain regions where immunization rates are low. Understanding diphtheria’s causes and symptoms is essential because untreated cases can lead to severe complications, including heart failure, paralysis, and even death.
This disease spreads from person to person, mainly through respiratory droplets or direct contact with an infected individual. The bacteria produce a toxin that creates a thick, gray coating in the throat, making breathing difficult. While vaccination has significantly reduced diphtheria cases worldwide, outbreaks still occur, emphasizing the need for awareness and preventive measures.
In this article, we will explore what diphtheria is, its causes, symptoms, complications, diagnosis, treatment, and ways to prevent it.
What is Diphtheria?
Diphtheria is an infectious disease caused by Corynebacterium diphtheriae. It mainly affects the mucous membranes of the throat and nose, producing toxins that lead to inflammation and tissue damage. In severe cases, it can spread to other organs, causing life-threatening complications.
Historical Background
Before the introduction of vaccines, diphtheria was a major cause of illness and death among children. It was commonly referred to as the “strangling angel” due to the thick membrane it forms in the throat, leading to suffocation. Thanks to vaccination efforts, diphtheria has become rare in many parts of the world, but occasional outbreaks still occur.
Common Misconceptions
- Diphtheria is just a sore throat: While it starts with throat pain, it can quickly become life-threatening.
- Only children get diphtheria: While children are more vulnerable, unvaccinated adults are also at risk.
- Vaccination provides lifelong immunity: Booster shots are necessary to maintain immunity.
Causes of Diphtheria
The Role of Corynebacterium diphtheriae
Diphtheria is caused by the bacterium Corynebacterium diphtheriae. This bacterium releases a toxin that damages tissues in the respiratory tract, leading to severe inflammation and the formation of a thick gray membrane in the throat.
Modes of Transmission
Diphtheria is highly contagious and spreads in several ways:
- Airborne Transmission: Infected individuals release bacteria into the air when coughing or sneezing. Breathing in these droplets can lead to infection.
- Direct Contact: Touching an infected person’s wounds or nasal secretions can transfer the bacteria.
- Contaminated Surfaces: Objects like towels, utensils, or toys can harbor the bacteria, making it easy to spread.
Risk Factors for Diphtheria
Certain individuals are more susceptible to diphtheria due to various factors:
- Age: Children under 5 and adults over 60 are more vulnerable.
- Lack of Vaccination: People who have not received the diphtheria vaccine are at higher risk.
- Crowded Living Conditions: Diphtheria spreads quickly in overcrowded and unsanitary environments.
- Weakened Immune System: People with chronic illnesses or malnutrition have a harder time fighting infections.
Symptoms of Diphtheria
Early Symptoms
In the initial stages, diphtheria may resemble a common cold or flu. Symptoms include:
- Fever and Chills: A mild fever (101°F or lower) is common.
- Sore Throat and Hoarseness: Painful swallowing and difficulty speaking may occur.
- Fatigue and Weakness: The toxin released by the bacteria drains energy, causing extreme tiredness.
Severe Symptoms
If left untreated, diphtheria progresses to more dangerous symptoms:
- Thick Gray Membrane: A hallmark sign, this leathery coating forms over the throat and tonsils, obstructing breathing.
- Difficulty Breathing and Swallowing: The membrane can block the airway, leading to choking.
- Swollen Neck (Bull Neck): The lymph nodes enlarge, causing the neck to appear swollen.
- Heart and Nerve Damage: The toxin can reach the heart, leading to myocarditis (inflammation), or affect the nerves, causing paralysis.
Diphtheria is a medical emergency, and anyone exhibiting these symptoms should seek immediate medical attention.
Complications of Diphtheria
Diphtheria is more than just a throat infection—it can lead to severe, life-threatening complications if not treated promptly. The bacterial toxin spreads throughout the body, affecting vital organs like the heart, nerves, and kidneys.
Respiratory Complications
One of the most immediate dangers of diphtheria is airway obstruction. The thick, gray membrane that forms in the throat can grow large enough to block airflow, making breathing extremely difficult. In severe cases, emergency procedures such as a tracheostomy (creating an opening in the windpipe) may be required to restore breathing.
Heart Complications
Diphtheria toxin can enter the bloodstream and damage the heart muscle, leading to:
- Myocarditis (inflammation of the heart) – This can cause irregular heartbeats (arrhythmias) and heart failure.
- Cardiac arrest – In severe cases, heart function may decline rapidly, leading to sudden death.
Nervous System Complications
Diphtheria toxins can attack the nerves, leading to neurological issues such as:
- Paralysis – Temporary muscle paralysis, especially in the arms and legs.
- Swallowing difficulties – If the nerves controlling the throat muscles are affected, patients may struggle to eat or drink.
- Breathing problems – Paralysis of the diaphragm can make it hard to breathe, requiring ventilator support.
Kidney Damage
The bacterial toxin can also harm the kidneys, leading to kidney failure in extreme cases. The kidneys may stop filtering waste properly, leading to dangerous toxin buildup in the body.
How Diphtheria is Diagnosed
Since diphtheria symptoms can resemble other respiratory infections, proper diagnosis is essential. Doctors use several methods to confirm the presence of the bacteria.
Physical Examination
A doctor may suspect diphtheria based on visible symptoms, especially:
- A thick gray membrane in the throat
- Swollen lymph nodes in the neck
- Difficulty breathing
Laboratory Tests
To confirm diphtheria, medical professionals may perform:
- Throat Swab Culture: A sample is taken from the throat and tested for Corynebacterium diphtheriae.
- Blood Tests: These may be used to check for signs of infection and toxin-related complications.
Prompt diagnosis is crucial since early treatment can prevent severe complications.
Treatment of Diphtheria
Diphtheria is a medical emergency that requires immediate treatment. The main treatment approaches include:
Antitoxin Therapy
- The diphtheria antitoxin is administered as soon as diphtheria is suspected.
- It neutralizes the bacterial toxin before it causes further damage.
- Early administration is critical to prevent severe complications.
Antibiotics
Doctors prescribe antibiotics such as:
- Penicillin or erythromycin to kill the bacteria.
- A full course (10–14 days) is necessary to ensure complete bacterial eradication.
Supportive Care
Severe cases may require hospitalization, where patients receive:
- Oxygen therapy if breathing is compromised.
- IV fluids and nutritional support if swallowing is difficult.
- Mechanical ventilation in cases of respiratory failure.
Even with treatment, patients need weeks to recover fully, and they remain contagious until the bacteria are completely eliminated.
Prevention of Diphtheria
The best way to prevent diphtheria is vaccination. However, other preventive measures are also important.
Importance of Vaccination
Diphtheria vaccines are highly effective in preventing infection. The main vaccines include:
- DTaP vaccine (for infants and young children)
- Tdap vaccine (for adolescents and adults)
- Td booster shot (recommended every 10 years)
Maintaining Good Hygiene
Since diphtheria spreads through close contact, good hygiene practices help reduce transmission:
- Wash hands frequently.
- Avoid sharing utensils and personal items.
- Cover the mouth when coughing or sneezing.
Public Health Measures
- Quarantine: Infected individuals should be isolated until they are no longer contagious.
- Contact Tracing: People in close contact with an infected person should receive preventive antibiotics and a vaccine booster if necessary.
Conclusion
Diphtheria is a serious bacterial infection that primarily affects the throat and respiratory system. Although rare in vaccinated populations, it remains a risk in areas with low immunization rates. The disease is highly contagious and can lead to life-threatening complications such as heart failure, paralysis, and kidney damage.
Early diagnosis and immediate treatment with antitoxin and antibiotics are crucial for recovery. The best prevention is vaccination, which provides long-term protection against diphtheria.
While diphtheria is no longer widespread in many countries, staying up to date with booster shots and practicing good hygiene can help prevent its resurgence.
FAQs About Diphtheria
Q1: Can diphtheria be completely cured?
Yes, with early treatment using antitoxin and antibiotics, diphtheria can be cured. However, severe cases may cause lasting complications such as heart or nerve damage.
Q2: Is diphtheria still common today?
Thanks to vaccination programs, diphtheria is rare in many countries. However, it still occurs in areas where immunization rates are low.
Q3: Can vaccinated people get diphtheria?
Vaccinated individuals are highly protected, but immunity can weaken over time. That’s why booster shots are recommended every 10 years.
Q4: How long does diphtheria last?
Without treatment, symptoms can persist for 2 to 6 weeks, with a high risk of complications. With proper treatment, recovery can take a few weeks, depending on the severity of the infection.
Q5: What should I do if I suspect diphtheria?
Seek immediate medical attention. Diphtheria is a medical emergency, and early treatment is essential to prevent serious complications.