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Diphtheria , is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity. A milder form of diphtheria can be restricted to the skin. It is caused by Corynebacterium diphtheriae, a facultatively anaerobic Gram-positive bacterium.
Diphtheria is a highly contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected individuals. Once quite common, diphtheria has largely been eradicated in developed nations through wide-spread vaccination. In the United States for instance, between 1980 and 2004 there have been 57 reported cases of diphtheria (and only five cases since 2000) as the DPT (Diphtheria–Pertussis–Tetanus) vaccine is given to all school children. Boosters of the vaccine are recommended for adults since the benefits of the vaccine decrease with age; they are particularly recommended for those traveling to areas where the disease has not been eradicated.
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-it is an infection caused by group A streptococcus bacteria,) 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.
The respiratory form has an incubation period of 2-5 days. The onset of disease is usually gradual. Symptoms include fatigue, fever, a mild sore throat and problems swallowing. Children infected have symptoms that include nausea, vomiting, chills, and a high fever, although some do not show symptoms until the infection has progressed further. In 10% of cases, patients experience neck swelling. These cases are associated with a higher risk of death.
In addition to symptoms at the site of infection (sore throat), the patient may experience more generalized symptoms, such as listlessness, pallor, and fast heart rate. These symptoms are caused by the toxin released by the bacterium. Low blood pressure may develop in these patients. Longer-term effects of the diphtheria toxin include cardiomyopathy and peripheral neuropathy (sensory type).
The cutaneous form of diphtheria is often a secondary infection of a preexisting skin disease. Signs of cutaneous diphtheria infection develop an average of seven days after the appearance of the primary skin disease
.A diphtheria skin lesion on the leg.
Causes:
Diphtheria is an infectious disease caused by bacterial microorganisms known as Corynebacterium diphtheriae. Other Corynebacterium species are responsible, too, but rarely.
Some strains of this bacterium produce a toxin – and infection with these toxigenic diphtheria bacilli is what leads to the most serious complications of diphtheria. The bacteria are toxigenic because they have become infected themselves by a certain type of virus.
The toxin that is released:
*Inhibits the production of proteins by cells
*Destroys the tissue at the site of the infection
*Leads to membrane formation – which leads to the telltale sign at the back of the throat
*Gets taken up into the bloodstream and distributed around the body’s tissues
*Causes myocarditis (inflammation of the heart) and neuritis (nerve damage)
*Can cause low platelet counts (thrombocytopenia) and produce protein in the urine (proteinuria).
Diphtheria is an infection spread only among humans – people are the only known reservoir for it. It is contagious via direct physical contact with:
*Airborne droplets. When an infected person’s sneeze or cough releases a mist of contaminated droplets, people nearby may inhale C. diphtheriae. Diphtheria spreads efficiently this way, particularly in crowded conditions.
*Contaminated personal items. People occasionally catch diphtheria from handling an infected person’s used tissues, drinking from the person’s unwashed glass, or coming into similarly close contact with other items on which bacteria-laden secretions may be deposited.
*Contaminated household items. In rare cases, diphtheria spreads on shared household items, such as towels or toys.
You can also come in contact with diphtheria-causing bacteria by touching an infected wound.
People who have been infected by the diphtheria bacteria and who haven’t been treated can infect nonimmunized people for up to six weeks — even if they don’t show any symptoms.
Diagnosis:
The current definition of diphtheria used by the Centers for Disease Control and Prevention (CDC) is based on both laboratory and clinical criteria.
Laboratory criteria
Isolation of Corynebacterium diphtheriae from a clinical specimen, or
Histopathologic diagnosis of diphtheria.
Clinical criteria
Upper respiratory tract illness with sore throat
Low-grade fever, and
An adherent pseudomembrane of the tonsil(s), pharynx, and/or nose.
Case classification
Probable: a clinically compatible case that is not laboratory-confirmed and is not epidemiologically linked to a laboratory-confirmed case
Confirmed: a clinically compatible case that is either laboratory-confirmed or epidemiologically linked to a laboratory-confirmed case
Empirical treatment should generally be started in a patient in whom suspicion of diphtheria is high.
Treatment:
The disease may remain manageable, but in more severe cases lymph nodes in the neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. In addition, an increase in heart rate may cause cardiac arrest. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in a hospital intensive care unit (ICU) and be given a diphtheria anti-toxin. Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration is associated with an increase in mortality risk. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.
Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends either:
Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
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Epidemiology:
Diphtheria is a serious disease, with fatality rates between 5% and 10%. In children under 5 years and adults over 40 years, the fatality rate may be as much as 20%. Outbreaks, though very rare, still occur worldwide, even in developed nations. After the breakup of the former Soviet Union in the late 1980s, vaccination rates in its constituent countries fell so low that there was an explosion of diphtheria cases. In 1991 there were 2,000 cases of diphtheria in the USSR. By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths. This was so great an increase that diphtheria was cited in the Guinness Book of World Records as “most resurgent disease”.
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.
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.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:
http://en.wikipedia.org/wiki/Diptheria
http://kidshealth.org/parent/infections/bacterial_viral/diphtheria.html
http://www.medicalnewstoday.com/articles/159534.php
http://www.mayoclinic.org/diseases-conditions/diphtheria/basics/causes/CON-20022303
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