Diphtheria (dif-THEER-e-uh) is a serious bacterial infection, usually affecting the mucous membranes of your nose and throat. The disease typically causes a bad sore throat, fever, swollen glands and weakness. Cutaneous, stool, and wound diphtheria are the most common types in the United States, often resulting from nontoxigenic strains. The GI and urinary tracts, conjunctivae, and ears seldom are involved.
Because of effective immunization, diphtheria has become rare in many parts of the world, including the United States. A massive and expanding epidemic of diphtheria in the former Soviet Union has been ongoing since 1990, especially in individuals age 15 and older. In the tropics, cutaneous diphtheria is more common than respiratory diphtheria. It's most likely to strike in areas where crowding and poor hygienic conditions prevail.
Diphtheria is caused by Corynebacterium diphtheriae, a gram-positive rod. Transmission usually occurs through intimate contact or by airborne respiratory droplets from apparently healthy carriers or convalescing patients. Many more people carry this disease than contract active infection.
Diphtheria is more prevalent during the colder months because of closer person-to-person contact indoors, but it can be contracted at any time of the year.
Diphtheria is highly contagious and is easily passed from the infected person to others
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.
In more advanced stages, the patient may have difficulty breathing or swallowing, complain of double vision, have slurred speech, or even show signs of going into shock (pale, cold skin; rapid heartbeat; sweating; and an anxious appearance).
Diagnostic testsCulture of throat swabs or of specimens taken from suspicious lesions that show C. diphtheriae confirms the diagnosis. Electrocardiogram abnormalities may indicate myocardium involvement.
Treatment of diphtheria is in hospital with diphtheria anti-toxin to neutralise the diphtheria toxins in the body and with antibiotics to kill remaining bacteria.
Patients are isolated and intensive care support may be needed if the heart, kidneys, or nervous system have been affected. Patients who have recovered are given a full course of diphtheria vaccine.
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:
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.
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