Diphtheria

What is diphtheria?

Diphtheria is an acute bacterial disease that can infect the body in the tonsils, nose, or throat (respiratory diphtheria) and/or the skin (skin or cutaneous diphtheria). A common childhood disease in the 1930s, a vaccine against diphtheria has made it very rare in the U.S. and other developing countries.

How is diphtheria transmitted?

The diphtheria bacterium can enter the body through the nose and mouth, causing respiratory diphtheria. It is transmitted from person to person by respiratory secretions or by breathing in droplets that contain diphtheria bacteria from an infected person when he or she is coughing or sneezing. It can also enter through a break in the skin and cause cutaneous diphtheria. After being exposed to the bacterium, it usually takes 2 to 4 days for symptoms to develop.

What are the symptoms of diphtheria?

The following are the most common symptoms of diphtheria. However, each individual may experience symptoms differently. Symptoms may include:

• Respiratory diphtheria. When a person is infected with diphtheria, the bacterium usually multiplies in the throat, leading to the respiratory version of diphtheria. A membrane may form over the throat and tonsils, causing a sore throat. Other common symptoms of respiratory diphtheria may include:

  • Breathing difficulty due to the presence of the membrane

  • Husky voice

  • Enlarged lymph glands

  • Increased heart rate

  • Stridor (a shrill breathing sound heard on inspiration)

  • Nasal drainage

  • Swelling of the palate (roof of the mouth)

  • Sore throat

  • Low-grade fever

  • Malaise

  Persons may die from asphyxiation when the membrane obstructs breathing. Other complications of respiratory diphtheria are caused by the diphtheria toxin released in the blood, leading to heart failure.

• Skin (cutaneous) diphtheria. With this type of diphtheria, the symptoms are usually milder and may include yellow spots or sores (similar to impetigo) on the skin.

The symptoms of diphtheria may resemble other medical conditions. Always consult your doctor for a diagnosis.

What is the treatment for diphtheria?

Specific treatment for diphtheria will be determined by your doctor based on:

• Your overall health and medical history

• Extent of the condition

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Penicillin is usually effective in treating respiratory diphtheria before it releases toxins in the blood. An antitoxin can be given in combination with the penicillin if diphtheria is suspected. Sometimes a tracheostomy (a breathing tube surgically inserted in the windpipe) is necessary if the patient has severe breathing difficulties.

How is diphtheria prevented?

In their first year of life, children in the U.S. are routinely given a triple vaccine that includes vaccine for diphtheria with several booster doses in childhood. This has made cases of diphtheria extremely rare in the U.S. Because diphtheria still prevails in underdeveloped countries, the vaccine remains necessary in case of exposure to a carrier (a person with diphtheria) who is visiting from another country.

The CDC recommends that children need five DTaP shots. A DTaP shot is a combination vaccine that protects against three diseases: diphtheria, tetanus, and pertussis. The first three shots are given at 2, 4, and 6 months of age. Between 15 and 18 months of age, the fourth shot is given, and a fifth shot when a child enters school at 4 to 6 years of age. At regular checkups for 11- or 12-year-olds, a preteen should get a dose of Tdap. The Tdap booster contains tetanus, diphtheria, and pertussis. If an adult did not get a Tdap as a preteen or teen, then he or she should get a dose of Tdap instead of the older type of booster shot (Td booster). Adults should then get a Td booster every 10 years, but it can be given before the 10-year mark. Always consult your doctor for advice.