DIPHTHERIA

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Last Updated : 4/6/2009
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Dr. Ira Shah
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What is diphtheria ?
Diphtheria is an infection caused by a bacteria known as corynebacterium diphtheriae (Klebs - Loeffler bacillus).

Is diphtheria common ?
Diphtheria is present worldwide and in the past has caused lot of deaths and epidemics. However with the advent of DPT vaccine and universal immunization of all children with DPT incidence of diphtheria has gone down considerably. The disease is now seen in unvaccinated children from developing countries.

How is diphtheria transmitted

?

Diphtheria bacteria can survive only in human beings. Diphtheria spreads by sneezing, coughing from an affected person (patient having diphtheria bug) to a susceptible patient. The peak incidence is during autumn and winter months. The disease is highly infectious and patient remains infected with ability to transmit the germ for 2 weeks or more.

What are the

symptoms of diphtheria

?

Diphtheria bacteria affect the nose, tonsils, throat, eye and wind pipe (breathing passage). Patients present with mild fever, cold, sore throat and difficulty in swallowing. Within 1-2 days, a white membrane appears on tonsils that may spread. The glands in the neck become swollen and enlarged giving a swollen neck appearance also known as "Bull neck". With severe disease, respiratory collapse and shock can occur. Due to the membrane spread, difficulty in breathing can also occur leading to suffocation.

How is the

diagnosis of diphtheria

made ?

Diagnosis of diphtheria is based on clinical examination and by isolating the germ from the throat.

What is the
treatment of diphtheria
?

Anti diphtheric serum (ADS) or Diphtheria immune globulin (DIG) neutralizes the diphtheria toxin that is responsible for the disease. It should be given as early as possible. Penicillin or erythromycin should be given 7-10 days to prevent the organism from persisting behind.
Patients with diphtheria should be hospitalized, isolated and treated with urgency. A careful monitoring for respiratory collapse, breathing difficulty and heart failure should be done. In patients with severe breathing difficulty a life-saving procedure called tracheostomy is required. This is a procedure by which a hole or opening is created straight in the windpipe to bypass the obstruction in the throat. Patients need bed rest for 2-3 weeks and need good nutritional support.

What are other
complications of diphtheria
?

Even after initial weeks of infection, diphtheria may lead to heart, nervous system, kidney and liver problems. Patients may present with heart failure, paralysis, kidney failure and hepatitis even after several weeks of initial infection. Hence early diagnosis and immediate treatment is essential.

How is diphtheria prevented ?
Diphtheria is prevented by DPT vaccine. All children should be given DPT vaccine at 6, 10 and 14 weeks of age with 2 booster doses at 18 months and 5 years of age.
For persons in contact with diphtheria patient, if the contact has been immunized with DPT, one need not worry and only a booster dose of diphtheria toxoid may be required.
If the contact is not given the vaccine, then the person should receive erythromycin or penicillin to prevent the disease.



Contributor Information and Disclosures Dr. Ira Shah
Consultant Pediatrician, B.J.Wadia Hospital for Children, Mumbai, India


First Created : 2/6/2001
References
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