What is Diphtheria? Symptoms and Treatment
Diphtheria is a serious bacterial infection caused by the microorganism Corynebacterium diphtheriae, affecting especially the throat and nasal mucosa, and most commonly seen in children. You can find answers to your questions such as what diphtheria means, what are the symptoms of diphtheria and how to cure diphtheria, in the rest of the article.
What is Diphtheria?
The infection, which was first described by Pierre Bretonneau in 1826, was named “Diphtherie”, which means “skin/covering” in Greek, because membrane formation was observed in the course of the disease. The microorganism that causes diphtheria was first produced in cultures by Loeffler in 1884, and within a few years, an antitoxin was developed to be used in treatment in response to the toxin produced by the microorganism.
From the 16th century to the 20th century, epidemics occurred due to diphtheria in many European countries and the United States, and thousands of people lost their lives as a result of these cases. By the 1980s, diphtheria had diminished its effectiveness, reaching the lowest number of cases of all time, and was seen in only 683 people in Europe. Two epidemics occurred in the former Soviet Republics between 1982-1985 and 1990-1995. More than 150,000 people have been affected by the epidemic.
Diphtheria is a rare but easily transmitted disease. If doctors do not think of the possibility of diphtheria during the examination, it delays the treatment of the disease and causes it to spread. In our country, within the framework of the “Turkey Vaccination Campaign” launched in 1985, vaccination rates were increased and an effective fight against diphtheria was achieved. Vaccinations administered since childhood have yielded their results, and there has been no diphtheria case in Turkey since 2002, except for one diphtheria case in 2011.
What Causes Diphtheria?
Diphtheria disease is caused by a toxin produced by the bacterium Corynebacterium diphtheriae. The toxin it produces is a protein that can easily enter the cell. A single molecule of this toxin can stop protein synthesis within a few hours, causing cell death. Doses as small as 0.1 µg/kg can kill a living thing if it is sensitive to it. Bacteria most commonly infect the nose and throat. The bacteria that settles in the throat and nasal mucosa spreads into the bloodstream with the toxin it secretes. It forms a gray membranous structure in the throat and nose. It causes the number of platelets, which enable blood clotting, to decrease. An abnormal increase is seen in the amount of protein excreted in the urine. Diphtheria, which can be transmitted through contact and air, can also cause necrosis by affecting tissues and nerves in advanced cases. It can lead to life-threatening complications such as myocarditis, stroke, and kidney failure.
What are the symptoms of diphtheria?
The most visible and common symptoms of diphtheria are:
- Gray-white membrane appearance in the throat and tonsils
- Fire
- Shake
- Swollen glands in the neck
- Cough
- drooling
- Sneeze
- Blockage
- runny nose
- Sore throat
- swollen glands
- Headache
- body aches
- Loss of appetite
- A general feeling of restlessness and discomfort
Symptoms of diphtheria usually appear within 2-5 days after infection occurs. In the beginning, a mild sore throat and low fever may occur, similar to a cold. After a few days, a clinical picture such as weakness, fatigue, sore throat, runny nose and high fever is observed. The most characteristic symptom of diphtheria is the formation of a gray or white, smooth, thick membrane in the throat. This membrane can be found in both tonsils or as a small spot on one tonsil. Bleeding may occur in the membrane from time to time. In patients with bleeding, the normally white-gray membrane appears dark red-black. In addition to local symptoms, general toxemia may occur due to bleeding. As the fever rises, the expanding membrane blocks the airway. Hoarseness and shortness of breath begin to occur.
As the infection progresses, additional symptoms may occur:
- Difficulty breathing and swallowing
- Nausea
- Vomiting
- vision problems
- speech disorder
- Pale and cold skin,
- excessive sweating
- rapid heartbeat
- symptoms of shock
- Soft palate paralysis
- acute heart failure
In rare cases, diphtheria can also be seen on the skin in the form of inflamed blisters on the legs and hands, or wounds that look like red, painful ulcers.
How Is Diphtheria Transmitted?
Diphtheria, popularly known as “silver disease”, can be easily transmitted from person to person through breathing or direct contact with skin lesions. Diphtheria can be transmitted to a healthy individual through the so-called droplet infection as a result of sneezing or coughing of an infected person. Bacteria are also spread by direct contact with personal items such as cups, pens, tissues, etc. used by the sick individual. Even if the patient’s complaints disappear, the risk of bacterial contamination continues until 6 weeks after the bacteria is ingested. Therefore, in order to prevent infection, close or direct contact should be avoided within the specified period, even if full recovery occurs.
How to Treat Diphtheria?
In diphtheria treatment, the primary goal is to prevent the spread of the bacteria. Antibiotic treatment is applied to remove the bacteria from the area and lose its effectiveness. Treatment with antibiotics such as erythromycin or penicillin usually lasts 2-3 weeks. In severe cases, antitoxin injection may be applied. Diphtheria antitoxin is a serum produced from horses. Antitoxin captures and neutralizes free circulating toxins. The dose and duration of antitoxin to be administered vary depending on the course and duration of the disease, location and size of the membrane. The person or people who come into contact with the infected person in diphtheria, which can be transmitted rapidly through respiratory tract, may also need to take antibiotics. In the treatment of diphtheria seen on the skin, in addition to diphtheria treatment, wounds must be thoroughly cleaned to reduce the risk of infection. It is also very important for people cleaning the wound to avoid direct contact. During treatment, your doctor may want you to stay in the hospital to avoid spreading the infection to others.
How Is Diphtheria Diagnosed?
The characteristic membrane image during physical examination based on the person’s complaints is sufficient for the diagnosis of diphtheria. In suspicious cases where the membrane structure is not visible, treatment is started immediately. For definitive diagnosis, swab samples taken from throat or skin wounds are cultured. The disease is diagnosed with the test results from the laboratory.
What is Diphtheria Vaccine?
Protecting against a disease is always more important than treating it. In line with this principle, the most important tool of preventive medicine is vaccination. Diphtheria is one of the diseases that can be prevented by vaccination. In our country, the diphtheria vaccine was administered as a single dose in 1937 and extremely effective results were obtained. The World Health Organization first started its Expanded Immunization Program to administer vaccines against diphtheria, whooping cough, tetanus, measles and tuberculosis in 1974. In our country, a combined vaccine (diphtheria-pertussis-tetanus vaccine) was applied in the 1970s. Since 2008, diphtheria vaccine has been administered as a 5-valent combination vaccine (DaBT-IPA-Hib) at the 2nd, 4th, 6th and 18th months of the newborn vaccination calendar. The protective effectiveness of the diphtheria vaccine was determined to be 97% in clinical findings. Diphtheria-tetanus vaccines, which provide protection for approximately 10 years, must be repeated every 10 years or when traveling to risky geographies.
Diphtheria vaccine should not be administered to people with a history of allergic reactions to vaccine ingredients. There is no obstacle for pregnant women to receive the vaccine.
The diphtheria vaccine, which is safe and highly effective against the disease, rarely has side effects. The most common side effects are regional reactions. Tenderness, skin rash, hardening of the skin and redness may occur in the area where the vaccine is applied. Although not common, fever has been observed in some people. Side effects that occur after vaccination resolve without requiring treatment.
Diphtheria, which has become very rare in the world due to vaccination in recent years, can still be seen in countries that are socio-economically underdeveloped and where vaccination is not sufficient in the society. It should not be forgotten that if there are symptoms that occur in case of travel to these countries or contact with suspicious people, a doctor should be consulted without neglecting it.
