Diphtheria Prevention

Though rare in the United States, diphtheria is a deadly infectious disease worldwide.

Diphtheria is a well-known infectious disease which has caused much sickness and death worldwide.

Before an effective vaccination was available, this was true in the United States as well. The microorganism responsible for this infection is Corynebacterium diphtheriae, and it tends to respond to treatment with either penicillin or erythromycin.

This is a reportable disease in the United States, and it is quite possible that the news media will also publicize occurrence of the disease in a community. Diphtheria is still endemic in several countries of Africa, the Americas, Asia/South Pacific, Middle East, and Europe as the vaccine may not be available in these regions.

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Initial clinical signs

It transmits via direct contact with respiratory secretions or skin lesions. When it infects the respiratory system, there may be fever, sore throat, and the presence of a fleshy, grey, firm membrane which covers the tonsils, pharynx, larynx, or nasal passages. It may even extend to the trachea. This is a pseudomembrane, and efforts to remove or dislodge it will likely result in bleeding.

Should the pseudomembrane extend to the trachea or larynx, the patient may suffer fatal airway obstruction.

Though the time necessary for the development of symptoms of diphtheria may range from 1 to 10 days, it usually takes 2 to 5 days for this to occur. In severe cases of the respiratory form of this disease, enlargement of the lymph nodes and swelling of the soft tissue of the neck may occur. Respiratory diphtheria always necessitates hospitalization.

The other form of diphtheria involves skin lesions, and it occurs via direct contact with another person who has it or rarely if one touches inanimate objects in the environment such as tables, chairs, or other items. The version with skin lesions, or cutaneous diphtheria, occurs more commonly in tropical regions of the world than in other areas where temperatures are low.

Diphtheria, therefore, is a medical condition which transmits person-to-person. One can also acquire diphtheria from food such as milk which may contain the microorganism. In rare instances, it may affect the eye, ear, or female reproductive tract.

Risk factors

Prior to the availability of immunization against diphtheria, children were especially susceptible to it. Several groups of people, however, are still prone to the acquisition of this disease. This includes people who travel to areas where the disease is endemic. Crowded environments and poor hygiene predispose to this disease, and lack of immunization will also place a person at risk.

Lack of immunization refers to individuals who have never had the vaccine, and it includes those who had the childhood primary vaccination series but who have not had boosters through the adult years. Adults in developing countries and in developed regions of the world who are at least 19 years old require a booster for tetanus and diphtheria every 10 years because the immunity from childhood vaccines declines with the passage of time.

Patients with immune system compromise will obviously be at risk for diphtheria. This includes patients who take long term corticosteroid therapy, immunosuppressive therapy after receipt of an organ transplant, elderly patients, pregnant women, and those with human immunodeficiency virus infection.

Even with adequate medical therapy today, five to ten percent of people who acquire respiratory diphtheria will not survive.

Sources

Centers for Disease Control. Diphtheria https://www.cdc.gov/diphtheria/index.html
U.S. National Library of Medicine. Medline Plus. Diphtheria. https://medlineplus.gov/diphtheria.html