Infectious Diseases

Diphtheria

What is diphtheria?

Diphtheria, a common childhood disease in the 1930s, is an acute bacterial disease that can infect the body in two areas:

• the throat (respiratory diphtheria)
• the skin (skin or cutaneous diphtheria)

A vaccine against diphtheria has made it very rare today in the US and other developing countries.

How is diphtheria transmitted?

The diphtheria bacterium can enter the body through the nose and mouth. However, it can also enter through a break in the skin. It is transmitted from person-to-person by respiratory secretions or droplets in the air. After being exposed to the bacteria, it usually takes two to four days for symptoms to develop.

What are the symptoms of diphtheria?

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

• respiratory diphtheria
  When a child is infected with diphtheria, the bacterium usually multiplies in the throat, leading to respiratory diphtheria. A membrane may form over the throat and tonsils, causing a sore throat. Other common symptoms of respiratory diphtheria may include:
  
  
  • breathing difficulty
  • husky voice
  • stridor (a shrill breathing sound heard during inspiration, or breathing in)
  • enlarged lymph glands of the neck
  • increased heart rate
  • nasal drainage
  • swelling of the palate (the roof of the mouth)
    
    

  Children 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 problems or medical conditions. Always consult your child's physician for a diagnosis.

How is diphtheria diagnosed?

A physician can usually diagnose the illness based on clinical examination. A swab culture of the mouth or affected mucous membrane may also be used to confirm the diagnosis.

Treatment of diphtheria:

Specific treatment for diphtheria will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

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

Prevention of diphtheria:

Children in the US are routinely given a triple vaccine that includes diphtheria in their first year. Because diphtheria still prevails in underdeveloped countries, the vaccine remains necessary in case of exposure to a carrier visiting from abroad.

Immunization against diphtheria, tetanus, and pertussis:

Diphtheria, tetanus, and pertussis vaccines prevent these diseases. Most children who receive all of their shots will be protected during childhood. A combination vaccine is given to babies and children and provides protection against all three diseases. There are several types of the vaccine:

• DTaP vaccine:
  
  
  • protects against diphtheria, tetanus, and pertussis.
    
    
  • is a newer form of the vaccine and is less likely to cause reactions than earlier types given.

When are DTaP vaccines given?

DTaP vaccines are given to babies and children at the following ages:

• 2 months
• 4 months
• 6 months
• 15 to 18 months
• 4 to 6 years

Children who are 11 to 12 years of age should receive a Td (tetanus and diphtheria) vaccine with a tetanus booster every 10 years thereafter.