Diphtheria: Causes, Symptoms & Treatment

Diphtheria is a serious infectious disease that can be fatal if left untreated. In the past, children were most at risk for this disease, which can be rapidly transmitted from person to person through droplet infections such as sneezing and coughing. Typical signs include fever, shortness of breath and morbid breathing sounds.

What is diphtheria?

Diphtheria is an infectious disease caused by bacterial infection. It is the bacterium Corynebacterium diphtheriae. However, the peculiarity of this bacterium is that it can only break out when it can produce toxins (poisons). Toxins are able to affect the stability of the membrane in the cells and thus cause their destruction. The disease always manifests itself locally in the infected areas of the human organism, where it leads to inflammation, the final result of which is the death of the tissue.

Causes

The cause of diphtheria is always pathogens that cause infection. The pathogen is also the cause of toxin being produced and causing the infected cells to die. Droplet infection from person to person is responsible for passing the pathogen. This always happens by sneezing or also by coughing. In most cases, diphtheria is preceded by a cold. Basically, however, the toxins (poisonous substances) are the cause of the outbreak of the disease, because they produce the inflammation of the upper airways and drive it acutely. As a result, they also damage the mucous membranes and thus the whitish pseudomembrane is formed from dead tissue of the damaged cells. So it comes increasingly to the life-threatening respiratory problems and it is not uncommon to damage the heart and also the kidneys, nerves and vessels.

Symptoms, complaints and signs

Due to the bacterial toxin, diphtheria causes local damage, but also a systemic effect, that is, affecting the entire body. After an incubation period of two to seven days, the first symptoms appear. This involves sore throat and difficulty swallowing. Patients have a fever, feel very ill, are tired and listless. In most cases, diphtheria affects the nasopharynx. Here, yellowish-white coatings form on the pharyngeal tonsils, which slowly spread throughout the nasopharynx and can lead to the dreaded obstruction of the airways. These coatings are painless and begin to bleed when you try to brush them off. They are referred to as pseudomembranes. A sweet odor from the patient’s mouth, similar to that of fermenting apples, is characteristic. If the nose is involved, a bloody-sided rhinitis occurs. In some patients, there is marked swelling of the throat and lymph nodes, which is clearly visible externally, called Caesarean neck. This can also lead to narrowing of the airways. More rarely, the skin is affected by diphtheria. In skin diphtheria, pustules, blisters, skin ulcers and swellings occur. Feared consequences of the systemic spread of bacterial toxins are inflammation of the heart muscle with development of cardiac arrhythmias and nerve damage to the nerves in the head and neck area.

Course

The course of diphtheria is accompanied by planar coatings, the above-mentioned pseudomembranes. These are basically located on the tonsils, palate, uvula and also on the nasal mucosa. In a very severe course of diphtheria, the symptoms spread very quickly and patients complain of severe shortness of breath, as a result of high fever and severe vomiting. Swelling of the lymph nodes is also a common manifestation of diphtheria, and liver and kidney damage also occur in some cases during the course. Complications can also occur if diphtheria is not treated in a timely manner, these include palatal sail paralysis and myocarditis.

Complications

Because of the different forms and intensity of notifiable diphtheria, complications that occur are quite varied. In the most dangerous form, toxic diphtheria, constriction of the airways comes into effect despite treatment. The infection can quickly spread to other organs and affect the liver and kidneys. In this case, the poison leads to inflammation of the heart muscle, also called myocarditis, and can quickly lead to death without treatment. It is not uncommon for the toxin to attack the nervous system as well.In this case, the complications are manifested by paralysis of various muscles. If the eye muscles are affected, visual disturbances occur, and damaged facial nerves are manifested by rigid facial expressions. If pharyngeal or laryngeal diphtheria is present, the complications become apparent through swallowing and speech disorders. The inflammation caused by the infection can last for several weeks despite medical treatment. Furthermore, diphtheria can also lead to complications of the kidneys, and even the brain and heart valves can become inflamed by it, even though these occurrences are rather rare. Treatment must be started at the slightest suspicion of diphtheria to minimize the spread and complications.

When should you go to the doctor?

Diphtheria, also known as choking flu before the development of modern antibiotics, is a highly contagious and very dangerous bacterial infectious disease. If diphtheria is suspected, a doctor must be consulted immediately. This is also because the disease is notifiable in Germany. The attending physicians must report suspected cases as well as actual illnesses and deaths caused by the disease to the public health department. Diphtheria mainly affects children who are infected in kindergarten or school. Since the aggressive pathogens are already transmitted by coughing or sneezing, infection occurs very quickly if the child has not been vaccinated. Since the bacteria that cause diphtheria form dangerous toxins that can damage internal organs if adequate treatment is not given promptly, parents or educators should act quickly. However, the disease, which is now rather rare in Germany, is often mistaken in its early stages for a comparatively harmless tonsillitis, because in diphtheria whitish-yellow pseudomembranes form on the tonsils. In addition, there is usually fever, cough, hoarseness and foul breathing, which is not uncommon for tonsillitis. Since a misdiagnosed diphtheria can be life-threatening, parents should always consult a doctor promptly if they experience such symptoms. However, there is no reason to panic, since the disease is now really very rare.

Treatment and therapy

Even the mere suspicion of diphtheria must cause the attending physician to initiate a suitable form of therapy. Various forms of therapy are available to him, such as isolating the sick patient. Furthermore, therapy is carried out with an antidote, the diphtheria antitoxin, which should already be administered in the case of an existing suspicion. Therapy with antibiotics is mandatory if the previous forms of therapy are no longer effective. It is usually treated with penicillin or also with erythromycin, these drugs should kill the pathogens and prevent toxin formation. If the trachea is very swollen due to the acute formation of mucus, the patient’s breathing is severely restricted, in which case machine ventilation is used. For this purpose, however, patients must be placed in an artificial coma. Under no circumstances should any form of therapy be terminated too early. The rule here is that treatment for diphtheria must not last less than 50 days. The treating physicians always pay special attention to the heart, which is especially monitored during the entire therapy. This continuous guarding is therefore necessary, because despite early initiated therapy, the mortality still lies between five and ten percent of those affected.

Outlook and prognosis

Especially in industrialized countries, diphtheria has become rare due to the available vaccine. As a rule, only vaccine refusers are affected here. Decisive for the prognosis and course of diphtheria disease is, on the one hand, the time at which the diagnosis is made and, on the other hand, the general state of health of the affected person. The earlier the disease is diagnosed and treated with antibiotics, the better the chances of recovery. With timely treatment, cure of diphtheria is possible without consequences. Without treatment, the chances of survival of diphtheria are poor. In general, about 5-10% of people with diphtheria die despite treatment. It is dangerous in the course especially if there are complications under the disease.The obstruction of the airways can lead to suffocation if an artificial airway is not created in time. The spread of bacterial toxins can also lead to inflammation of the heart muscle, among other places. As a result, cardiac arrhythmias and even cardiovascular arrest can occur even after diphtheria has healed. Another danger is nerve damage to important cranial nerves. More rarely, permanent damage can result from kidney damage, inflammation of the brain, or strokes.

Follow-up

The measures of aftercare turn out to be very low in most cases of diphtheria. Thus, the early detection and treatment of the disease is in the foreground in this disease, so that it does not come to further complaints, complications and, in the worst case, to the death of the affected person. The earlier diphtheria is detected, the better the further course of the disease usually is. In order to prevent a recurrence of diphtheria, a vaccination against this disease should be given if possible. After the expiration of the vaccination, it must be refreshed again. The treatment of diphtheria is usually carried out with the help of medicines, mainly antibiotics are used. When taking the antibiotics, it is necessary to follow the doctor’s instructions so that no complications occur. They should not be taken together with alcohol, otherwise their effect is significantly reduced. In case of doubt or ambiguity, a doctor should always be contacted. Even after the symptoms of diphtheria have successfully subsided, treatment should still be continued. Even after treatment, further regular examinations of the body are usually still useful.

What you can do yourself

To prevent diphtheria, only a vaccination helps. This contains the weakened form of the diphtheria toxin as the active ingredient. Even though the disease has become rare, there is a risk that the pathogens are brought from endemic areas and lead to the disease or spread. Therefore, most parents have their children vaccinated when they are still infants. The intervals are listed in the vaccination calendar. Vaccinations begin in the child’s third month of life and continue in the fourth, fifth, and 12th and 15th months of life. The first booster vaccination is due in the 5th/6th year of life. Since there is no compulsory vaccination in Germany, the Standing Commission on Vaccination (STIKO) recommends a new booster vaccination for adolescents aged 9-17. Adults should get their booster vaccination every 10 years. Many neglect to do this in adulthood. However, booster protection is necessary because as the years go by, the antibodies present in the blood decrease. The immune system can no longer react adequately to pathogens. Those who have themselves and their families vaccinated also protect children who cannot tolerate vaccinations or are not allowed to receive them for medical reasons. This prevents them from contracting the disease from sick people, especially in public institutions. Self-help measures for diphtheria are not possible. If the disease is suspected, a physician should be consulted immediately, and persons in contact should also be treated.