Symptoms
A few days after transmission of the diphtheria bacteria, the disease begins with sore throat and headache, nausea or vomiting, fever, and difficulty swallowing. Later, the typical symptoms appear:
- Hoarseness, up to voicelessness
- Whistling breathing (stridor)
- Barking cough
- Swelling of the lymph nodes and swelling of the soft tissues of the neck.
- Coatings of the mucous membrane
Diphtheria manifests as tonsillitis and/or pharyngitis with typical grayish-white, sweet-smelling coatings that can spread in the palate to the larynx and vocal cords. The coatings begin to bleed after they are removed and can close the airways to such an extent that the patient suffers severe respiratory distress or even suffocates. In infants and young children, nasal diphtheria usually occurs with a purulent, bloody rhinitis. This makes breathing through the nose difficult, the child becomes restless and sometimes refuses to eat. Rarely, skin or wound diphtheria also occurs, especially in the tropics.
Causes
The causative agent of diphtheria is the toxin-producing, gram-positive bacterium . Transmission occurs via droplet infection or direct contact. More rarely, in the infection is caused by other corynebacteria (, ). The incubation period is 2-5 days. The bacteria secrete a toxin into the host’s circulation.
Complications
Diphtheria toxin can cause severe complications such as myocarditis, circulatory failure, kidney and liver damage, inflammation of the trachea, respiratory distress, asphyxiation, or paralysis (soft palate paralysis, pharyngeal muscle paralysis, etc.) for weeks after infection. Mortality is relatively high, but can be significantly reduced by immediate administration of diphtheria antitoxin.
Diagnosis
The disease is diagnosed by medical treatment. A swab is taken from the throat or nasopharynx (under the membranes!). This provides cultural evidence of the pathogen and evidence of toxin-forming ability. Similar symptoms are caused by viral pseudocroup, streptococcal angina, oral thrush, and mononucleosis, among others.
Prevention
Extremely effective active vaccination with toxoid vaccine protects against the disease. It is inactivated diphtheria toxin (toxoid). It must be administered in infancy and is given in combination with vaccination against tetanus, pertussis, polio, and Haemophilius influenzae type b. Repeat vaccinations are required. See also under DTPa-IPV-Hib vaccination.
Nonpharmacologic treatment
To support drug therapy: bed rest, oral care with chamomile or sage tea, light, mushy diet, adequate fluid intake.
Drug treatment
Antidote (diphtheria antitoxin) is considered the first-line drug. It is antibody that neutralizes the circulating toxin and should be administered as soon as possible. Antibiotics are also used to prevent the proliferation of bacteria. At the same time, the disease is treated symptomatically. If severe, intensive medical intervention may be needed (e.g., intubation).
