Diphtheria has become rare in Germany. However, it has not been completely eradicated, like smallpox, for example. It is usually introduced through travel to Eastern European countries or Third World countries. Diphtheria is a highly contagious bacterial infectious disease that begins with an inflammation of the respiratory tract. If not treated in time or left untreated, it can be fatal. It is transmitted by the toxin-producing “Corynebacterium diphtheriae” via droplet infection, i.e. when coughing, sneezing and speaking, very rarely also by smear infection. The bacterium causes local tissue destruction and produces a toxin that acts on the cardiac and nervous systems.
Diphtheria in Germany
In Germany, diphtheria has not been heard of for a long time. The last major epidemic (peak between 1942-1945) subsided until the 1960s. While 4,302 people died of diphtheria in the 1950s, only 273 people died in the 1960s. Thanks to high childhood vaccination rates, only isolated cases have been reported since 1984. However, due to vaccination gaps, it has reappeared more frequently in recent years. It is usually brought by travelers who have been in Eastern European or Third World countries.
Incubation period of diphtheria
The incubation period is usually two to five days. Affected persons are contagious as long as the pathogen can be detected in secretions and wounds. In the untreated, this period is two weeks; if the disease is treated with antibiotics, it is only two to four days.
Symptoms of diphtheria
After an incubation period of one to six days, the disease usually begins in the throat area with sore throat and swallowing pain, fever and fatigue. The typical white-yellowish coatings known as pseudomembranes form on the tonsils. A sweetish odor, which can already be perceived at some distance, is considered characteristic. If the larynx is affected, barking cough, hoarseness and loss of voice (so-called real croup) and increasing shortness of breath due to swelling of the mucous membranes are added. These swellings represent the actual threat to life. A typical symptom of laryngeal swelling is also a pulling breathing sound (stridor). In infants and young children, the nose is often affected (nasal diphtheria) with a purulent, bloody rhinitis. A rarer form of diphtheria is skin/wound diphtheria with skin ulcers and lesions. It occurs mainly in the tropics, and in Western countries particularly in certain groups of people, such as the homeless.
Complications
Toxins can be carried in the blood to organs distant from the site of inflammation, such as the heart, liver, or kidney. This can lead to the life-threatening complications. The most important, in addition to narrowing of the airways, are inflammation of the heart muscle and nervous system. Less common complications include kidney failure, encephalitis, cerebral infarction and pulmonary embolism.
Diagnosis of diphtheria
Because diphtheria is a very rare disease, many doctors have never seen it. In the early stages, it can easily be mistaken for tonsillitis, bacterial laryngitis, or pseudocroup. If a person has had contact with people who come from a diphtheria area, or has been there himself, it is essential that the doctor be made aware of this. Since a successful therapy depends on a quick diagnosis, the doctor must first rely on the visible symptoms. Then, to confirm the diagnosis, a throat swab is taken and bacteriologically tested in the laboratory. However, the results of the test can be expected after 12 hours at the earliest.
Treatment of diphtheria
Treatment is initiated as soon as it is suspected. An antidote (diphtheria antitoxin) must be given as soon as possible to neutralize the toxin. In addition, antibiotics (penicillin or erythromycin) are given for at least ten days. The patient must usually remain on strict bed rest for five to six weeks.
Vaccination against diphtheria
The best prevention is vaccination in infancy. Vaccination mode: from the beginning of the 3rd month of life, three times at intervals of six to eight weeks (depending on the vaccine combination), then the fourth vaccination is given from the 12th to the 15th month of life. The booster vaccination takes place from the 6th year of life and between the 10th and 18th year of life.But even in adulthood, a basic immunization (with three vaccinations) or a booster vaccination can be performed at any time. However, the disease or the vaccination do not leave a lifelong immunity. According to the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute, vaccination should be performed if basic immunization is missing or incomplete, or if the last booster vaccination was given more than 10 years ago.
Vaccination protection when traveling abroad
Vaccination protection among young children and preschoolers in Germany is very good at over 95%. However, the recommended booster vaccinations are often no longer carried out. And adults also often no longer take care of their booster at 10-year intervals. As a result, only about one-third of adults currently have safely protective antibodies. Vaccination protection should therefore be updated before traveling to one of the endemic areas. Important: With a one-time booster – with previous basic immunization – the complete vaccination protection is restored. If no basic immunization is available, travel to an infectious area should not be undertaken until after the 2nd vaccination at the earliest.
