Diphtheria causes, symptoms and treatment methods

Diphtheria is an infectious disease caused by a type of bacteria that primarily affects the upper respiratory system. It produces dangerous toxins that can impact the heart and nerves. Vaccination is the best way to prevent the disease, but despite this, there is still a risk in some areas due to low vaccination coverage. In this Dalili Medical article, we will explore the causes and symptoms of diphtheria, how it is diagnosed and treated, as well as the most important preventive measures that help limit its spread.

Is Diphtheria Contagious?
Yes, diphtheria is highly contagious! The disease spreads through:

• Airborne droplets when an infected person coughs or sneezes.
• Contact with contaminated personal items such as towels, cups, or personal utensils used by an infected person.

What Can an Infected Person Expect?
Treatment can be effective, but even with proper medical care, the fatality rate is 1 in 10 cases.
Without treatment, the disease is much more dangerous, with a 1 in 2 fatality rate!

Vaccination is the best solution, and anyone who is not vaccinated should visit the nearest healthcare center to get the vaccine as soon as possible.

Duration of Diphtheria

• Treatment Duration: Recovery typically takes two to three weeks after starting treatment.
• Skin Ulcers: If the infection affects the skin, healing may take two to three months.
• Scarring: In some cases, diphtheria skin ulcers may leave permanent scars.

What Is Diphtheria?
Diphtheria is a contagious bacterial infection caused by Corynebacterium diphtheriae. This bacteria releases dangerous toxins that form a thick gray membrane in the throat, which can lead to difficulty swallowing and breathing.

In warm climates, diphtheria can cause skin ulcers that take a long time to heal and are covered with a grayish layer. This type, known as cutaneous diphtheria, is more common in overcrowded areas with poor hygiene.

In the past, there was a major diphtheria outbreak in the United States, peaking in 1921 with around 206,000 cases. However, thanks to routine vaccinations, the disease is now very rare in most countries.

Ways Diphtheria Spreads

Diphtheria is highly contagious and spreads in various ways, especially in crowded areas or places with poor hygiene. The main transmission methods include:

1. Airborne Droplets (Coughing or Sneezing)

• When an infected person coughs or sneezes, they release bacteria-laden droplets into the air.
• A healthy person can inhale these droplets and become infected.
• This is the most common way the disease spreads, making isolation crucial for infected individuals.

2. Contact with Mucus or Saliva

• Touching the mucus or saliva of an infected person, such as when someone wipes their nose with their hand and then touches a surface.
• Infection can also spread through kissing or sharing eating and drinking utensils with an infected person.

3. Using Contaminated Personal Items

• Sharing spoons, cups, toothbrushes, or towels with an infected person can transfer the bacteria.

4. Touching Contaminated Surfaces

• The bacteria can survive for a short time on surfaces like tables, doorknobs, and toys.
• If someone touches a contaminated surface and then touches their nose or mouth, they may become infected.

5. Direct Contact with Infected Wounds (Cutaneous Diphtheria)

• In cases of skin diphtheria, bacteria are present in infected wounds.
• If someone touches these wounds directly or uses contaminated objects, the infection can spread.

6. Transmission from Asymptomatic Carriers

• Some individuals carry the bacteria without showing symptoms.
• They can unknowingly spread the disease to others.

Different Types of Diphtheria

There are two main types of diphtheria, classified based on the area affected by the bacteria:

1. Respiratory Diphtheria

This is the most common and severe type, affecting the respiratory system, especially the throat and tonsils. It occurs when bacteria produce toxins that form a thick gray or white membrane in the throat, leading to:

• Difficulty breathing
• Severe sore throat
• Swollen neck
• High fever

2. Cutaneous Diphtheria

This is a milder but still contagious form of diphtheria that affects the skin. It occurs when bacteria enter through wounds or scratches, causing:

• Open skin ulcers
• Peeling skin
• Localized infections

Other Rare Types of Diphtheria:

• Nasal Diphtheria: Affects the nose with mild symptoms but remains contagious.
• Ocular Diphtheria: Infects the eye, causing severe redness and inflammation.
• Genital Diphtheria: A rare form that affects the genital area in some cases.

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Causes of Diphtheria

The primary cause of diphtheria is the bacterium Corynebacterium diphtheriae, which spreads from person to person in several ways. The main risk factors include:

1. Infection from an Infected Person

• The bacteria spread through droplets released during coughing or sneezing.
• Direct contact with saliva or mucus from an infected person can cause transmission.

2. Contact with Contaminated Surfaces or Objects

• Sharing personal items like toothbrushes, spoons, or cups with an infected person can spread the bacteria.
• Touching contaminated surfaces that carry infected respiratory droplets.

3. Open Wounds or Skin Lesions

• If open wounds come into contact with diphtheria bacteria, cutaneous diphtheria infection can occur.
• This type spreads more easily in poor hygiene conditions.

4. Lack of Vaccination

• Unvaccinated individuals (who haven’t received the DTP or Td vaccine) are at a much higher risk.
• Children and elderly people with weak immune systems are at greater risk if they are not vaccinated.

5. Overcrowded and Unsanitary Environments

• The disease spreads more in crowded areas like schools and refugee camps.
• Poor personal hygiene and lack of handwashing contribute to the spread of infection.

Diphtheria Symptoms

Symptoms usually appear 2 to 5 days after infection and vary depending on the type of diphtheria (respiratory or cutaneous).

1. Respiratory Diphtheria Symptoms (Most Common)

• Severe sore throat and difficulty swallowing
• Thick gray or white membrane on the tonsils, throat, or nose
• Fever (high temperature)
• Swollen neck ("bull neck" due to enlarged lymph nodes)
• Dry cough and hoarse voice
• Breathing difficulties due to airway obstruction
• Foul-smelling nasal discharge (in some cases)
• General weakness and extreme fatigue

2. Cutaneous Diphtheria Symptoms

• Painful skin ulcers with a grayish crust
• Redness and swelling in the affected areas
• Localized skin infections
• Slow wound healing

Severe Complications If Left Untreated

• Heart problems (e.g., myocarditis)
• Nerve damage (can cause temporary paralysis)
• Blocked airway due to the thick membrane
• Death in severe cases, especially in children and the elderly

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Diphtheria Complications

If not treated quickly, diphtheria can lead to serious complications, particularly in children and elderly individuals. These complications occur due to toxins released by the bacteria, which affect vital organs.

1. Airway Obstruction

• The thick membrane in the throat and tonsils can block the airway, making breathing extremely difficult.
• This is one of the deadliest complications, and if untreated, it can cause suffocation.

2. Heart Problems

• Diphtheria toxins can reach the heart, leading to myocarditis (inflammation of the heart muscle), causing:
  • Irregular heartbeat
  • Heart failure
  • Sudden cardiac arrest

3. Nervous System Problems

• The toxins can attack nerves, causing temporary paralysis, usually affecting:
  • Swallowing and speech nerves, leading to difficulty eating and drinking
  • Peripheral nerves, causing weakness in the limbs
• In severe cases, paralysis of breathing muscles can be fatal without emergency medical intervention.

4. Acute Kidney Failure

• The bacterial toxins can damage the kidneys, leading to kidney failure, which can be life-threatening.

5. Septicemia (Blood Poisoning)

• In rare cases, diphtheria can spread into the bloodstream, causing septicemia, which can lead to organ failure and death.

6. Cutaneous Diphtheria Complications

• If infected wounds are not treated, they can lead to severe skin infections and secondary bacterial infections, spreading throughout the body.

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Who Is at Higher Risk for Complications?

• Children under 5 years old
• Elderly individuals
• People with weakened immune systems
• Unvaccinated individuals

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Diphtheria Diagnosis

If a doctor suspects diphtheria, they will perform several tests to confirm the diagnosis. Rapid diagnosis is crucial because diphtheria is dangerous and requires immediate treatment.

1. Physical Examination

The doctor will check for the classic diphtheria signs, such as:

• Thick gray or white membrane in the throat or tonsils
• Swollen neck (bull neck appearance)
• Severe sore throat with difficulty swallowing or breathing
• General weakness and extreme fatigue

2. Throat Swab Test (Bacterial Culture)

• A throat or nasal swab is taken and sent to the lab.
• The sample is placed on a special culture medium to check for diphtheria bacteria growth.
• Results take 24–48 hours, but if the case is severe, treatment starts immediately before confirmation.

3. Diphtheria Toxin Test

• If the sample is positive, an additional test may be done to see if the bacteria produce harmful toxins.

4. Blood Tests & Additional Examinations

In some cases, the doctor may order:

• ECG (Electrocardiogram): To check for heart complications.
• Blood tests: To assess the infection’s impact on the body.

Diagnosis of Cutaneous Diphtheria
The doctor takes a swab from the infected wounds and analyzes it in the laboratory to confirm the presence of the bacteria.

Is Diphtheria Still Present Today?
Diphtheria has become very rare in developed countries due to improved living standards and routine childhood vaccinations. However, in the past, it was a major cause of death in places like the United States before widespread vaccination programs were introduced.

In some countries without strong immunization programs, the disease still exists. This means there is still a global risk of its spread if vaccinations and international travel are not properly managed.

Where Is Diphtheria More Prevalent?
Diphtheria remains endemic in some parts of the world, meaning it is consistently present in certain regions. The disease is more commonly found in:

• Asia
• The Dominican Republic
• Eastern Europe
• Haiti
• The South Pacific
• The Middle East

Recommended Diphtheria Vaccination Schedule
Diphtheria vaccination is included in combination vaccines like DTP (Diphtheria, Tetanus, Pertussis) for children or Td (Tetanus, Diphtheria) for adults. Vaccination is crucial as it provides long-term immunity against the disease.

Vaccination Schedule for Children:

Age	Vaccine Type
2 months	First dose of DTP
4 months	Second dose of DTP
6 months	Third dose of DTP
18 months	Fourth dose of DTP (booster)
5 - 6 years	Fifth dose of DTP (booster before school)

Vaccination Schedule for Adolescents and Adults:

Age	Vaccine Type
11 - 12 years	Tdap booster dose
Every 10 years	Td booster dose to maintain immunity

Important Notes:

• If a person did not receive the vaccine during childhood, they need three doses of Tdap or Td at intervals determined by a doctor.
• Pregnant women are recommended to receive one dose of Tdap during each pregnancy to protect the newborn.
• The vaccine not only protects against diphtheria but also against tetanus and whooping cough (pertussis).

Conclusion:
Following the vaccination schedule is the best way to prevent diphtheria and stop its spread.

Diphtheria Treatment with Medications
Diphtheria treatment relies on a combination of antitoxin and antibiotics to eliminate the bacteria and prevent complications. These medications must be taken under medical supervision because the disease is severe and can lead to fatal complications.

1. Diphtheria Antitoxin

• The most important medication for diphtheria treatment, working to neutralize the toxins released by the bacteria before they cause heart or nerve damage.
• Administered via intravenous (IV) or intramuscular (IM) injection.
• A doctor may perform an allergy test before administration, as some patients may have allergic reactions.

2. Antibiotics

Antibiotics help kill the bacteria and prevent its spread. The most commonly used medications are:

Medication	Dosage & Administration
Erythromycin	40-50 mg/kg per day for 14 days (oral or IV)
Penicillin G	600,000 – 1,200,000 IU per day (IM or IV) for 10-14 days
Penicillin V	In mild cases, taken orally for 10 days

3. Supportive Medications for Symptom Relief

• Fever reducers and pain relievers (such as Paracetamol or Ibuprofen) to reduce fever and pain.
• Bronchodilators if the patient experiences severe breathing difficulties.
• IV fluids if the patient is unable to eat or drink due to throat inflammation.

4. Isolation and Preventive Treatment for Contacts

• The patient is isolated in the hospital for at least 48 hours after starting treatment.
• Close contacts must receive a preventive dose of Erythromycin or Penicillin, even if they have no symptoms.
• If contacts have not been vaccinated against diphtheria, they must receive the vaccine immediately.

Important Notes:

• Treatment should begin as soon as diphtheria is suspected, even before lab results confirm the infection, as it is a rapidly spreading and life-threatening disease.
• If complications affect the heart or nerves, intensive care may be required.
• After recovery, the patient must get vaccinated, as diphtheria does not provide long-term natural immunity.

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Herbal Remedies for Diphtheria: Are They Effective?

Diphtheria is a serious disease requiring immediate medical treatment with antitoxin and antibiotics. Delayed treatment can lead to fatal complications like heart problems, nerve damage, and respiratory failure.

However, some herbs may help relieve symptoms and support the immune system, but they should never replace medical treatment.

Herbs That May Help Relieve Symptoms

1. Ginger

   • Known for its antibacterial and anti-inflammatory properties.
   • May help soothe throat inflammation and strengthen immunity.
   • How to use:
     • Drink warm ginger tea with honey and lemon 2-3 times daily.

2. Garlic

   • A natural antibiotic that helps fight bacteria.
   • Has antiseptic and anti-inflammatory properties.
   • How to use:
     • Chew a raw garlic clove daily.
     • Mix crushed garlic with lemon juice and warm water and use as a gargle.

3. Turmeric

   • Contains curcumin, which has antibacterial and anti-inflammatory effects.
   • Helps boost immunity and reduce throat congestion.
   • How to use:
     • Drink turmeric milk (1 teaspoon of turmeric in warm milk).

4. Honey

   • A natural antibacterial and throat soother.
   • How to use:
     • Mix 1 tablespoon of honey in warm water or herbal tea.
     • Combine honey with lemon juice and consume slowly.

5. Basil Leaves

   • Helps reduce throat inflammation and fight bacteria.
   • How to use:
     • Boil basil leaves in water and drink it as tea.
     • Use basil water as a gargle.

6. Cinnamon

   • Contains antimicrobial compounds that help reduce inflammation.
   • How to use:
     • Drink cinnamon tea with honey.
     • Add cinnamon to warm milk or water.

Final Note:

While these herbs may provide symptom relief, they are NOT a substitute for medical treatment. Diphtheria is life-threatening and requires immediate antibiotic and antitoxin therapy under medical supervision.

Does Exercise Help in Treating Diphtheria?

Diphtheria is a serious disease that affects the respiratory system, heart, and nerves, and its primary treatment is antitoxin and antibiotics.

However, exercise is not part of the primary treatment for diphtheria because the disease causes severe weakness, breathing difficulties, and sometimes heart complications. Therefore, complete rest is recommended during the illness.

Why Is Exercise Not Recommended During Diphtheria?

• Severe fatigue and weakness: Diphtheria causes general body weakness, and exercise can increase exhaustion.
• Breathing difficulties: The disease can cause throat obstruction and difficulty breathing, and exercise may worsen the problem.
• Heart complications ❤️: Diphtheria can affect the heart muscle, making any intense physical activity extremely dangerous.

When Can Exercise Be Resumed After Recovery?

• After full recovery, a doctor may recommend light exercises like walking to regain physical strength.
• If the patient had heart or nerve complications, they must consult a doctor before engaging in any physical activity.

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Which Doctors Treat Diphtheria?

A doctor treating diphtheria is usually a specialist in infectious diseases or pediatrics, as the disease commonly affects children. However, in some cases, other specialists may be involved:

• Infectious disease specialist (for general treatment and management).
• Pediatrician (for treating children with diphtheria).
• ENT specialist (if breathing problems occur).
• Cardiologist ❤️ (if heart complications arise due to bacterial toxins).

What to Do If Diphtheria Is Suspected?

If diphtheria is suspected, the patient should go to the nearest hospital or healthcare center immediately to receive the appropriate treatment as quickly as possible.