A Family Doctor's Tale - DIPHTHERIA

DOC I HAVE DIPHTHERIA

Diphtheria is seldom seen because of the childhood vaccination regime which has been in place since the 1960.

It is a highly infectious disease which can cause a thick exudate in the throat and windpipe resulting in blockage of  breathing.

Treatment is by antibiotics and isolation in hospital.


Diphtheria is an acute, infectious childhood disease of the respiratory tract caused by the bacillus Corynebacterium diphtheriae, a Gram positive, non-sporulating aerobic micro-organism.



Diphtheria is transmitted by droplets from the throat of infected patients or clothes soiled by discharges from the patients.

It is highly infectious.

Incubation period is 2-4 days.

The organism multiplies in the upper respiratory tract, secreting toxins which produce necrosis and fibrinous exudate.
This fibrinous exudate can form a leathery membrane which extends through the throat, tonsils, nasopharynx, larynx and trachea.

Through the blood, the toxin can spread to the heart, nervous system and kidneys. Infections may also be localized in wounds in the skin,conjunctiva and rarely the vagina.

The infections occur in persons of all ages.

The incubation period is usually 2-4 days after contact with an infected patient.

Symptoms start off with:

1. sudden onset of malaise

2. mild fever

3. sore throat

4. Thick white or grayish tonsillar exudate

5. Membrane may spread to nasopharynx

5. cervical lymphadenopathy(enlarged lymph nodes in the neck)


6. difficult breathing

7. respiratory stridor,

8. hoarseness of voice

9. brassy cough

10.dilirium and coma

Complications of Diphtheria are:


The worst affected are children below the 1 year old.

Some serious complications are:

1.myocarditis

2.cranial nerve paralysis, especially the soft palate and oculomotor nerves

3.peripheral neuritis

4.laryngeal obstruction

5.death can occur if there is obstruction to breathing.

Serious complications are less with older children or adults.

Adults rarely get Diphtheria because their immunity from vaccination usually last 10 years after the last dose.

When adults get Diphtheria, there is only slight inflammation with little or no exudates.

Diagnosis of  Diphtheria is based on:


1.Pharyngeal and nasal swabs for culture in Loeffler medium

2.Methylene blue stain of membrane

Treatment of Diphtheria is by:


Isolation in hospital is necessary because of fear of infection.

1.Antibiotics (erythromycin or Penicillin) are used in the treatment of Diphtheria.

2.Antitoxin can be given by intramuscular or intravenous injection

3.Intravenous fluids given for dehydration

4.Tracheostomy if breathing obstruction is bad

5.Oxygen therapy in cases of breathing difficulty

6.Cardiac failure should be treated

Besides antibiotics, the following will help:

Steam inhalation


cough mixtures


avoid smokes, dust, dry air,sudden temperature change

Vaccination against Diphtheria is the best prevention .

Since vaccination began, the worldwide incidence of Diphtheria has declined.

Vaccination against diphtheria, pertussis (whooping cough), tetanus (DPT) is usually given to a baby at 3 months of age and repeated at 4 and 5 months of age.


There is also a booster vaccination at 18 months.

The prognosis in Diphtheria is generally good now as compared to 50 years ago.


Death occurs in 10% of cases.

Mortality is highest in children under 10 and adults over 50.

One attack usually confers immunity.