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Diphtheria

DEFINTION:

An acute illness caused by a toxin released from the bacterium Corynebacterium diphtheriae.

SYMPTOMS:

Cold symptoms including a runny nose and congestion, fever, sore throat, and difficulty breathing leading to stupor, coma or death.

CAUSES:

A toxin released from the bacterium Corynebacterium diphtheriae.

CONTAGION:

This is a contagious illness spread by coughing, sneezing or talking. The illness incubates over two to four days.

DIAGNOSIS:

A white membrane can be seen in the nose or mouth. When the membrane is scraped, bleeding occurs. This, combined with the symptoms, makes diphtheria a possibility. A culture for the bacteria from a scraping of the membrane will confirm the diagnosis.

TREATMENT:

The treatment depends on removing the toxin from the body. Giving anti-toxin does this. Antibiotics such as penicillin or erythromycin are also given to kill the bacteria producing the toxin. If the disease progresses, supportive measures can be taken such as fluids, bed rest and good nutrition.

OUTCOME:

Before anti-toxins and antibiotics were available, there was a 50% death rate. This was due to suffocation from the membrane covering the airway. With antibiotics and anti-toxins, the mortality rate is less than 5% and is due to complications such as myocarditis (heart disease). With vaccination, the illness is very rare.

DISCUSSION:

Diphtheria is being slowly eradicated due to vaccination although there is still a long way to go. The illness is highly contagious and susceptible individuals are at high risk. The illness usually starts as a simply cold but it can rapidly progress to the mouth and throat causing an obstructed airway. A white or gray membrane can be seen in the nose or mouth. If the illness is suspected, immediate treatment is necessary to prevent progression. Complications of the illness include airway obstruction, myocarditis (heart disease) and neurologic problems such as paralysis of the eyes, diaphragm and limbs. Once diagnosed both treatment and isolation are necessary. Any exposed individuals should receive diphtheria toxoid and a shot of penicillin. The vaccine is the only way to prevent contracting the illness. Vaccine is part of the DaPT given at two, four and six months of age with a booster dose at fifteen months and four years of age. Td (Tetanus diphtheria) booster shots are given every ten years, starting at eleven years of age. With vaccination the incidence of this illness has decreased from 70,000 cases per year to 2 cases per year.

ONE DOCTOR'S OPINION:

This disease is very rare now in the United States due to vaccination. The vaccine has no serious side effects and should be given to everyone. There are still outbreaks of this illness in Eastern Europe and Russia so we should not become complacent and miss the vaccine. This illness is so easy to prevent and so harsh if contracted that vaccination cannot be stressed too much. My advice is to vaccinate.