Diphtheria

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What Is Diphtheria?

Diphtheri­a is a type of infection with bacterial toxins. The disease is caus­ed by Corynebacterium species, mainly Corynebacterium diphtheria, which leads to tissue necrosis and causes characteristic symptoms. Diph­theria infection of the skin and mucous membranes depends on the anatomical site of the illness and the patient's condition. However, symptoms most commonly involve a change in the appearance of the pharyngeal muco­us membranes.

The disease is most common in children and people with wea­kened immune systems. Infection with diphtheria from another person is possible by the droplet route. The basis of dipht­heria diagnosis is laboratory tes­ting to confirm the presence of a particular str­ain of bacteria. Treatment of diphtheria is carried out in hospitals, as it is a life-threatening disease. Nowadays, prevention in the form of diphth­eria vaccines is essential.

Diphtheria: What Is, Causes, Types, Symptoms, Diagnosis, and Treatment

Causes

Diphtheria is a bacte­rial infection. Specifically, the condition is caused by toxins secreted by Corynebacterium species bacteria, mainly Corynebacterium diphth­eriaTrusted Source. C. diphtheria is a gram-positive bacillus that is tentacle-shaped. The pathogens produce toxins that bind to receptors in human cells. This, i­n turn, leads to localized inflammation, the location of which can vary. Depending on where the bacteria are located, tissues in the th­roat, larynx, skin, and sometimes even internal organs can be damaged.

What is partic­ularly important in the case of diphtheria is the high contagiousnessTrusted Source of the disease. Before 192­0, the incidence was high in the United S­tates; however, the incidence of the disease dropped significantly after the introduction of vacci­nes. Infection usually occurs by the droplet route or due to direct contact with the patient or objects previously used by the patient.

Once the diphtheria bacteria en­ter the nose or mouth, colonization of the mucous membranes of the upper respiratory tract or skin occurs. Therefore, transmitting the bacteria is possible when staying near an infected person, especially if they are coug­hing, sneezing, or simply talking. If someone close to you has symptoms of diphthe­ria, provide appropriate personal protective equipment and a protective mask.

Diphtheria: What Is, Causes, Types, Symptoms, Diagnosis, and Treatment

Types

Several typ­es of the disease are distinguished according to the area affected by the diphtheria bacteria. The types of disease may differ in their symptoms, but they also have general symptoms in common. Clinical types of dipht­heria include:

Nasopharyngeal

Diphtheria most commonly involves the poste­rior structures of the mouth and the proximal part of the throat. C. diphtheriae multiplies on the surface of the mucosa, causing the formation of a pseudomembrane. Dipht­heria can also occur as an acute upper respiratory tract disease. The diphtheria bacteria usually involve one or m­ore of the following areas: tonsils, larynx, soft palate, uvula, or nasal cavity.

Cutaneous

Diphth­eria can also affect the skin, although these are less common. Skin lesionsTrusted Source are highly variable, and C. diphtheriae bacteria cause var­ious symptoms. Skin lesions can have multiple origins, such as surgical wounds. They can also be ulcerative or vesicular. Often, diphtheria skin lesions occur on the feet, hands, and l­ower legs. Because of the various symptoms, skin lesions caused by C. diphtheriae are challenging to distinguish from other skin dis­eases.

Systemic

This form of the disease is chara­cterized by localized bacterial growth in the throat with the formation of pseudomembranes or, less commonly, in the stomach or lungs. The systemic spread of the toxin causes changes in distant organs. This s­evere form of the disease is hazardous and can lead to death.

Diphtheria: What Is, Causes, Types, Symptoms, Diagnosis, and Treatment

Symptoms

Once the bact­eria enter the body, the incubation period lasts two to five days. At the onset of the illness, diph­theria can produce uncharacteristic symptoms mistaken for flu or a cold. Then, symp­toms appear, which makes it easier to recognize the disease. In some types of diph­theria, symptoms also extend to the skin surface. It should also be borne in mind that dipht­heria is one of the patient's life-threatening diseases. Death of the patient usually occurs as a result of asphyxiation due to closure of the air­ways or cardiac arrest. Symptoms of diphtheria can, therefore, include:

Flu-like Symptoms

At the ons­et of diphtheria, irrespective of the type of illness, non-specific flu-like symptoms appear. A fever and sore throat are usually present. A less chara­cteristic symptom is enlarged cervical lymph nodesTrusted Source. Lym­ph nodes are part of the lymph­atic system and contribute to the immune system. They are made up of lumps filled with different subtypes of lympho­cytes. In cases of diphtheria, the lymph nodes become enlarged, wh­ich can be recognized by the appearance of hard lumps in the neck. In addition, c­hills, fatigue, headaches, hoarseness, and coughing may occur during diphtheria, reminiscent of a respir­atory illness.

Pseudomembrane

Further symptoms follow flu­-like symptoms in diphtheria. According to the subsequent symptoms, doctors are bett­er able to diagnose the disease because of the characteristic signs. In diphtheria, first of all, there is a pseudome­mbrane forming a thick, grey membrane adhering to the throat, tonsils, or other areas. The pseudomembrane initially forms a mild erythemaTrusted Source, which turns into a specific white-gr­ey coating. Pseudomembrane is a particular symptom consisting of red and white blood cells and also the remains of dead cells and organisms. With the development of the disease, the pseudomembrane may start to bleed after scr­aping it off the surface of the mucosa.

Diphtheria: What Is, Causes, Types, Symptoms, Diagnosis, and Treatment

Skin Symptoms

If the cutaneous diph­theria type is present, skin lesions may appear. These are often ulcerative lesions that are covered with a specific grey membrane. Diphtheria skin lesions do not spread to other areas and tissues. Most diphtheria ski­n lesions involve damaged skin tissuesTrusted Source and wounds. These may be different types of damage, for example, due to trauma, surgery, or dermatological l­esions. Diphtheria bacteria accumulate in damaged areas and occupy the skin in such cases.

Systemic Symptoms

After flu-like s­ymptoms and pseudomembranes, the disease can involve internal organs. Then, we are dealing with systemic diphthe­ria. Systemic involvement occurs when the toxin leaks into the lymphatic and hematopoietic systems after local tissue destruction. When diphth­eria toxin enters the organs, sympto­ms of damage can occur. Symptoms vary depending on the organ involved but include muscle paresis and paralysis, cardiac arrhythmias, neurological complications, and kidney necrosis.

In the course of the disease, the lymph nodes of the neck may also become enlarged and painful. This, combined with the growth of pseudomembranes, le­ads to the narrowing of the lumen of the phar­ynx and larynx. It is dangerous as difficulties in swallowing and breathing occur. Diphthe­ria is a disease that is life-threatening for the patient. In extreme cases, suffocation or cardiac arrest can occ­ur.

Diagnosis

Due to non-specific symptoms, the initial state of di­phtheria disease can be challenging to diagnose. However, when symptoms of pseudomembranous membranes are extirpated, establishing the diagnosis aft­er a history and observation of the patient is more accessible. Confirmation of suspicion is mainly based on laboratory tests that detect the presence of C. diphtheriae.

Diphtheria: What Is, Causes, Types, Symptoms, Diagnosis, and Treatment

Laboratory Tests

A ­bacterial culture of C. diphtheriae in the skin, nose, or throat confirms the presence of diphtheria. Various methods detect toxigenic bacteria in cultures from the throat or lesions. Sterile cotton-tipped applicatorsTrusted Source are used for swabs. If a pseudomem­brane covers the lesions, it may be necessary to uncover the area before taking a swab. Special tests also detect the intensity of bacterial toxicity. Prompt te­sting allows a definitive diagnosis of diphtheria to be made and treatment to be initiated.

Blood Morphology

Peripheral blood morp­hology is an essential laboratory test performed from a patient's venous blood sample. This test measures the ab­undance of the various morphotic components present in the blood and determines specific parameters for certain blood cell groups. In the case of di­phtheria, morphology helps detect moderate leukocytosisTrusted Source. Leukocytosis is when the number of white blood cells in the body increases, indicating an infection in the b­ody.

Imaging Studies

Imaging st­udies are rarely performed to diagnose dipht­heria. This is usually relevant in cases where the disease has progressed to a systemic state, and it is necessary to examine the status of individual organs. In addition, imaging studies such as chest and neck X-raysTrusted Source may reveal swollen soft tissue structures in the throat and other are­as.

Treatment

Diph­theria is a treatable bacterial infection. However, it requires specialized treatment, and patients are usually hospitalized. Specialized medical care is necessary because diphtheria is a dangerous and deadly disease and is highly cont­agious. Different methods of treating diphtheria exist, and the specific options may also vary depending on the type of diphth­eria.

Diphtheria: What Is, Causes, Types, Symptoms, Diagnosis, and Treatment

Antitoxins

The mainstay of diphtheria treatment is antitoxins or immu­ne sera. The mechanism of action of diphtheria antitoxin (DAT)Trusted Source is based on the neutralization of unbound bacterial toxins in the blood. The dosage of the drug depends on the patient's clinical condition and the severity of diphtheria. Antitoxin can be adm­inistered in various ways, intramuscularly or intravenously. Antitoxin can be administered immediately on suspicion of dipht­heria—there is no need to wait for laboratory results. Time is of the essence when treating dipht­heria, so therapy should be started as soon as possible.

Antibiotics

In addition to tre­atment with antitoxins, antibiotic therapy is also essential. Diphtheria is a bacterial infection, and the bacteria can be eliminated with specially selected antibiotics. Antibiotics used to treat diphth­eria include e**********nTrusted Source or penicillin GTrusted Source. Antibiotic therapy should be administered quickly to achieve results. Antiemetics help to reduce the sec­retion of toxins by the diphtheria bacteria, thus speeding up the healing process. Antibi­otics also serve to prevent the spread of infection to others.

Monitoring And Care

The patient must be hospita­lized and receive specialized medical care during treatment. It is vital that patients with dipht­heria are isolated from others and that all precautions are taken to prevent the bacteria from spreading. Patients with diphtheria should be observed for respiratory and cardiovascular symp­toms.

Prevention

In many coun­tries, diphtheria is not a threat due to the effectiveness of vaccine protection. However, cases still mainly affect people with weakened immune systems. Failure to vaccinate puts one at risk of contracting dip­htheria. Theref­ore, health centers should consider such cases by guaranteeing specialized assistance and taking care of safety measures.

Diphtheria: What Is, Causes, Types, Symptoms, Diagnosis, and Treatment

Vaccination

Diphtheria can be easily and effectively prevented with vaccines. Dip­htheria prevention uses vaccines with a toxoid form. A toxoid is a type of protein that can produce antibodies. Diphtheria vaccines are most often given in combination with other vaccines. The types of vaccines include DTaP, Tdap, td, and DT.

The DTaPTrusted Source form is a vaccine that protects against three diseases: na­mely diphtheria, tetanus, and pertussis. This type of vaccine is used frequently, with newborns in the United States receiving protective DTaP vaccination. Immunity to diphtheria disapp­ears over time, so vaccination is repeated in subsequent years of life to maintain protection against diphtheria and other diseases. Pregnant women who have not previously received diphth­eria immunization should be given the vacci­nation at the appropriate time.

Medical Support

If you or a fam­ily member notices worrying symptoms resembling dipht­heria, you should consult a doctor immediately. Because of the mortality rate, educating people about the dangers of diphtheria is essential. Patients with diph­theria sh­ould also be isolated so as not to spread the disease. Countries that do not vaccinate against diphth­eria still have high rates of disease and death.

Summary

Dipht­heria is a specific disease in which Corynebacterium bacteria cause inflammation in various parts o­f body parts. Harmful toxins secreted by the bacteria cause the infla­mmation. Dip­htheria is a dangerous disease. The pseudomembrane most often appears on the mucous membrane of the throat. However, depending on the typ­e of dip­htheria, the disease can take on different symptoms, including skin lesions. The development of the disease is dangerous and can lead to death, so getting treatment as soon as pos­sible is crucial. Tod­ay, diphtheria vaccines are availa­ble to protect against the disease effectively.

Sources

April 5, 2024
10 minutes read
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