Corynebacterium diphtheriae is an organism that causes a severe swelling of the throat and tissue inflammation of the upper respiratory tract in humans. Commonly known as Diphtheria, this bacterial infection spreads quickly and easily. The toxin secreted by the bacteria damages the surrounding tissue and causes a membrane to grow - often blocking the airways and causing breathing/swallowing difficulties. Diphtheria is a serious pathogenic disease.

There are four known serotypes: gravis, mitis, intermedius and belfanti, Toxin-producing strains of C. ulcerans may also cause a diphtheria-like illness.

In its early stages, Diphtheria can be mistaken for a bad sore throat, strep throat or tonsilitus. A low-grade fever and swollen neck glands are the other early symptoms.

The toxin, or poison, caused by Corynebacterium diphtheriae bacteria usually attacks the tonsils first and causes fever, red sore throat, weakness, and headache. The toxin destroys the normal throat tissue, causing the throat to swell. As the tissue dies, the toxin forms a thick, grayish white or yellow membrane that may completely block the throat. Without treatment, the membrane will spread to cover the entire throat and larynx. The victim has difficulty breathing, swallowing, and talking without acute pain and possibly fever. The lymph glands in the neck become enlarged and swollen. The breath has an unpleasant, distinct odor. Supportive measures, such as inserting a breathing tube (intubation), may be necessary if the patient cannot breathe on their own or if there is the risk for airway obstruction.

In severe cases, Diphtheria toxin spreads through the bloodstream and can lead to potentially life-threatening complications as it affects other organs of the body, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys' ability to clear wastes. It can also cause nerve damage, leading to paralysis.

Overcrowding and poor living conditions can further contribute to the spread of diphtheria. The infection most often strikes before the age of 15 and is fatal in nearly 10 percent of cases, even if properly treated. Recovery tends to be slow in those who do survive.

It is usually spread through contact with infected people or things they have touched. Breathing the air contaminated by the coughing or sneezing from a sick individual is another means of transmission.

Who are at Risk?

Children under 5 and adults over 60 years old are particularly at risk for contracting the infection. People living in crowded or unclean conditions, those who aren't well nourished, and children and adults who don't have up-to-date immunizations are also at risk.

Diphtheria is rare in the United States and Europe, where health officials have been immunizing children against it for decades. However, it's still common in developing countries where immunizations aren't given routinely. In 1993 and 1994, more than 50,000 cases were reported during a serious outbreak of diphtheria in countries of the former Soviet Union.

Prevention

Although diphtheria is still a serious problem in many underdeveloped countries, active immunizations in many developed countries have helped to decrease the number of reported cases of diphtheria infection. Recent epidemics in Eastern Europe and Russia, combined with low levels of protective diphtheria antitoxin (DAT) in adult populations, have caused concern that outbreaks of diphtheria could occur in developed countries.

The immunization DPT (Diphtheria-Pertussis-Tetanus) vaccine is given to all U.S school children to help combat the infection.After the initial series of immunizations in childhood, booster shots of the diphtheria vaccine are needed to help maintain immunity.

Careful hand washing by everyone in your house is a good way to help avoid spread of the infection. Because of pain and difficulty swallowing, you may need to get your nutrition through liquids and soft foods for a while.

Diagnosis

The use of enzyme-linked immunosorbent assays for determining Diphtheria antibody levels has been evaluated as simple to perform, economical, and precise. Thus the "ELISA" diagnostic test is a very practical method.

The formation of this coating (or membrane) in the nose, throat, or airway makes a diphtheria infection different from other more common infections such as strep throat. The appearance of this membrane is important in making a visual diagnosis.

Treatment

An antitoxin. The antitoxin neutralizes the diphtheria toxin already circulating in your body. The antitoxin is injected into a vein (intravenously) or into a muscle (intramuscular injection). Initially, doctors may perform skin allergy tests to make sure that the infected person doesn't have an allergy to the antitoxin. Persons who are allergic must first be desensitized to the antitoxin. Doctors accomplish this by initially giving small doses of the antitoxin and then gradually increasing the dosage. Antibiotics. Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help kill many kinds of bacteria in the body (even good ones), clearing up infections. Antibiotics reduce the length of time that a person with diphtheria is contagious.

Children and adults who have diphtheria often need to be in the hospital for treatment. They may be isolated in an intensive care unit because diphtheria can spread easily to anyone not immunized. Doctors may remove some of the thick, gray covering in the throat if the covering is obstructing breathing.

Once you recover from diphtheria, it is a good idea to get a full course of diphtheria vaccine to prevent a recurrence. Having diphtheria doesn't guarantee you lifetime immunity. You can get diphtheria more than once if you're not fully immunized against it.

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