Diphtheria

Overview

Diphtheria primarily affects the nose, throat and larynx. The toxins formed by the diphtheria bacteria can have a life-threatening effect on the breathing, cardiovascular and nervous systems. Typical symptoms include a barking cough, fever and a greyish white coating in the throat. Vaccination is recommended and is included in the Swiss vaccination schedule.

Symptoms

Depending on how it enters the body and the location of the bacteria/toxin, various symptoms appear after one to five days:

• Severely swollen, painful neck lymph nodes; completely swollen neck (“bull neck”)
• Very poor general condition, fever
• Breath smells weirdly sweet or rotten
• Muffled speech
• Croup, true croup:
  • Symptoms are often similar to those of pseudo croup
  • First symptoms: growing hoarseness and barking cough
  • Noises when inhaling
  • Difficulty swallowing (doesn't occur with pseudo croup)
  • As the disease progresses, possibly shortness of breath and choking fits (“true croup”)
• Pharyngeal diphtheria:
  • Inflamed, very red back of throat
  • Greyish white or brownish white, flat and sticky coating, also on the tonsils
  • Bleeding when trying to remove the coating
  • Swollen lymph nodes behind the angles of the jaw
• Nasal diphtheria:
  • Mainly affects babies and small children
  • Bloody and watery nasal discharge is typical
  • General condition is usually only slightly impaired
• Wound or skin diphtheria:
  • Ulcers displaying the typical coating described above (for pharyngeal diphtheria)
  • Often other bacteria are also involved
• Complications/spread through the body
  • Heart: myocarditis, heart arrhythmia
  • Nerves: inflammation and paralysis of nerves (e.g. soft palate, swallowing muscles, arms, legs)
  • Liver and kidney damage
  • General tendency to bleed
  • Multiple organ failure is possible

Causes and treatment

Cause

• Diphtheria is caused by a bacterium (Corynebacterium diphtheriae)
  • More or less eradicated in Europe thanks to good hygiene and consistent vaccination practices
  • Still found in parts of Eastern Europe and the Third World
• Spread through droplet infection (sneezing, coughing), rarely also through smear infection
• The toxin released by the bacteria triggers local cell death (necrosis) and causes the well-known symptoms

Further treatment by your doctor / in hospital

Possible tests

• Physical examination
• Swab to identify the pathogen (bacterial culture)
• Identification of diphtheria toxin

Possible therapies

• Early administration of antiserum (antitoxin) against the bacterial toxin
• Antibiotics to reduce bacterial multiplication
• Patient must always be isolated and admitted to hospital
• Intensive care measures
  • Intubation (artificial respiration) if there's a danger of suffocation
  • Acute cardiac insufficiency, heart arrhythmia or kidney failure

What can I do myself?

• Most important measure against diphtheria: vaccination
  • Standard vaccination included in the Swiss vaccination schedule
  • Combination vaccine against many diseases/pathogens
  • Urgently recommended
• Medical advice for travellers to third-world countries

When to see a doctor?

• High fever (above 38 degrees)
• Signs of shortness of breath
  • Skin and muscles around the ribs get sucked in when breathing
  • Bluish discolouration of the lips (cyanosis)
  • Fear of suffocation
• Muffled speech and rattling when breathing out
• Excessive salivation, difficulty swallowing
• Significantly accelerated pulse
• Disorientation
• Barking cough
• Severe throat pain with painful swelling
• Greyish/brownish white coating (throat, tonsils, skin)
• Symptoms appear during/after a trip to Eastern Europe (in particular Russia) or countries outside Europe

Further information

Diphtheria must be reported to the Federal Office of Public Health (FOPH)
www.bag.admin.ch/bag/en

Synonyms

diphtheria, true croup, croup syndrome