An acute and highly contagious bacterial disease causing inflammation of the mucous membranes, formation of a false membrane in the throat which hinders breathing and swallowing, and potentially fatal heart and nerve damage by a bacterial toxin in the blood. It is now rare in developed countries owing to immunization. It is an infection caused by the bacterium Corynebacterium diphtheriae. Signs and symptoms may vary from mild to severe. They usually start two to five days after exposure. In severe cases a grey or white patch develops in the throat. The neck may swell in part due to large lymph nodes.
Symptoms: The symptoms of diphtheria usually begin two to seven days after infection. Symptoms of diphtheria include fever of 38 C (100.4 F) or above, chills, fatigue, bluish skin coloration (cyanosis), sore throat, hoarseness, cough, headache, difficulty swallowing, painful swallowing, difficulty breathing, rapid breathing, foul-smelling bloodstained nasal discharge and lymphadenopathy. Symptoms can also include cardiac arrhythmias, myocarditis, and cranial and peripheral nerve palsies.
Diagnosis: The current clinical case definition of diphtheria used by the United States' Centers for Disease Control and Prevention (CDC) is based on both laboratory and clinical criteria. Laboratory criteria . Isolation of Corynebacterium diphtheriae from a gram stain or throat culture from a clinical specimen, or Histopathologic diagnosis of diphtheria by a stain called "Albert's Stain". Clinical criteria ? Upper respiratory tract illness with sore throat .Low-grade fever (>102 F (39 C) is rare) ? An adherent, dense, grey pseudomembrane covering the posterior aspect of the pharynx. In severe cases, it can extend to cover the entire tracheobronchial tree.
Treament: Antibiotics have not been demonstrated to affect healing of local infection in diphtheria patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends ? Metronidazole ? Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or ? Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
Epidemology: In 2013 it resulted in 3,300 deaths down from 8,000 deaths in 1990. In children under five years and adults over 40 years, the fatality rate may be as much as 20%. In 1991, there were 2,000 cases of diphtheria in the USSR. By 1998, according to Red Cross estimates, there were as many as 200,000 cases in the Commonwealth of Independent States, with 5,000 deaths.