Diphtheria is a highly contagious infection caused by strains of bacteria called Corynebacterium diphtheriae, which produces a toxin that destroys healthy tissue within the upper airways causing a membrane to grow across the windpipe. It can also affect the skin causing blisters and ulcers. The disease spreads easily and happens quickly, and can affect all age groups, however unimmunized children, are particularly at risk. Moreover, adults over 60 years old, living in crowded or unclean conditions, and malnourishment are at risk for contracting the disease. In severe cases, the disease can lead to death due to damage to organs.
Situation at a glance
Although globally the incidence of diphtheria has reduced dramatically in the past five decades, recently, the Nigerian government confirmed the outbreak of diphtheria in 21 of the 36 states and the Federal Capital Territory. According to the Nigeria Centre for Disease Control and Prevention (NCDC), so far 1439 suspected cases of diphtheria have been reported, of which 557 (39%) were confirmed. Among the confirmed cases, 73 deaths (case fatality ratio of 13%) have been recorded due to the outbreak. Rural areas of Borno state were reported to be the most affected parts of the country in 2011.
Diphtheria bacteria can be spread from person to person, usually through inhalation of airborne droplets, like from coughing or sneezing, or by direct contact with infected patients by mucous secretions or skin ulcerations.
Sign and symptoms
Symptoms of diphtheria depend on the body part that is affected. However, the upper airways and the skin are commonly affected. When the bacteria infect the airways, it can cause sore throat, mild fever, swollen glands in the neck (bull neck), barking cough, wheezing, difficulty in breathing, tachycardia (racing heart), and weakness. The bacteria produce a toxin that destroys the healthy tissues lining airways and within two to three days, the dead tissue forms a thick, grey coating that can build up in the throat or nose, which can cover tissues in the nose, tonsils, voice box, and throat, resulting in breathing and swallowing difficulty. If the toxin gets into the bloodstream, it can cause heart, kidney, and nerve damage. When the bacteria infect the skin, it can cause open sores or ulcers. However, diphtheria skin infections rarely result in severe disease.
Diagnosis of diphtheria is made based on presenting signs and symptoms as described above, and a laboratory test. A swab sample is taken from the throat or a sore and analyzed for traces of Corynebacterium diphtheriae in the laboratory.
The treatment for diphtheria should begin immediately, sometimes even before the laboratory test results are confirmed. Diphtheria antitoxin is typically prescribed to stop damage to the organs. In addition, antibiotics, commonly penicillin or erythromycin, are prescribed to fight infection. Individuals with diphtheria are kept in isolation to prevent others from becoming infected. However, an infected person is no longer contagious around 48 hours after taking antibiotics. Surgery may be done to remove the grey membrane in the throat, if necessary. Diphtheria recovery necessitates adequate bed rest and if the heart is impacted, it is very essential to avoid any physical activity. In the short term, patients may need to supplement their nutrition with liquids and soft foods due to pain and difficulty swallowing. When treatment is completed, a test is repeated to ensure that the bacteria have been eliminated. Once the bacteria are gone, a vaccine is administered to prevent future infections .
Diphtheria can result in several long-term complications such as blockage of airways, myocarditis (damage to the heart muscle), polyneuropathy (nerve damage), lethargy (sluggishness), paralysis (being unable to move), and loss of lung function.
Prevention of diphtheria usually involves the administration of several vaccines, which are designed to prevent not only diphtheria but also to protect against multiple infections at once, such as pertussis (whooping cough) and tetanus.
- Centers for Disease Control and Prevention. National Center for Immunization and Respiratory Diseases (NCIRD) – Diphtheria.
- World Health Organization. Disease Outbreak News; Diphtheria – Nigeria.
Dr. Aminu Alhassan Ibrahim is a lecturer I in the Department of Physiotherapy, School of Basic Medical Science (SBMS), Skyline University, Nigeria. He obtained a Doctor of Philosophy (PhD) degree in Orthopaedic and Sports Physiotherapy from Bayero University, Kano, Nigeria, a Master of Physiotherapy (MPTh) in Orthopaedic Physiotherapy from SRM University, India, and a Bachelor of Physiotherapy (BPT) from Bayero University, Kano, Nigeria.
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