Diphtheria

Diphtheria is a preventable disease through vaccination. Proper immunization significantly reduces the risk of contracting diphtheria, even for individuals with certain risk factors. The likelihood of infection increases if you:

• Are unvaccinated or inadequately vaccinated
• Live in temperate or cold environments
• Frequently travel to areas where diphtheria is common
• Have close contact with someone infected with diphtheria
• Have a weakened immune system
• Live in overcrowded or unsanitary conditions

Diphtheria is more commonly seen in children but can also affect older individuals with underlying health conditions. People in low socioeconomic environments are also at a higher risk. Additionally, regions such as Southeast Asia, Russia, the Baltic states, and Eastern Europe report higher cases of diphtheria.

Physical Examination and Medical History

The physician usually begins by evaluating the patient's symptoms and medical history, particularly vaccination status and possible exposure to an infected person. The throat is checked for the characteristic gray or green membrane that suggests diphtheria.

Culture

A definitive diagnosis is confirmed through a throat swab or wound sample, which is sent to a lab to test for bacterial growth. This process may take time, so treatment is often initiated based on the physical exam findings.

Toxin Testing

• This test identifies the toxins produced by Corynebacterium diphtheriae. It helps differentiate between toxigenic and non-toxigenic strains and is performed using:
• Elek test
• PCR testing
• Enzyme immunoassay (EIA)

Blood Tests

• Complete Blood Count (CBC): Assesses the extent of infection by evaluating various blood parameters.
• Troponin I: A cardiac marker that helps determine the level of heart damage.
• Diphtheria Antitoxoid Antibody: Measures the levels of antibodies that can either be from prior infection or vaccination.

Imaging Studies

• Chest and Neck X-ray: These help identify swelling in the soft tissues around the pharynx, epiglottis, and chest.
• Electrocardiography (ECG): Performed when heart complications are suspected.

Specialists to Consult

Immediate medical attention is crucial to prevent systemic complications from diphtheria. Seeking timely treatment can improve recovery and reduce risks. You may need to consult:

• General physician
• ENT specialist
• Infectious disease specialist
• Pulmonologist

For heart-related complications, a cardiologist should be consulted. If the patient is a child, a pediatrician will be the most appropriate doctor for care.

Vaccination

Diphtheria is a preventable disease through vaccination. Before the diphtheria vaccine was introduced, it was a major cause of hospitalization and death, particularly among infants and children. Proper vaccination is the most effective method to prevent diphtheria and reduce its spread within communities.

Types of Diphtheria Vaccines

• DTaP Vaccine: Designed for young children, this vaccine provides protection against diphtheria, tetanus, and whooping cough.
• DT Vaccine: Protects young children against diphtheria and tetanus.
• Tdap Vaccine: Given to preteens, teens, and adults, this vaccine provides protection against diphtheria, tetanus, and whooping cough.
• Td Vaccine: Intended for preteens, teens, and adults, this vaccine helps protect against tetanus and diphtheria.

Things to Consider Before Vaccination

It is important to inform your doctor if:

• You are feeling unwell on the day of the vaccination.
• You have experienced severe reactions to any previous vaccines.
• You have any known allergies.
• You are pregnant.

Who Should Be Vaccinated?

• Babies and Children: Infants need three doses of the DTaP vaccine, with follow-up doses at ages 2, 4, and 6 months. The fourth dose is given between 15 and 18 months, and the fifth dose is given at 4 to 6 years.
• Pregnant Women: The Tdap vaccine is recommended during the third trimester of each pregnancy. This protects both the mother and the baby in the initial months of life.
• Preteens and Teens: A single dose of Tdap is recommended at 11-12 years old to boost immunity.
• Adults: If an adult has not received the Tdap vaccine previously, they can get it at any time. Following the initial dose, the Td or Tdap vaccine should be administered every 10 years.

Vaccination is also advised for:

• Individuals traveling overseas who haven’t had a diphtheria vaccine in the last 10 years.
• Laboratory workers who may come into contact with the bacteria that causes diphtheria.

Who Should Not Get These Vaccines?

Vaccines are generally safe and rarely cause severe reactions. However, they should not be given if the individual:

• Had a life-threatening allergic reaction to a previous vaccine dose.
• Has a severe allergy to any component of the vaccine.

Side Effects of Vaccination

Most people who receive the diphtheria vaccine experience no serious side effects. If any side effects do occur, they are typically mild and resolve on their own. Common side effects may include:

• Redness and swelling at the injection site
• Fever
• Loss of appetite
• Fatigue
• Vomiting
• Headache
• Chills
• Muscle aches

Managing the Side Effects

The side effects are usually short-lived and can be managed easily. They typically occur within the first 1-2 days following the vaccine. To alleviate discomfort, you can:

• Drink plenty of fluids
• Avoid overdressing children
• Take paracetamol (after consulting with a doctor) to manage fever or swelling at the injection site

If diphtheria is suspected, treatment usually begins even before laboratory results confirm the diagnosis to prevent further complications. The patient’s symptoms, general health, and age will be considered before starting treatment. The two main treatment options are:

Diphtheria Antitoxin (DAT):

The prompt administration of diphtheria antitoxin, either intravenously or intramuscularly, is the most effective treatment. It helps neutralize the unbound toxins produced by the bacteria. Antitoxins do not neutralize toxins already bound to tissues, which is why early treatment is critical to avoid complications.

Antibiotics:

Antibiotics are effective in the early stages of the disease before the bacteria release toxins into the bloodstream. They help:

• Reduce the amount of toxins circulating in the blood
• Accelerate recovery
• Prevent the spread of the infection

Common antibiotics used in treating diphtheria include erythromycin and penicillin G. In cases of antibiotic resistance, linezolid and vancomycin may be used. It is essential to complete the entire prescribed course of antibiotics to ensure the bacteria are fully eradicated from the body.

Additional treatment measures may include:

• Hospitalization: In severe cases, the patient may need to be hospitalized.
• Isolation: To prevent transmission, the patient may need to be isolated.
• Other Medications: Corticosteroids, adrenaline, or antihistamines may be used to address any severe reactions to the antitoxin.
• Tracheostomy: If the patient has severe breathing difficulties, a tube may be surgically inserted into the windpipe.
• Surgery: If necessary, surgery may be required to remove the thick gray membrane from the throat.
• Treatment of Complications: Medications may be needed to treat myocarditis (heart inflammation) or other complications.
• Bed Rest: Extended bed rest for one month or longer is often necessary for full recovery.
• Wound Care: For cutaneous diphtheria, cleaning sores with soap and water is essential.

The bacterial toxin produced in diphtheria can affect multiple organs and lead to serious complications after the pseudomembrane separates from the tissues in 7 to 10 days:

Cardiac Complications:

• Myocarditis (inflammation of the heart muscle)
• Cardiac arrhythmia (irregular heartbeat)
• Circulatory collapse
• The heart is usually the first organ affected, often in the second or third week.

Neurological Complications:

• Neuritis (which can lead to respiratory failure and pneumonia)
• Nerve weakness
• Encephalitis (rare in children)
• Oculomotor nerve palsy (involuntary eye movement)
• Reflux of food through the nose

Respiratory Obstruction:

• The pseudomembrane in the throat can block the airway, causing suffocation. This requires immediate mechanical ventilation or intubation.

Kidney Damage:

• The toxin can also damage the kidneys, impairing their ability to filter waste from the bloodstream.

Home Remedies

While diphtheria requires immediate medical attention to prevent life-threatening complications, certain home remedies can complement the prescribed treatment. It’s essential to consult a doctor before using any home remedies:

• Garlic: Chewing a garlic clove every 3-4 hours for a week may help reduce fever and soothe the throat.
• Pineapple: Pineapple juice, rich in bromelain, can help clear throat deposits and manage coughing.
• Basil Leaves (Tulsi): Known for its antibacterial properties, basil can help reduce respiratory infections. It can be consumed as water infused with basil leaves.
• Passion Flower: This herb can help alleviate diphtheria symptoms. Add a tablespoon of passion flower powder to boiling water, strain, and drink twice a day.
• Castor Leaves: With anti-inflammatory and antimicrobial properties, castor leaves can be taken orally. A paste of castor leaves, garlic juice, and drumstick leaves can be inhaled to clear the nasal passages.

Soft Food Diet

Due to the sore throat and difficulty swallowing caused by diphtheria, it is recommended to consume soft foods and liquids to make eating easier.

Self-Isolation

Diphtheria is highly contagious, so isolating the patient is crucial to prevent the spread of the infection to others.

Maintain Hygiene

Strict hygiene practices should be followed by those caring for the patient. Caregivers should wash their hands frequently, especially before handling food or the patient.

Vaccination

Even after recovering from diphtheria, the patient should receive a vaccination as there is a risk of reinfection. Caregivers and close contacts of the patient should also receive a booster shot.

Adequate Rest

Since recovery from diphtheria can be slow, especially if the infection was severe, patients should take proper rest for several weeks. Physical activity should be minimized, particularly if the heart has been affected by the infection.

Testing for Close Contacts

Anyone in close contact with the patient should get tested for diphtheria. If there is any suspicion of infection, treatment should begin, even for those who have been vaccinated.

Here are some tips to help manage life with diphtheria:

Choose Food Carefully

Patients often struggle to swallow due to the membrane in the throat. Soft foods and liquids are easier to consume. Including healthy foods like fresh fruits and vegetables in the form of juices or smoothies may speed up recovery.

Recommended Foods

• Fluids (juices)
• Milk
• Garlic
• Semi-solid foods (ice cream)
• Fruits and vegetables

Foods to Avoid

• Spicy foods
• Saturated oils and trans fats

Stay Hydrated

Drinking enough water, especially before bed, helps clear the throat and loosen mucus.

Rest Properly

Adequate rest is vital for recovery. Avoid vigorous exercise and allow the body to heal. Do not resume physical activities too soon, especially if the heart has been affected.

Sleep Properly

Avoid sleeping on the back to prevent mucus buildup in the throat. Use one or two pillows to elevate the head and open up the airways.

Practice Yoga

Breathing exercises like pranayama can aid in easier breathing. Yoga poses like sarvangasana and uttanasana can help relax the body and promote restful sleep.