The signs and symptoms typically presents within the first 2 to 5 days from infection. The symptomatology of the disease includes the following:

• Pseudomembrane formation (gray membrane covering the throat and tonsils) [8]
• Odynophagia (painful swallowing)
• Hoarseness of voice
• Adenopahty of the neck lymph nodes
• Dyspnea or tachypnea
• Oropharyngeal discharges
• Fever and chills
• Malaise
• Skin ulcers covered by a gray membrane

• Weakness

  Definitions noun Diphtheria is defined as an infectious disease, caused by the bacteria corynebacterium diphtheriae, with a high fever, weakness and difficult breathing and swallowing. [yourdictionary.com]

  In the backdrop of poor immunization coverage, non-existent adult boosters, weak case based surveillance and persistence of multiple foci, there is a heightened risk of re-emergence of the disease in epidemic forms in India. [ncbi.nlm.nih.gov]

  Muscle pain or weakness. Face muscle weakness or uneven smile. Very bad dizziness or passing out. What are some other side effects of Diphtheria and Tetanus Toxoids? All drugs may cause side effects. [drugs.com]

  Commonly affected organs include the heart and nervous system, leading to complications such as inflammation of the heart (myocarditis), cardiac rhythm and conduction disturbances, muscle weakness, numbness (nerve), and vision changes. [emedicinehealth.com]

• Chills

  Symptoms of diphtheria also include: a high temperature (fever) of 38C (100.4F) or above chills fatigue (extreme tiredness) sore throat hoarse voice cough headache difficulty swallowing or pain when swallowing difficulty breathing foul-smelling, bloodstained [web.archive.org]

  Constitutional signs of fever and chills can also be present. Diagnosis The diagnosis of diphtheria is done with the use of a detailed medical history and the careful physical examination of the throat. [symptoma.com]

  Meanwhile, during screening in the health camp at Gopanpally, the doctors referred five children to the Fever Hospital who had typical symptoms of Diphtheria including sore throat, fever and chills. [thehindu.com]

  Signs and Symptoms Diphtheria can cause a mild fever, a sore throat, and chills a few days after infection with the bacteria. A nasal discharge, fatigue, and a thick gray membrane covering the throat may develop as well. [healthychildren.org]

• Streptococcal Pharyngitis

  "Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis". Pediatrics. 126 (3): e557–64. doi:10.1542/peds.2009-2648. PMID 20696723. [en.wikipedia.org]

  Mild cases resemble streptococcal pharyngitis. The pseudo-membrane may be absent, especially in vaccinated cases. The severity of the disease depends on the toxigenicity of C. diphtheriae. [health.nsw.gov.au]

  The membrane bleeds when swabbed, unlike that in typical streptococcal pharyngitis or infectious mononucleosis. The onset is insidious, with early symptoms of malaise, sore throat, anorexia and low-grade fever (rarely >39.1 °C). [www2.health.vic.gov.au]

  Milder infections resemble streptococcal pharyngitis and the pseudomembrane may not develop, particularly where there has been previous vaccination. Carriers do not usually have any symptoms. [patient.info]

• Severe Pain

  People who are allergic to the vaccine or its ingredients People who are sick — wait until you get better Children who had brain or nerve damage within 7 days Ask a doctor if your child had severe pain or swelling after a vaccine, nervous system problems [immunizationinfo.com]

• Sore Throat

  He had a previous history of fever, severe sore throat and bloody nasal discharge. A throat swab was negative for Corynebacterium diphtheria; however, he had received antibiotics at a primary care clinic prior to presentation. [ncbi.nlm.nih.gov]

  Formerly known in England as the Boulogne sore throat, since it spread from France. [web.archive.org]

  Typical symptoms include a sore throat, general feeling of illness, and fever, sometimes with swollen lymph nodes, and a tough, gray pseudomembrane forms in the throat. [msdmanuals.com]

• Hoarseness

  We report a case of a 7-year-old unimmunized child who presented with a 2 week history of nasal quality speech, hoarseness of the voice, regurgitation of feeds, and unstable gait. [ncbi.nlm.nih.gov]

  Symptoms of diphtheria also include: a high temperature (fever) of 38C (100.4F) or above chills fatigue (extreme tiredness) sore throat hoarse voice cough headache difficulty swallowing or pain when swallowing difficulty breathing foul-smelling, bloodstained [web.archive.org]

  Symptoms usually occur 1 to 7 days after the bacteria enter your body: Fever and chills Sore throat, hoarseness Painful swallowing Croup-like (barking) cough Drooling (suggests airway blockage is about to occur) Bluish coloration of the skin Bloody, watery [nlm.nih.gov]

  Hoarseness, paralysis of the palate, or stridor (high-pitched breathing sound) are also clues. [medicalnewstoday.com]

• Nasal Discharge

  He had a previous history of fever, severe sore throat and bloody nasal discharge. A throat swab was negative for Corynebacterium diphtheria; however, he had received antibiotics at a primary care clinic prior to presentation. [ncbi.nlm.nih.gov]

  discharge swollen glands (nodes) in the neck pale, blue skin Diphtheria that affects the skin Diphtheria can occasionally affect the skin rather than the throat. [web.archive.org]

  A nasal discharge, fatigue, and a thick gray membrane covering the throat may develop as well. [healthychildren.org]

  Skin diphtheria causes a nasal discharge and excoriated skin around the nose. [healthcentral.com]

• Stridor

  The primary distinction: stridor is a sign of airway obstruction, whereas croup is a syndrome that can cause stridor. [web.archive.org]

  Other manifestations include cervical lymphadenopathy, soft tissue swelling of the neck, stridor, and/or difficulty breathing as a result of partial airway obstruction. [amboss.com]

  […] swallowing Croup-like (barking) cough Drooling (suggests airway blockage is about to occur) Bluish coloration of the skin Bloody, watery drainage from nose Breathing problems, including difficulty breathing, fast breathing, high-pitched breathing sound (stridor [nlm.nih.gov]

  Local edema may cause a visibly swollen neck (bull neck), hoarseness, stridor, and dyspnea. The membrane may extend to the larynx, trachea, and bronchi and may partially obstruct the airway or suddenly detach, causing complete obstruction. [msdmanuals.com]

• Dyspnea

  Symptoms include formation of an inflammatory pseudomembrane, fever, sore throat, headaches, coughing, dysphagia, dyspnea, and prominently swollen cervical lymph nodes. [orpha.net]

  The symptomatology of the disease includes the following: Pseudomembrane formation (gray membrane covering the throat and tonsils) Odynophagia (painful swallowing) Hoarseness of voice Adenopahty of the neck lymph nodes Dyspnea or tachypnea Oropharyngeal [symptoma.com]

  Croup usually is self-limiting; dyspnea and stridor typically arise as the patient starts to recover from the illness. Respiratory distress from croup varies from mild to moderate; it rarely progresses to upper airway obstruction. [web.archive.org]

  Oxygen is administered as necessary to relieve dyspnea and cyanosis. Cardiac complications are usually more severe in adults; thus the convalescent period is extended for these patients. Prevention. [medical-dictionary.thefreedictionary.com]

  Local edema may cause a visibly swollen neck (bull neck), hoarseness, stridor, and dyspnea. The membrane may extend to the larynx, trachea, and bronchi and may partially obstruct the airway or suddenly detach, causing complete obstruction. [msdmanuals.com]

• Vomiting

  Severe symptoms can include choking, vomiting, or brain damage; infection can even lead to death. How is it spread? Whooping cough is spread by coughing or sneezing. [immunize.ca]

  These can be followed by difficulties in breathing and swallowing, and vomiting. Immunization: The diphtheria vaccine utilizes an inactivated diphtheria toxin that enables the body to neutralize the poison. [unicef.org]

  […] few weeks.[3] The vaccine is safe during pregnancy and among those who have a poor immune function.[3] DTP vaccines may cause additional adverse effects such as fever, irritability, drowsiness, loss of appetite, and, in 6–13% of vaccine recipients, vomiting [en.wikipedia.org]

  ‘Possible reactions to immunisation against diphtheria and tetanus and pertussis include fever, vomiting, and listlessness.’ [oxforddictionaries.com]

• Nausea

  In respiratory tract infections, the main symptoms are sore throat and fever, sometimes accompanied by nausea, vomiting, headache, and swelling of the neck. [redplanet.travel]

  […] treatment Responses to combined vaccines (DTaP, Td, Tdap) Common responses Decreased appetite Vomiting or diarrhoea Irritability, restlessness Unusual crying Limb swelling after the 4th or 5th vaccine dose Muscle or joint stiffness or pain Headache or nausea [immune.org.nz]

  Children may also have a fast heart rate, nausea, vomiting, chills, and a headache. The lymph nodes in the neck may swell (called bull neck). The inflammation may make the throat swell, narrowing the airway and making breathing extremely difficult. [msdmanuals.com]

  Mild side effects of Tdap may include : Pain, redness, or swelling in the arm where the shot was given Mild fever Headache Tiredness Stomach upset, including nausea, vomiting, or diarrhea Muscle aches and pains Swollen glands Continued Mild side effects [webmd.com]

• Dysphagia

  We present a case of a Caucasian woman aged 67 years referred with a 4-day history of sore throat, dysphagia, fever and nasal blockage. Examination revealed a swollen neck and pharyngeal pseudomembrane. [ncbi.nlm.nih.gov]

  Symptoms include formation of an inflammatory pseudomembrane, fever, sore throat, headaches, coughing, dysphagia, dyspnea, and prominently swollen cervical lymph nodes. [orpha.net]

  After an incubation period, which averages 5 days, and a prodromal period of between 12 and 24 hours, patients develop mild sore throat, dysphagia, low-grade fever, and tachycardia. [msdmanuals.com]

• Tonsillar Ulcer

  Hippocrates had recognized the unfavorable implications of a sort of spiderweb (or membrane) in patients with tonsillar ulcers (2), and both Bard's 1771 contribution and the introduction of tracheostomy for laryngeal diphtheria in France in the 1820s [doi.org]

• Muscle Weakness

  It often causes muscle weakness in the arms and legs. Paralysis : Diphtheria can paralyze a breathing muscle (diaphragm) within 30 minutes or up to 6 weeks after the first symptoms of diphtheria. Patients may need to use a respirator. [immunizationinfo.com]

  Symptoms include sore throat, low-grade fever, muscle weakness, loss of appetite and enlarged lymph nodes located in the neck. [health.ny.gov]

  Diphtheria may start off like many other respiratory diseases, with fever, muscle weakness, and sore throat. But then it gets worse—a lot worse. [chadhayesmd.com]

  Muscle pain or weakness. Face muscle weakness or uneven smile. Very bad dizziness or passing out. What are some other side effects of Diphtheria and Tetanus Toxoids? All drugs may cause side effects. [drugs.com]

  Commonly affected organs include the heart and nervous system, leading to complications such as inflammation of the heart (myocarditis), cardiac rhythm and conduction disturbances, muscle weakness, numbness (nerve), and vision changes. [emedicinehealth.com]

• Eczema

  […] months — — Tonsillitis, adenoids (post-operative) 2 months — — Tuberculosis (active or inactive with positive Mantoux test results) With specialist's approval — — Chronic lung suppuration + — — Allergies (anaphylaxis, serum sickness, bronchial asthma, eczema [doi.org]

  These sores appear on the arms and legs and resemble other skin disorders, such as eczema, psoriasis, and impetigo. A few people have open sores that do not heal. Sores may be painful and red and may ooze. [msdmanuals.com]

  The infection can coexist with other infections and skin conditions and may look no different from eczema, psoriasis, or impetigo. [medicalnewstoday.com]

• Diplopia

  The symptoms of nervous system involvement can include seeing double (diplopia), painful or difficult swallowing, and slurred speech or loss of voice, which are all indications of the exotoxin's effect on nerve functions. [medical-dictionary.thefreedictionary.com]

• Neck Swelling

  Symptoms may include: A moderate to severe sore throat Swollen and sore lymph nodes in the neck Swelling of the neck Heart and nervous system complications Diphtheria in your skin can cause lesions (damaged skin tissue or sores). [bccdc.ca]

  Neck swelling is usually present in severe disease. Cutaneous diphtheria presents as infected skin lesions which lack a characteristic appearance. Etiologic Agent Toxin-producing strains of Corynebacterium diphtheriae. [meningitis-angels.org]

  […] and neck swelling (producing a "bull neck" appearance) Difficulty breathing As respiratory diphtheria progresses, individuals may develop the classic adherent thick, gray membrane (pseudomembrane) forming over the lining tissue of the tonsils, pharynx [emedicinehealth.com]

Patients can be easily diagnosed clinically with the aid of a detailed medical history and the demonstration of the throat signs like the pseudomembrane formation and the neck adenopathy. A throat swab can be performed for culture and sensitivity purposes where a specialized culture media is used to grow Corynebacterium diptheriae. In cases of cutaneous diphtheria, a skin sample is biopsied and processed to demonstrate the infecting bacillus in culture. Diphtheria which complicates to myocarditis can be assessed using serum troponin I levels to determine its severity [9].

Diphtheria is a potentially fatal disease that warrants immediate medical care and treatment. Patients are promptly given diphtheria antitoxins intravenously or intramuscularly to neutralize the circulating diphtheria toxin in the body. Due care and diligence must be observed in the introduction of the antitoxin because this can cause a life-threatening hypersensitivity reaction among susceptible patients. Antibiotics like penicillin and erythromycin are also being used in the treatment of diphtheria infections [10]. The antibiotic therapy clears up the bacterial load of the infections and shortens its infective stage.

The international mortality rate for all forms of diphtheria is 5% to 10%. Mortality increases beyond 20% among children below 5 years or age and adults beyond 40 years of age. Toxigenic forms of the diphtheria bacteria are associated with increased mortality and morbidity among patients. Regions of the world with high immunization patterns have lower mortality ratings than those with low immunization coverage. Diphtheria in its aggressive bacteremia phase may carry a poorer prognosis and could reach a mortality rate of up to 40% [7].

Diphtheria is brought about by the gram positive aerobic bacillus Corynebacterium diphtheria. The aerobic bacterium propagates near the surface of the throat’s mucous membrane. The pathogen can be spread via airborne droplet through sneezing and coughing. There are less common ways of diphtheria transmission like the inadvertent contact with personal belongings and household items (i.e. towels, toys, and tissue papers).

In the United States, diphtheria occured in at least 200,000 patients annually before the advent of the vaccination in the 1920’s [4]. Effective preventive measures and mass immunizations have eradicated the disease, and limited the incidence of diphtheria infections to 1,000 cases per annum at the maximum. Sporadic occurrence of diphtheria has been noted among the Native American population, alcoholics, homeless people, and those in the low socioeconomic group [5]. In the international arena, the World Health Organizations has continually regarded diphtheria as a public health threat in the poor and developing nations.

Large epidemics were recorded in the Russian federation and the Baltic states during the periods 1990 to 1995. Moreover, diphtheria outbreaks in small pockets were documented in the regions of the sub-Saharan Africa, France, and India [6]. After the development of the vaccine, mortality rate of diphtheria in United States has gone down to 1 case per 100 million population. There is no sexual and racial predilection to the diphtheria infection.

When the diphtheria bacillus attaches to the airway mucosal epithelium, the local endosomes consequently release exotoxins that cause a localized inflammation. This process causes cell destruction and necrosis of the epithelium. Toxins may be carried hematologically or lymphatically to distant sites and organs in the advent of the cell destruction. The diphtheria toxin may affect the myocardium, the nervous system, and the kidneys. The toxigenic strains of the diphtheria bacteria are the most insidious and invasive in terms of organ afflictions and complications.

The most effective way in preventing diphtheria is by active immunization during childhood. The protection developed from the initial immunization will fade in time and would render the host susceptible to diphtheria infection once again. Booster shots when the child reaches 12 years old and every 10 years henceforth will essentially boost the immune system against the diphtheria infection. Early detection and treatment is paramount in shortening its clinical course and preventing its spread and transmission.

Diphtheria is a serious infection of the upper airways which usually involves the mucous membrane of throat and nose. The hallmark sign of diphtheria is the pseudomembrane formation at the back of the throat accompanied by symptoms of sore throat, fever, and weakness. Primary diphtheria is easily controlled by antibacterial therapy while complicated cases may cause damage to the kidneys, heart and the nervous system [3].

Definition

Diphtheria is a potentially life-threatening infection of the upper respiratory airways caused by the aerobic bacillus Corynebacterium diphtheria.

Cause

The diphtheria infection is caused by the toxigenic type and the non-toxigenic type of Corynebacterium diphtheria.

Symptoms

Patients suffering from diphtheria typically present with a pseudomembrane formation over the throat and tonsils with bilateral lymph node enlargement. Cutaneous diphtheria presents as ulcers with a grayish membrane. Constitutional signs of fever and chills can also be present.

Diagnosis

The diagnosis of diphtheria is done with the use of a detailed medical history and the careful physical examination of the throat. Culture and sensitivity of the bacteria taken from throat swabs and skin ulcer scrapings may also elucidate the infecting bacteria.

Treatment and follow-up

Patients with diphtheria are injected with diphtheria antitoxin and given penicillin and erythromycin antibiotics to control the disease. Primary prevention with the use of active immunization with diphtheria is the best way to control the spread of the illness.

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