Diphtheria

Types of Diphtheria

There are toxigenic and nontoxigenic strains of Corynebacterium diphtheriae that can cause disease. Strains that produce toxins cause an inflammation of the heart (myocarditis) and nerve inflammation and disease (neuritis and neuropathy). These toxins can also cause low platelet counts (thrombocytopenia) and protein in the urine (proteinuria). Where mm carditis experiences an early onset, it is often fatal. Neuritis often affects motor nerves and can resolve with possible paralysis of the soft palate, eye muscles, limbs, and diaphragm. Secondary pneumonia and respiratory failure are known to occur from paralysis of the diaphragm. Other complications are otitis media and respiratory insufficiency from airway obstruction. This is most common in infected infants. When the infection manifests in nonimmunized persons, the bacteria releases the toxin and subsequent damage occurs in the body. Toxigenic strains are more often associated with severe or fatal illness. This is mainly in the form of respiratory or other mucosal surface infections.

Diagnosis and Treatment

Diphtheria is best diagnosed clinically by identifying a gray membrane covering the throat and possibly inflamed tonsils and with an accompanying sore throat, fever and malaise. Any mucosal membrane can be infected (i.e., various nasopharyngeal, coetaneous, genital, and ocular). The diagnosis can also be confirmed with a throat culture if the laboratory capabilities [Page 532]exist. Corynebacterium diphtheriae is an aerobic gram-positive bacillus.

For those who are not vaccinated and contract the disease, active immunization and strong antibiotics are the best course of treatment. For those who are infected and are exposed to diphtheria, they must receive a booster of diphtheria toxoid plus active immunization and strong antibiotics. The most common vaccination program is the diphtheria toxoid mixed with tetanus and or pertussis vaccines. Vaccination provides the best preventative treatment.

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