Corynebacterium diphtheriae (Diphtheria)

diphtheriaBacteria: Corynebacterium diphtheriae (C. diphtheriae)

VaccineDTaP, Tdap, or TD

Transmission

Diphtheria spreads very easily through the air from person to person through coughs, sneezes, and even by laughing. It can also be spread to someone who picks up tissues or drinking glasses that have been used by an infected person.

If someone has been infected, they can spread the bacteria for up to four weeks, even if they are not showing symptoms.

Symptoms

Should your child get diphtheria, he would come down with a sore throat, a mild fever (101 degrees or less), chills, and swollen neck glands. The toxin that is released by the bacteria can lead to a thick fuzzy gray or black coating in the nose, throat, or airway that can cause breathing problems and difficulty swallowing. Sometimes children may complain of double vision, have slurred speech, or even signs of going into shock (pale, cold skin, rapid heartbeat, sweating, and an anxious appearance).

Who is at Risk:

Those who are at severe risk for infection are children under five and adults over sixty years old. Also, people living in crowded or unclean conditions, those who are under nourished, and those who remain unvaccinated are at higher risk for diphtheria infection.

Possible Complications

Should your child have a more dangerous case of diphtheria, the toxin spreads through the bloodstream and cause life-threatening damage to other organs, such as the heart and kidneys.  It also can cause nerve damage and paralysis.  Up to 40% to 50% of those who have more serious cases of diphtheria and who don’t get treated may die.And about 1 out of 10 people who get diphtheria in general may die.1

Pregnancy/Unborn Child/Newborn Risk:

The Tdap vaccine is especially important for health care professionals, anyone caring for a baby under 12 months, and pregnant women. All pregnant women are advised to get the Tdap vaccine, preferably between 27 and 36 weeks’ gestation.

Prevention:

The best and really the only way to prevent diphtheria is through vaccination.

Currently in the United States, it is recommended that children receive five doses of the DTaP vaccine to avoid getting these three bacterial diseases. The doses are at 2 months old, 4 months old, 6 months old, between 15-18 months old, and between 4-6 years old.

Since immunity wears off to these three bacteria over time, boosters are recommended for everyone over a lifetime.

The DTaP vaccine is given in five doses to children under the ages of 7. Following this series, the tetanus and diphtheria (Td) vaccine is recommended to all individuals every ten years. A tetanus and diphtheria vaccine with a pertussis booster, called the Tdap (not to be confused with DTaP) vaccine (which has a reduced dose of the diphtheria and pertussis vaccine), is recommended to replace one of the Td boosters any time between the ages of 11 and 64. The recommendation for this Tdap booster is between the ages of 11 and 12 years of age.

Because of vaccination, diphtheria is very rare in the United States, however it is still common in developing countries.  

Treatment:

A throat culture is used to diagnose cases of diphtheria. Once diagnosed, the health department is notified right away, and anyone in contact with the diagnosed person would also be brought in for treatment. Anyone who has diphtheria would need to be treated in the hospital and isolated from other patients, especially the elderly, those who are immunocompromised, and those who are unvaccinated.

The infected person would receive an intravenous anti-toxin to neutralize the diphtheria toxin released by the bacteria and already circulating through the body. Antibiotics are also given to kill remaining bacteria.

If the infection has already progressed, the patient may be placed on a ventilator to help them breathe. In such advanced cases, toxins may have already spread to the  heart, kidneys, or central nervous system, and in which case, the patient would be given IV fluids, oxygen, and/or heart medication.

Anyone who has been in close contact with the patient would need to be treated, also. This would include the assessment of immunity (whether or not vaccinated properly and had boosters) and throat cultures. Most likely those in close contact would be given a booster vaccine and possibly precautionary antibiotics.

Prognosis:

If your child were to contract diphtheria and be hospitalized immediately, he would most likely recover.

Once the antibiotics and anti-toxin have taken effect, your child would need to be on bed rest for about 4-6 weeks, or until fully recovered. The best rest is especially important for those who develop inflammation of the heart muscle due to the diphtheria toxin.

Immunity to diphtheria fades over time, so having the disease does not guarantee life-long immunity. Even after recovery, your child needs to have a full course of TDaP to prevent contracting the disease a second time. 

 

Resources:

  1. Centers for Disease Control and Prevention (CDC). www.cdc.gov
  2. Medline Plus.US National Library of Medicine. National Institutes of Health. www.nlm.nih.gov
  3. WebMD. www.webmd.com
  4. Kids Health. Nemours. www.kidshealth.org

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