What is Diphtheria?
Diphtheria is a serious bacterial infection caused by Corynebacterium diphtheriae. It spreads through droplets from coughs or sneezes and mainly affects the throat and nose. The bacteria produce a toxin that can cause serious complications. Symptoms usually appear 2 to 7 days after exposure.
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Cause
- The toxin produced by Corynebacterium diphtheriae
Symptoms
- Thick, grey, sticky membranes (pseudomembranes) on the tonsils or throat causing difficulty swallowing
- Swollen lymph nodes in the neck, which may become very large
- Airway obstruction that can cause breathing difficulty or suffocation if the infection spreads to the nose, voice box (larynx), windpipe (trachea), or lungs
- Low-grade fever
- Effects of the toxin may cause heart problems (myocarditis), nerve damage affecting swallowing, vision, breathing, and movement, usually 1–3 months after illness starts
- Possible kidney failure
Diagnosis
- Throat swab culture to identify the bacteria
Treatment
- Urgent hospital referral is required
- Isolation with contact and droplet precautions until three throat or nose swabs are negative for the bacteria
- Procaine benzylpenicillin 1.2 million international units (MIU) given daily by intramuscular injection until swallowing improves
Dosage
- For children, procaine benzylpenicillin 50,000 IU/kg once daily IM until swallowing is possible
- Once swallowing improves:
- Oral Penicillin V is given to complete 14 days
- Adults: 250 mg every 6 hours
- Children 1-6 years: 125 mg every 6 hours
- Children under 1 year: 12.5 mg/kg every 6 hours
If allergic to penicillin:
- Erythromycin 500 mg every 6 hours for 14 days in adults
- Children receive 50 mg/kg every 6 hours
Prevention
- Patients are isolated and close contacts are monitored for 7 days
- Close contacts receive a single dose of benzathine penicillin by injection:
- Children under 10 years: 600,000 IU
- Older children and adults: 1.2 MIU
- Immunisation status of contacts is checked, and vaccination is completed or boosted if needed
- Routine immunisation of all children with diphtheria-containing vaccines is essential
