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Diphtheria

What is diphtheria?

Diphtheria is a bacteria-based illness mostly affecting the respiratory system. It is characterized by a sore throat, low-grade fever, and sticky greyish membranes developing on of the tonsils, pharynx, and/or nose.

What are the symptoms of diphtheria?

Initially presenting as a sore throat, diphtheria often leads to respiratory distress due to obstruction of the airways by the membranes. The bacteria remain in the upper airways but produce a toxin which spreads to other parts of the body through blood circulation, affecting the nerves and heart in particular.  

When the bacteria that causes diphtheria get into and attach to the lining of the respiratory system, they produce a poison (toxin) that can cause:

  • Weakness
  • A sore throat
  • Fever
  • Swollen glands in the neck
MSF, Doctors Without Borders, diphtheria
Auscultation of a diphtheria patient, symptoms visible. Photo: MSF-HOLLAND

The poison destroys healthy tissues in the respiratory system.

Within two to three days, the dead tissue forms a sticky grey coating that can build up in the throat or nose, making it very hard to breathe and swallow.

The poison may also get into the bloodstream and cause damage to the heart, kidneys, and nerves.

Diagnosing diphtheria

A diagnosis of diphtheria can be confirmed by taking a sample of cells from the throat or nose, or from a wound on the skin.

This will be examined to see whether the bacteria that cause diphtheria are present.

Treating diphtheria

Patients with diphtheria need to be admitted for monitoring and isolation. The earlier the treatment is given, the better the chances of recovery are for the patient.

Patients receive antibiotics to eliminate the bacteria from the throat, and an infusion of antitoxins to neutralise the circulating toxin and avoid complications.

During the recovery phase, patients need to receive a full course of immunisation – having had diphtheria does not give automatic protection against it.

The diphtheria anti-toxin is the main means of reducing mortality and the risk of other diphtheria-caused complications, such as myocarditis (damage to the heart muscle) and neuropathies (nerve damage). Antibiotic treatment for 14 days helps reduce transmission.

MSF, Doctors Without Borders, Diphtheria
Ismaeli, a 10-year-old boy, lies down on a bed at MSF’s Diphtheria Treatment Centre in Bangladesh. Photo: Anna Surinyach

How can diphtheria be prevented?

The best protection is immunization. Diphtheria immunization is now part of the immunization schedules in most countries worldwide. Booster shots are then needed every ten years, but countries cannot always afford to deliver booster doses during adulthood. This means that immunity wanes with time, increasing the risk of contracting diphtheria. Those who were never vaccinated against diphtheria are at greater risk of contracting the disease.

What is the treatment?

Patients with diphtheria need to be admitted for monitoring and isolation. They receive antibiotics to eliminate the bacteria from their throat, and an infusion of antitoxin to neutralize the circulating toxin and avoid complications. The earlier the treatment is given, the better the chances of recovery are for the patient. During the recovery phase, patients need to receive a full course of immunization, as having had diphtheria does not give automatic protection against it.

  • Diphtheria anti-toxin is the number one priority to reduce mortality and to reduce risk of other diphtheria-caused complications, such as myocarditis and neuropathies.
  • Antibiotic treatment for 14 days helps reduce transmission

It is also crucial that people who were in close contact with a diphtheria patient receive antibiotics for prophylaxis and potentially the vaccine. This will prevent them from developing the disease and halt transmission, and therefore help stop the outbreak.