Diphtheria is a severe bacterial infection which typically affects nose and throat mucous membranes. This usually triggers a sore throat, cough, swollen glands, and fatigue, but the main symptom is a layer of thick, a grey substance that covers the back of the throat that blocks the airway and triggers a person to struggle for breath.

TYPES

DIPHTHERIA

Diphtheria is a severe bacterial infection which usually affects nose and throat mucous membranes.

CUTANEOUS (SKIN) DIPTHERIA

The second form of diphtheria may affect the skin, resulting in the normal pain, redness and swelling associated with other infections of the bacteria. Ulcers that are filled with a grey the membrane can also grow in cutaneous diphtheria.

PATHOPHYSIOLOGY

Diphtheria adheres to mucosal epithelial cells where the endosomal released exotoxin causes a localized inflammatory reaction that is accompanied by tissue degradation and necrosis. The toxin is composed of two joined proteins. The B fragment binds on the surface of the susceptible host cell to a receptor, which proteolytically cleaves the membrane lipid layer allowing segment A to enter.

Molecularly, it is suggested that the cellular susceptibility is also due to modification of diphthamide, dependent on types of human leukocyte antigen (HLA) predisposing to more severe infection. The diphthamide molecule is present in all eukaryotic species and is located on a translation elongation factor 2 (eEF2) histidine residue. EEF2 is responsible for altering this residue of histidine and is the basis for diphtheria toxin (DT).

Fragment A inhibits the transfer of amino acid from RNA translocase to the ribosomal amino acid chain, thus inhibiting protein synthesis is required for normal functioning of the host cell. DT triggers the catalytic transfer of NAD to diphthamide, which inactivates the elongation factor, resulting in the inactivation of eEF2, resulting in blockage of protein synthesis and subsequent cell death. Regional tissue damage enables the lymphatic and haematological transfer of the poison to other areas of the body. Diphtheria toxin development can affect distant organs like the myocardium, kidneys, and nervous system.

CAUSES

  • Airborne droplets
  • Contaminated personal items
  • Contaminated household items

CLINICAL MANIFESTATIONS

  • A thick, grey membrane covering your throat and tonsils
  • A sore throat and hoarseness
  • Swollen glands (enlarged lymph nodes) in your neck
  • Difficulty breathing or rapid breathing
  • Nasal discharge
  • Fever and chills
  • Malaise

RISK FACTORS

  • Children and adults who don’t have up-to-date immunizations
  • People living in crowded or unsanitary conditions
  • Anyone who travels to an area where diphtheria is endemic

COMPLICATIONS

  • Breathing problems: The bacteria that cause diphtheria can produce a toxin. In the immediate region of infection, this toxin destroys the tissue — typically the nose and throat. The infection at this site creates a thick, grey-coloured membrane made up of dead cells, bacteria, and other substances. This membrane can inhibit respiration.
  • Heart damage: The diphtheria toxin can spread through the bloodstream and affect other tissues in the body, including heart muscle, causing complications such as heart muscle inflammation (myocarditis). Heart damage from myocarditis can be mild, showing up on an electrocardiogram as minor anomalies, or severe, leading to congestive heart failure and sudden death.
  • Nerve damage: The toxin can also cause damage to the nerves. Typical targets are the throat’s nerves, where poor nerve conduction can cause swallowing difficulty. Nerves to the arms and legs can also get inflamed, leading to muscle weakness. When Cutaneous diphtheria toxin affects the nerves that help regulate the muscles used in breathing, it can paralyze these muscles. For a respirator or other tool, respiration can then become difficult to help with breathing.

TREATMENT

ANTITOXIN

An antitoxin is given to the infected infant or adult. The antitoxin, which is injected into a vein or muscle neutralizes the already circulating diphtheria toxin within the body.

ANTIBIOTICS

Diphtheria is also treated with antibiotics, such as penicillin or erythromycin. Antibiotics help destroy bacteria in the body, clearing up infections.

MANAGEMENT

  • Eating a healthier diet
  • Maintaining a healthy weight
  • Quitting smoking
  • Exercising regularly
  • Managing stress

PREVENTION

Usually, the diphtheria vaccine is paired with tetanus vaccinations and whooping cough (pertussis). Diphtheria, tetanus, and pertussis vaccine is known as the three-in-one vaccine. The latest version of this vaccine is named the children’s DTaP vaccine, and the teenage and adult Tdap vaccine.

BOOSTER SHOTS

After the initial series of childhood immunizations, diphtheria vaccine booster shots are required to help keep you safe. This is because, over time, the immunity to diphtheria disappears. Children who received all the necessary vaccines before age 7 would receive their first booster shot at around age 11 or 12. 10 years later, the next booster shot is prescribed, and then repeated at intervals of 10 years. Booster shots are particularly useful when you’re travelling to an area where diphtheria is common.

Tetanus booster — the tetanus-diphtheria (Td) vaccine — is paired with the diphtheria booster.
This combination vaccine is delivered by injection, normally into the arm or leg. Tdap is a combination vaccine against tetanus, diphtheria and acellular pertussis (whooping cough). It’s a one-time substitute vaccine for teenagers aged 11 to 18 and adults who haven’t had a Tdap booster before. This is also recommended for someone who is pregnant, regardless of previous vaccination status.

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