Diphtheria

• Diphtheria is a serious bacterial infection that usually affects the nose and throat. Most patients become infected after inhaling the bacteria and develop thick, gray membranes in the back of their throats that may cause difficulty breathing. However, if the bacteria enter a wound, diphtheria may affect the skin instead. Some individuals may become infected with the bacteria but only experience mild, if any, symptoms. These individuals are called carriers because they can still spread the infection to others.
• In the past, diphtheria was considered a leading cause of death among children. However, diphtheria is now considered a rare disease in the United States because individuals are routinely vaccinated shortly after birth. According to the U.S. Centers for Disease Control and Prevention (CDC), fewer than five cases have occurred each year since 1980. Most cases of diphtheria occur in unvaccinated or inadequately vaccinated populations.
• The infection is still common in developing countries that do not have access to immunizations. For instance, in the 1990s, Russia and the independent countries of the former Soviet Union experienced serious outbreaks of diphtheria, which caused about 5,000 deaths. These areas have since gained access to the diphtheria vaccine, which has significantly decreased number of diphtheria outbreaks. However, the circulation of diphtheria has not yet been eliminated from the region.
• Treatment is available for individuals who develop diphtheria. Patients typically receive antibiotics, antitoxins, and intravenous (IV) fluids. If left untreated, diphtheria can cause serious complications in the advanced stages of the disease. Patients are at risk of experiencing extreme difficulty breathing, heart damage, kidney damage, and nerve damage. According to the World Health Organization (WHO), an estimated 10% of patients with diphtheria die from complications.

• General: Diphtheria is caused by a bacterium called Corynebacterium diphtheria. As the bacteria multiply in the body they cause pain and inflammation in the nose and throat or affected skin. The bacteria also release a toxin (or poison) that may damage the heart, brain, kidneys, and nerves. Most cases of diphtheria occur if a person is not vaccinated or does not receive regular booster shots to maintain immunity.
• Transmission: The bacteria can spread from person to person via air droplets. When an infected person coughs, sneezes, talks, etc., tiny mucus droplets enter the air. Individuals can become infected if they inhale these droplets. People may also become infected if they touch their nose or mouth after touching contaminated objects, such as door handles, towels, or dirty tissues.
• The bacteria can also enter the body through broken skin. Touching a contaminated object and then touching an open wound may lead to a diphtheria infection of the skin, which causes the affected area to become swollen, red, and painful.
• Individuals who have untreated diphtheria can spread the infection to non-immunized individuals for up to six weeks, even if they do not have symptoms.

• General: Signs and symptoms usually develop two to five days after a person becomes infected. Some people may not experience symptoms for as long as 10 days. Some people may become infected with the bacteria, but experience mild, if any, symptoms. These individuals are called carriers because they can still spread the infection to others.
• Nose and throat: If the bacteria enter the nose or mouth, common symptoms include painful or difficult swallowing, sore throat/hoarseness, enlarged lymph nodes in the neck, nasal discharge, general feeling of discomfort, thick and gray membrane covering the throat and tonsils, difficulty breathing, rapid breathing, and fever.
• Cutaneous (skin) diphtheria: If a wound becomes infected with diphtheria, the affected skin typically becomes swollen, red, and painful. Patches of gray, sticky material may also be present.

• If diphtheria is suspected, treatment is generally started immediately, before test results are back from the laboratory. This is because diphtheria can be life threatening if not treated promptly. If diphtheria of the nose or throat is suspected, a healthcare provider will use a swab to take a sample from the gray membrane in the throat. If cutaneous diphtheria is suspected, a sample of tissue from the infected wound is taken. The sample is then grown in a laboratory. If the bacterium is present, a positive diagnosis is made.

• General: Complications are most likely to occur if patients do not receive prompt treatment. Complications are the result of a toxin that the diphtheria-causing bacteria release. With treatment, about 90% of patients are able to recover from complications. However, recovery from complications is generally slow.
• Breathing
  problems: When the bacteria infect the nose or throat, the tissues become damaged. As a result, a thick gray-colored membrane, which is primarily made up of dead cells, bacteria, and bacterial toxins, develops inside the nose and throat. This membrane, which is visible to the naked eye, may obstruct the airways and make breathing difficult.
• Heart damage: Left untreated, the diphtheria toxin may enter the bloodstream and spread to other areas of the body, including the heart. The toxin may cause the heart to become inflamed, a condition called myocarditis. Symptoms of myocarditis may include chest pain, increased heartbeat, joint pain, and fever. Myocarditis may only cause minimal damage to the heart. However, in severe cases, it may lead to congestive heart failure or sudden death.
• Kidney damage: The diphtheria toxin may lead to kidney damage. When the kidneys are damaged, they are unable to filter wastes from the blood properly. As a result, toxins and waste products may build up in the blood.
• Nerve damage: The bacterial toxin may also cause nerve damage, especially the nerves in the throat. When the nerves in the throat are impaired, it may be difficult to swallow. Other commonly affected nerves include those in the legs and arms, often leading to muscle weakness. Sometimes the nerves that control the muscles involved in breathing may become damaged. As a result, the muscles are unable to function properly and the patient has difficulty breathing.

• General: If diphtheria is suspected, aggressive treatment is started immediately, even before the patient's test results come back from the lab.
• Patients with diphtheria are usually admitted into the hospital for treatment. They may be isolated in an intensive care unit because the infection can spread easily to individuals who are not vaccinated.
• If the throat is affected, patients often need to obtain their nutrition through liquids and soft foods for several weeks. This is because swallowing may be painful and difficult until the infection is treated.
• Antitoxin: Patients with diphtheria receive injections with a medication called antitoxin, which neutralizes the bacteria's poison in the body. Because there is a slight risk of a serious allergic reaction to the antitoxin, doctors may first perform an allergy skin test. If the patient is allergic to the medication, he/she will receive small doses that are gradually increased over time. This process, called desensitization, prevents the patient from developing a severe allergic reaction.
• Antibiotics: Patients with diphtheria also receive antibiotics, which destroy the bacteria in the body. Commonly prescribed antibiotics include penicillin and erythromycin.
• Patients
  should take medications exactly as prescribed. Even if symptoms appear to go away, patients should take all of their medication because the bacteria may still be in the body. Stopping medication early may allow the infection to return. Also, stopping medication early may lead to drug resistance. The few remaining bacteria in the body that survived most of the treatment are the most difficult to kill. If the bacteria become resistant to treatment, the medications will no longer be effective.
• Breathing assistance: Some of the thick gray membrane in the back of the throat may make breathing difficult. It is important that patients do not try to remove the membrane themselves. This is because the membrane will bleed and possibly increase the body's absorption of the bacteria's toxins. In serious, advanced cases, patients may be hooked up to machines, called ventilators, to help them breathe. Once the bacteria are destroyed, patients are able to breathe on their own again.
• Get plenty of rest: Recovery from diphtheria is a slow process and may require up to six weeks of bed rest. This is especially important for individuals who experience myocarditis (enlarged heart) or heart damage.
• Vaccine: Once a patient has completely recovered from diphtheria, he/she must receive a full course of the diphtheria vaccine in order to prevent the infection from coming back in the future. Children younger than seven years of age will receive either the diphtheria/tetanus (DT) vaccine or the diphtheria/pertussis/tetanus (DTaP) vaccine. Individuals who are older than seven years of age will receive the tetanus and diphtheria (Td) vaccine. Individuals need to receive booster shots every 10 years in order to maintain their immunity.

Note
: Diphtheria is a serious bacterial infection. Currently, there is a lack of scientific data on the use of integrative therapies for the treatment or prevention of diphtheria. The integrative therapies listed below should be used only under the supervision of a qualified healthcare provider, and should not be used in replacement of other proven therapies or preventive measures.

C

Unclear or conflicting scientific evidence

• L-carnitine
  : Early studies suggest that carnitine may be beneficial for patients with diphtheria, mainly in terms of myocardial (heart) damage. However, additional study is needed to confirm these findings.
• Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.

• General: Individuals can prevent diphtheria infections by receiving the diphtheria vaccine. In the United States, individuals are routinely vaccinated at birth, and they receive booster shots every few years in order to maintain immunity.
• The vaccine has been shown to effectively prevent diphtheria. Some children may experience side effects, such as mild fever, irritability, tenderness at the injection site, and drowsiness. In rare cases, children may experience allergic reactions to the vaccine. Allergic reactions to vaccines are rare, and symptoms can range from mild to severe. The most serious allergic reaction, called anaphylaxis, can be life threatening. Symptoms can develop anywhere from several minutes to several hours after the vaccine is administered. Individuals who experience symptoms, such as hives, dizziness, difficulty breathing, or increased heartbeat, should be taken to the nearest hospital for urgent medical treatment. A few children, including those who have progressive brain disorders, may not be able to receive the vaccine.
• Diphtheria, tetanus, and pertussis (DTP or DTaP): For convenience purposes, the diphtheria vaccine is usually combined with vaccines for other infections. For instance, children usually receive a combination vaccine that protects against diphtheria, tetanus, and whopping cough (also called pertussis). Tetanus (sometimes called lockjaw) is a potentially deadly disease that causes the jaw and other muscles to spasm. Pertussis is a highly-contagious and potentially deadly respiratory infection. This combination vaccine is called the diphtheria, tetanus, and pertussis (DTP or DTaP) vaccine. The first of five DTP shots are given during infancy. Individuals typically receive shots when they are two months, four months, six months, 15-18 months, and four to six years old.
• Diphtheria and tetanus (DT): Another combination vaccine, called DT, protects against diphtheria and tetanus. This shot may be given to individuals who are younger than seven years of age.
• Tetanus and diphtheria (Td): A third type of vaccine, called the Td vaccine, also protects against tetanus and diphtheria. However, this vaccine is made up of a slightly different dose of the diphtheria vaccine than the DT vaccine. This vaccine is only given to individuals who are older than seven years of age. The first two doses of this vaccine are separated by four to eight weeks. The third dose is given six to 12 months after the second dose.
• Booster shots: Over time, a patient's immunity to diphtheria starts to decline. Therefore, patients receive booster shots. Usually, the first booster shot is given when individuals are 12 years old. Then, patients receive one shot every 10 years. In most cases, booster shots are a combination of the diphtheria and tetanus vaccine, also called the tetanus diphtheria (Td) vaccine.