This document provides information on diphtheria, including its history, causes, symptoms, treatment and prevention. It notes that diphtheria is caused by Corynebacterium diphtheriae and presents as a membrane in the throat that can lead to breathing difficulties. Major developments in its treatment included the antitoxin developed in the 1890s and vaccines introduced in the early 20th century. Control relies on early detection, isolation, antitoxin treatment and active immunization of infants with diphtheria and combination vaccines.

1. DIPHTHERIA
DR. SHAFI -UR- RAHMAN KHAN
D.P.H. – 1
UPGRADED DEPT. OF COMMUNITY MEDICINE
K.G.M.U. LUCKNOW

2. Introduction
• Diphtheria takes its name from the Greek word
“Dipthera” meaning leather and was named in
1826 by French physician Pierre Britonneau.
• This is because it refers to the leathery, sheath like
membrane that grows on the tonsils, throat and in
the nose.
• It was said that the disease killed as many as 80%
of the children below 10 yrs.

3. History
• Joseph O’Dwyer in 1880 developed tubes that were
that inserted into the throat, to prevent suffocation
and obstruction of airways.
• In 1884, Friedrich Loeffler discovered the causative
organism Corynebacterium diphtheriae.
• In 1890s the Emil Von Behring developed an antitoxin
that did not kill the bacterium, but neutralized the toxic
poisons the bacterium releases into the body.
• The first successful vaccine for Diphtheria was
developed in 1913 by Emil Von Behring.

4. Definition
. Diphtheria is an acute infectious disease caused by toxigenic
strains of Corynebacterium diphtheriae.
• Clinical types :- 1. Anterior Nasal
2. Faucial
3. Laryngeal
4. Other parts – cutaneous skin, vulva
. The baccili multiply locally in the throat.
. The Exotoxin produced is responsible for :-
a. The formation of a “false membrane” commonly over the
tonsils, pharynx or larynx.
b. Marked congestion, oedema or local tissue destruction.
c. Sign and Symptoms of toxaemia.
d. Enlargement of regional lymph nodes.

5. Problem Statement
• World
• Developed Countries - Rare
• Developing Countries – Endemic
• The true no of diphtheria cases and deaths are
unknown because of incomplete reporting from
most countries.
• India
• Endemic disease
• Declining trend due to increasing coverage of
child population by Immunization.
• 1987----- 12952 cases
• 2013 ----- 4090 cases
• Declined by 68%

6. Epidemiological determinants
• Agent factors
• Corynebacterium diphthriae is a gram positive, non-
motile organism which produces a powerful Exotoxin.
• Four types of diphtheria bacilli – gravis, mitis, belfanti,
intermedius.
• Source of infection may be a Case or Carrier. Carriers
are common sources of infection. Immunization does
not prevent the carrier state.
• Infective materials are Nasopharyngeal secretions,
discharges from skin lesions etc.
• Period of Infectivity may vary 14 to 28 days from the
onset of disease.

7. Host factors
Age :- affects children aged 1 to 5 yrs.
Sex :- both sexes are affected.
Immunity :- Infants born of immune mothers
are relatively immune during the first few
weeks or months of life.
Environmental factors
Occur in all seasons, winter months are
favourable.
Mode of transmission
Mainly by droplet infection.

8. Portal of Entry
-Respiratory tract is commonly the portal of entry.
Incubation period :- 2 to 6 days.
Clinical features :-
-Pharyngotonsillar diphtheria have a sore throat,
difficulty in swallowing and low grade fever.
-Examination of the throat may show mild erythema,
localized exudate or a Psuedomembrane. Attempts
to remove the membrane results in bleeding.
-Bull-necked appearance in severe cases.
-The toxin is absorbed and results in toxic damage in
heart muscle, liver, kidneys and adrenals
accompanied by gross haemorrhage.

9. Control of Diphtheria
1. Cases and Carriers
a. Early detection :- Active search for cases and
carriers amongst family and school contacts.
Carriers can be detected only by culture
method. Swabs should be taken from both
nose and throat.
b. Isolation :- All cases, suspected cases and
carriers should be isolated for at least 14 days
or until proved free of infection.

10. Treatment
a. Cases :-
- Diphtheria antitoxin, IM or IV, dose according to
severity.
1. Mild early Pharyngeal/Laryngeal disease ----- 20000 to 40000 units
2. Moderate Nasopharyngeal disease ----- 40000 to 60000 units
3. Severe extensive disease ----- 80000 to 100000 units
- Every case is treated with Penicillin or
Erythromycin for 5 to 6 days.
b. Carriers :-
- Carriers should be treated with 10 days course of
Erythromycin.

11. 2. Contacts
- Contacts should be throat swabbed and their
immunity status determined.
- Close contacts should receive prophylactic
Penicillin or Erythromycin.
- They should be given 1000 to 2000 units of
Diphtheria antitoxin and actively immunised.
3. Community
- Control of community is by Active immunization
with Diphtheria toxoid of all infants as early as
possible with booster doses every 10 yrs.

12. Diphtheria Immunization
a. Combined vaccines
b. Single vaccines
c. Antisera
a. Combined vaccines
1. DPT Vaccine
- Immunization against 3 diseases namely Diphtheria,
Whooping cough and Tetanus.
- Pertusis component in DPT vaccine enhances the
potency of Diphtheria toxoid.
- Two types of DPT vaccine – Plain and Adsorbed.
- Adsorption increases the immunological effectiveness
of vaccine.
- DPT vaccine should be stored in a refrigerator between
2 – 8 degree C.

13. - Should be administered as early as 6 weeks after birth.
- Three doses of DPT vaccine of 0.5 ml each at an
interval of 4 weeks is necessary for primary
immunization with boosters at one and half yr to 2
yrs and another at 5 to 6 yrs.
- Administered Intramuscularly in antero-lateral
aspect of the thigh.
- Fever and mild local reactions are common. The
most severe complications are Neurological i.e.
encephalitis, prolonged convulsions, Infantile
spasms and Reye’s syndome.

14. 2. Pentavalent Vaccine
- It provides protection from 5 diseases namely Diphtheria,
Pertusis, Tetanus, Hepatitis- B and Haemophilus Influenza
type B.
- It replaces DPT and Hepatitis B primary vaccination schedule
at 6, 10 and 14 weeks but the birth dose of Hepatitis B and
booster doses of DPT are continued.
b. Single Vaccines
- Single vaccines e.g. FT, APT, PTAP, PTAH are less frequently
used.
- Each dose of these antigen contains 25 Loeffler units of
diphtheria toxoid.
c. Antisera
- Diphtheria antitoxin is prepared in Horse serum and is used for
treatment of diphtheria and for passive prophylaxis.

15. Thank you