Diphtheria is an infection caused by Corynebacterium diphtheriae that mainly affects the respiratory tract. It produces a toxin that destroys tissue and forms a grey membrane. Symptoms range from sore throat to airway obstruction. Complications can include heart damage, nerve palsies, and death in 3% of cases. Diagnosis is by symptoms and testing throat/nasal swabs. Treatment is diphtheria antitoxin and antibiotics like erythromycin for 14 days. Vaccination is the best preventative measure and is included in worldwide immunization programs.

1. DIPHTHERIA
BY DR PRUDHVI KILARU
JUNIOR RESIDENT
DEPT OF GENERAL MEDICINE

2. INTRODUCTION
• Derived for the Greek word “diphthera” meaning leather.
• First described by Hippocrates in 6th century BC
• Nasopharyngeal and skin infection
• Caused by Corynebacterium diphtheria.
• Nasopharyngeal diphtheria caused by toxigenic strains.
• Cutaneous diphtheria caused by non-toxigenic strains.
• Human is the only reservoir.
• Mostly droplet transmission.

4. • Diphtheria affect people of all ages, but most of it strikes
unimmunized children.
• In temperate climates diphtheria tends to occur during the colder
months.
• Risk factors include lack of vaccination, old-age, low socio-economic
status, overcrowding, alcoholism.
• It is commonly seen in winters in tropical zones and occurs
throughout the year in temperate zones

5. Clinical presentations
• Asymptomatic
• Respiratory diphtheria
- Anterior nasal diphtheria
- Pharyngeal and tonsillar diphtheria
- Laryngeal diphtheria
• Cutaneous diphtheria

6. Anterior nasal
Diphtheria
• Onset is similar to common cold
• Bloodstained mucopurulent discharge
• White membrane formed a nasal septum
• Mild due to poor systemic absorption of the toxin
from this site
• Can be terminated rapidly by diphtheria antitoxin
and antibiotic therapy

7. Pharyngeal and
tonsillar diphtheria
• Most common sight of diphtheria
• Malise, sore throat, anorexia and low-grade fever with insidious onset of
pharyngitis
• The pseudomembrane start forming within 2 to 3 days
• The pseudomembrane is firm and white which gradually changes to grey, green,
and black with progression of necrosis.
• Extensive pseudomembrane formation may lead to respiratory obstruction
• Progression may lead to extensive oedema of the tonsillar, submandibular, and
Paratracheal region giving a characteristic Bullneck appearance
• If enough toxin is absorb the patient develops prostations, pallor, rapid pulse,
coma and me even die

9. Laryngeal diphtheria
• Can be an extension of pharyngeal diphtheria or can involve this site
only
• Fever
• Hoarseness of voice
• Barking cough
• Pseudomembrane can lead to airway obstruction and death

10. Cutaneous diphtheria
• Skin infection with scaling rashes or ulcers
• Clear demarcation with membrane
• Infections are common in the tropics and may be
responsible for natural immunity

11. Causes and transmission
• Diphtheria is an infection caused by the Corynebacterium Diphtheria
• Diphtheria is transmitted from person to person usually through
respiratory droplets via coughing or sneezing
• Rarely surface transmission has also been seen.

12. Portal of entry
• Respiratory routes: such as nose mouth larynx and pharynx
• Non-respiratory routes: such as skin, conjunctiva, ear, genital area and
nervous system

13. Incubation period
• Average of 2 to 4 days,
occasionally longer
• Cases must be isolating until
cultures from 3 daily nose and
throat swabs are negative

14. Signs and symptoms
• When Diphtheria enters the respiratory tract it attaches itself to the
lining and produces the toxin which causes the symptoms like
weakness, sore throat, fever and swollen glands in the neck
• The toxin destroys healthy tissue in the respiratory tract within 2 to 3
days, the dead tissue forms of thick grey coating that can buildup in
the throat or nose. This thick grey coating is called pseudomembrane
• This pseudomembrane can extend onto the nose, tonsils, larynx and
pharynx making it very hard to breathe and swallow
• The toxin can also enter the bloodstream and cause damage to the
heart, kidneys and nerves.
• Diphtheria is fatal in about 3% of cases

15. Complications
• Airway obstruction
• Damage to the heart muscle- myocarditis
• Nerve damage- polyneuropathy
• Muscle paralysis
• respiratory infections like pneumonia or respiratory failure
• Diphtheria can rearly lead to death

16. Diagnosis and treatment
• Diagnosis is usually done by looking for signs and symptoms. Throat
and nasal swab can be confirmatory. Samples can also be collected
from skin lesions.
• Treatment for diphtheria can we started right away even without
library confirmation.
• Treatment for diphtheria includes antitoxin and antibiotics.
• The recommended antibiotic treatment for diphtheria is
erythromycin orally or by injection for 14 days or procaine penicillin
G daily intramuscularly for 14 days. Oral penicillin V 250 mg 4 times
daily is given instead of injections for people who cannot swallow.
• The disease is usually not contagious 48 hours after antibiotics are
initiated. Elimination of the organism should be documented by two
consecutive negative cultures after therapy in completed.

17. Prevention and
control
• The best way to prevent diphtheria is to get
vaccinated.
• There are 4 vaccines used to prevent bacteria:
DTaP, Tdap, DT and Td. Each of these vaccines
prevent diphtheria and tetanus; DTaP and Tdap
also help prevent pertussis. DTaP and DT are
given to children younger than seven years old,
while Tdap and Td are given to older children,
teens and adults.
• Active immunisation should be given to all
children.
• Routine DPT vaccine sustain vaccination
coverage.

18. Programs
• WHO included the vaccine in EPI (expanded
program on immunisation) since 1974.
• India included the vaccine in UIP (universal
immunisation program) since 1985.
• DTP3 vaccine coverage in India was 87% in 2015.

19. Key points
• Spread this from person to person
• Symptoms vary from minor to severe illness.
• Complications are frequent.
• Anti-toxins and antibiotics are definitive treatments.
• Most effective method of prevention is to maintain a high level of
immunisation coverage.

20. THANK YOU.