Diphtheria

Introduction
• Diphtheria is a serious bacterial infection that primarily affects
the respiratory system, specifically the nose, throat, and tonsils.
• It is caused by the bacterium Corynebacterium diphtheriae,
which produces a toxin that can lead to severe complications,
including respiratory failure and death.
• A gram-positive bacterium, causes both endemic and epidemic
diphtheria, first described by Hippocrates in the 5th century BC
• This infection was once a common childhood illness, but thanks
to widespread vaccination programs, cases have significantly
declined in many parts of the world. However, diphtheria
remains a threat in regions with low vaccination coverage,
underscoring the importance of ongoing vaccination efforts to
protect individuals and communities.
 Epidemiology of Diphtheria in Nigeria
• Diphtheria, once largely controlled through widespread
immunization, has seen a resurgence in Nigeria, particularly due
to lapses in vaccination coverage and other public health
challenges.
• Current Situation
• Resurgence: Nigeria has witnessed a resurgence of diphtheria
cases in recent years, especially in states like Kano, Jigawa, and
Lagos.
• Outbreaks: Outbreaks have been reported, often in areas with
low immunization coverage and poor living conditions.
• Risk Factors
• Vaccination Gaps: Inadequate immunization coverage is a
significant factor, with many children not receiving the necessary
DTP (Diphtheria, Tetanus, Pertussis) vaccine doses.
 Cont.
• Crowded Living Conditions: Overcrowded living conditions in
urban slums and some rural areas increase the risk of
transmission.
• Health System Challenges: Challenges in the healthcare
system, including vaccine distribution and public health
infrastructure, contribute to the persistence and spread of
diphtheria.
• Affected Populations: Children: The majority of cases are seen
in unvaccinated or partially vaccinated children under the age
of 5.
• Geographical Spread: The disease is more prevalent in the
northern regions of Nigeria, where vaccination rates are
typically lower.
 Causes and Transmission of Diphtheria

• Diphtheria is caused by the bacterium Corynebacterium

diphtheriae, which is spread through respiratory droplets
released into the air when an infected person coughs,
sneezes, or talks.
• These droplets can travel short distances and land on the
mucous membranes of other people's nose or mouth,
where the bacteria can then multiply and cause infection.
• Transmission can also occur through contact with
contaminated surfaces or objects, such as shared utensils
or toys, where the bacteria can survive for a period of time.
 Other factors
• Close Contact: Diphtheria spreads most easily through close
contact with an infected person, such as living in the same
household or being in close proximity for extended periods.
• Crowded Environments: Crowded environments, like
schools, daycare centers, and public transportation, can
increase the risk of transmission as it allows for greater
potential for respiratory droplets to spread.
• Poor Hygiene: Insufficient hand hygiene practices, such as
not washing hands frequently and thoroughly, can facilitate
the spread of the bacteria. This is particularly important
after contact with an infected person or contaminated
surfaces.
 Pathophysiology of Diphtheria
• Risk Factors: Overcrowding, poor health, substandard living
conditions, incomplete immunization, and immunocompromised
states increase susceptibility and transmission of diphtheria.
• Transmission: Diphtheria is mainly transmitted via respiratory
droplets from infected patients and carriers. It can also spread
through skin contact with wound exudates.
• Pathogen Action: C. diphtheriae adheres to mucosal cells,
releasing exotoxins that cause local inflammation, tissue
destruction, and necrosis.
• Toxin Mechanism: The diphtheria toxin inhibits protein synthesis
by inactivating elongation factor eEF2, leading to cell death.
• Systemic Spread: The toxin can spread to distant organs (heart,
kidneys, nervous system), causing severe complications.
Nontoxigenic strains generally cause milder infections but can
still be invasive.
 Signs and Symptoms of Diphtheria

• The symptoms of diphtheria typically appear 2-5 days

after exposure to the bacteria.
• The most common symptom is a sore throat, often
accompanied by fever, swelling of the lymph nodes in
the neck, and a distinctive grayish-white membrane
that forms on the tonsils and back of the throat.
• This membrane can obstruct breathing and make
swallowing difficult.
Fig
 Other symptoms may include:
Early Symptoms
• Sore throat
• Fever
• Swollen lymph nodes in the neck
• Difficulty swallowing
• Hoarseness
• Runny nose
Late Symptoms
• Difficulty breathing
• Rapid heartbeat
• Rapid heartbeat
• Paralysis
• Cyanosis (blue discoloration of the skin)
 Diagnosis and Testing for Diphtheria

• Diagnosing diphtheria typically involves a

combination of clinical assessment and laboratory
testing. A doctor will take a medical history, perform
a physical examination, and observe the patient's
symptoms.
• The presence of a grayish-white membrane in the
throat is a strong indicator of diphtheria, but
laboratory confirmation is crucial to ensure accurate
diagnosis and proper treatment.
 Cont.
Throat Swab Culture
• A throat swab is taken to collect a sample of the bacteria,
which is then grown in a laboratory. This is the most
reliable method for diagnosing diphtheria.
Blood Tests
• Blood tests can detect the presence of toxins produced by
the diphtheria bacteria, further confirming the diagnosis.
Rapid Diagnostic Tests
• Rapid tests can provide preliminary results within a few
hours, but they may not be as accurate as laboratory
cultures.
 Treatment and Management of
Diphtheria
• The primary treatment for diphtheria is a
combination of antibiotics and antitoxin.
• Antibiotics, such as penicillin or erythromycin, are
used to kill the bacteria and prevent further spread.
• Diphtheria antitoxin is a specific antibody that
neutralizes the toxin produced by the bacteria.
• Antitoxin must be administered as soon as possible
after diagnosis to minimize the risk of complications.
 Cont.
• Antibiotics: Penicillin, erythromycin
• Antitoxin: Diphtheria antitoxin
• Supportive Care: Oxygen therapy,
airway management, fluid
resuscitation
 Prevention

• Vaccination is the most effective way to prevent

diphtheria.
• The diphtheria vaccine is typically combined with
other vaccines, such as tetanus and pertussis, into a
single vaccine called DPT. (Routine immunization)
• This vaccine is highly effective in preventing serious
illness and death from diphtheria.
 Cont
• Infancy: Infants receive a series of DPT vaccines beginning at
2 months of age. The series is completed with booster doses
at 4 months, 6 months, 15-18 months, and 4-6 years of age.
• Adolescence and Adulthood: Booster doses are
recommended for adolescents and adults every 10 years to
maintain immunity. This is especially important for
individuals who travel to regions with a higher risk of
diphtheria.
• Pregnant Women: Pregnant women should receive a
booster dose of the DPT vaccine to protect both themselves
and their newborns. This is crucial because newborns are
more vulnerable to serious illness from diphtheria.
 Importance of Public Health Measures

• Public health measures play a critical role in

controlling and preventing diphtheria
outbreaks. These measures include:
• Vaccination Programs: Maintaining high
vaccination coverage rates is essential to protect
individuals and communities from diphtheria.
• Public health programs should prioritize
reaching underserved populations who may
have limited access to vaccination.
 Cont.
• Surveillance and Outbreak Response: Promptly identifying
and investigating suspected cases of diphtheria is crucial to
prevent further spread.
• Public health authorities should implement effective outbreak
response measures, including contact tracing, isolation of
infected individuals, and vaccination of close contacts.
• Education and Awareness: Public health campaigns can raise
awareness about diphtheria, its symptoms, and the
importance of vaccination.
• Educating healthcare providers and the general public about
diphtheria is vital for early detection and prompt
management of cases.
 Complications of Diphtheria

• Diphtheria can lead to serious complications, some

of which can be life-threatening.
• These complications arise from the toxin produced
by the bacteria, which damages tissues and
interferes with vital bodily functions.
• The most common complications include:
• Respiratory Complications
• The membrane formed in the throat can
obstruct breathing, leading to respiratory
distress, suffocation, and even death.
 Cont.
• Myocarditis
• The diphtheria toxin can damage the heart
muscle, causing inflammation and potentially
leading to heart failure.
• Neurological Complications
• The toxin can affect the nervous system,
leading to paralysis of muscles, including those
involved in breathing and swallowing.
• Peripheral Neuropathy
• Damage to nerves in the extremities can cause
weakness, numbness, and loss of sensation.
Conclusion