Diphtheria: What it is, Causes, Symptoms, Treatment & Types

What is Diphtheria?

Diphtheria is a bacterial infection caused by the Corynebacterium diphtheriae bacteria, whose toxigenic strains produce a thick, grey membrane in the respiratory tract. This infection in the nose and throat can make breathing and swallowing difficult. If the toxins from the bacteria enter the bloodstream, they can also harm other organs like the heart, nerves, and kidneys.

Diphtheria spreads through respiratory droplets, such as coughs and sneezes. Although there are many vaccination programmes aimed at preventing this condition, the disease continues to pose significant health risks, especially in areas with limited resources.

What are the Types of Diphtheria?

The types of diphtheria include the following:

How Common is Diphtheria in India?

Diphtheria is one of the recurring diseases in the category of vaccine-preventable diseases in India. An overall incidence of 2.3 and 2.7 per million population has been reported in 2022 and 2023, respectively. This signifies continuous transmission along with an increase in the numbers when compared to the previous year.

Therefore, addressing immunisation gaps and raising awareness around diphtheria are essential for eradicating this disease in the country.

What Are the Symptoms of Diphtheria?

Symptoms of diphtheria generally develop between two and five days after exposure to the bacteria. As the condition progresses, the bacteria create toxins which can cause serious respiratory issues and harm to other organs.

How Does Diphtheria Progress?

Diphtheria progresses through different phases as the bacteria multiply and release toxins in the body. The following table highlights the progression of the disease in each phase:

Diseases Similar to Diphtheria

Several medical conditions can cause symptoms that resemble diphtheria, especially sore throat, fever, and difficulty swallowing. Understanding the differences between these diseases can help in early diagnosis and appropriate treatment.

Diphtheria Vs. Strep Throat Vs. Epiglottitis Vs. Infectious Mononucleosis

What Are the Causes and Risk Factors of Diphtheria?

The cause and risk factors of diphtheria include:

Complications Associated With Diphtheria

Diphtheria, when left untreated, can lead to serious, sometimes even life-threatening complications, such as:

• Heart Complications: Diphtheria can damage the heart muscle, leading to an irregular heartbeat and even heart failure.

• Nerve Injuries: The infection can affect nerves responsible for motor abilities and breathing.

• Respiratory Obstruction: Affected individuals can develop a pseudomembrane in the throat, leading to swelling and thereby blocking the air passage.

• Kidney Impairment: The toxin released by the bacteria can impair the functioning of the kidneys.

• Paralysis: In some severe cases, diphtheria infection can cause paralysis due to nerve damage.

When Should I See My Healthcare Provider?

You should see your healthcare provider if you have any of the following symptoms:

• Sore throat accompanied by fever

• Trouble breathing

• Trouble swallowing

• Swollen glands in the neck

• Greyish-white membrane covering the membranes in the mouth and throat

• Exposure to an infected person with diphtheria

Timely medical care can help prevent complications caused by diphtheria.

How is Diphtheria Diagnosed?

Diphtheria can be diagnosed either clinically or via laboratory tests.

Note: Diagnosis of diphtheria relies on identification by physical examination and laboratory findings. Treatment starts as soon as physicians suspect diphtheria in a patient, because any delay may lead to serious complications.

How is Diphtheria Treated?

Treatment of diphtheria should start immediately after the diagnosis. It usually involves:

• Antibiotics: Their role includes eradicating the bacteria and stopping the production of the toxin.

• Antitoxin: In this case, antitoxin is used to neutralise the diphtheria toxin before it damages body organs.

• Hospital Treatment: If diphtheria is serious enough to require hospitalisation, it should be conducted as follows - Providing oxygen, Ensuring open airways, Monitoring vital signs & Checking heart rate

• Intravenous Fluids and Oxygen Therapy: If patients have trouble swallowing or have breathing difficulties, they may need intravenous fluids and oxygen therapy in the hospital.

• Isolation: Isolating infected individuals is necessary to avoid transmission.

• Post-Infection Vaccinations: Vaccination for diphtheria may still be recommended even after recovery because the infection does not always provide long-term immunity.

Common Medicines Used to Treat Diphtheria

The treatment of diphtheria focuses on eliminating the bacteria, neutralising the toxin, and preventing complications. Some medications typically prescribed to treat diphtheria include:

• Diphtheria Antitoxin (DAT): Diphtheria antitoxin works by neutralising the toxin circulating in the bloodstream before it damages other organs, such as the heart and kidneys. However, it cannot reverse any organ damage that has already occurred, which is why early treatment is essential.

• Penicillin: Penicillin is one of the most regularly administered medicines to treat diphtheria. It helps in eliminating the Corynebacterium diphtheriae bacteria from the body, preventing further toxin production and reducing transmission risk.

• Erythromycin: Erythromycin is another antibiotic that is frequently used, especially in patients who are allergic to penicillin. It effectively clears the bacterial infection and shortens the period during which the patient remains contagious.

• Paracetamol: Paracetamol is used to reduce fever, aches and pains in the body and a sore throat. It helps to control the symptoms and so increases the comfort level of the patient during recovery.

Note: The medicines mentioned above should only be used under the supervision of a qualified healthcare professional. Diphtheria may require hospitalisation and intensive monitoring for complications.

Recovery and Care After Diphtheria Infection

Most people with diphtheria recover completely when treatment begins early. However, the recovery period may take several weeks, particularly in severe cases or complications. During this period, patients require adequate rest, proper nutrition, and careful monitoring.

What is the Prognosis for Diphtheria?

Treatment for diphtheria can last for several weeks or even months. Most people recover completely if treatment is started early. But if complications develop, such as heart or nerve damage, recovery can take longer.

Early diagnosis enables individuals to regain their health without worrying about developing any other adverse effects from this infection.

Can Diphtheria Be Cured?

Yes, early diagnosis and treatment of diphtheria ensure a complete cure of this infection. Treatment involves removing the pathogen with antibiotics and neutralising its toxins with diphtheria antitoxin. Most patients recover fully when treatment begins early.

Note: A cure does not correct the already developed complications caused by toxins in the body parts affected by the diphtheria infection. Early diagnosis and vaccination play a major role in such cases.

How to Prevent Diphtheria?

Vaccination is still the most effective way to prevent diphtheria. The WHO has suggested that there should be several vaccinations, as well as boosters, to maintain protection against the disease.

Prevention methods include:

• Following the vaccination schedule as recommended

• Getting booster doses where necessary

• Avoiding close-contact with diphtheria-infected individuals

• Maintaining hygienic practices

• Consulting a doctor at the first signs of infection

Diphtheria Treatment Cost in India

The cost of diphtheria treatment in India varies based on the severity of the infection, the need for intensive care, and the length of hospitalisation. Mild illnesses usually require fewer medical resources, while serious infections with consequences can greatly raise the cost of treatment.

Note: The cost of diphtheria treatment in India can vary considerably depending on the severity of the infection, the need for intensive care, the city, and the type of hospital chosen. The above figures are approximate estimates based on consultation, investigation, and hospitalisation costs published by Indian healthcare providers and government-approved rate schedules.

Does Health Insurance Cover Diphtheria?

Yes, health insurance plans in India will cover the cost of hospitalisation and treatment for diphtheria, depending on the terms and conditions of the policy. This usually includes hospital investigations, prescriptions issued by a physician, consultations with physicians, and even daycare treatments.

However, the coverage amount, waiting periods, exclusions, and conditions for claims can differ among insurance providers. Therefore, you should always review the policy document thoroughly.

How Much Health Insurance Coverage Is Needed for Diphtheria Treatment?

The coverage amount needed for diphtheria treatment depends on factors like severity of disease, treatment costs, choice of hospital and length of hospitalisation.

A ₹5 lakh health insurance cover is sufficient for moderate or mild cases requiring hospitalisation. Higher health insurance coverage, ranging between ₹5 and ₹10 lakh, can help if you anticipate a longer hospital stay.