Diphtheria is an infectious respiratory disease, which mainly affects young children. It used to be a dreaded disease with high mortality, but nowadays it is very rare in developed countries thanks to the vaccination.


The cause of the disease is bacterium Corynebacterium diphtheriae. The microorganism is transmitted by droplet infection. When the droplets are inhaled, the bacteria colonize mucous membranes of the upper respiratory tract. The bacteria proliferate, multiply and produce a toxin (diphtheric toxin), which is absorbed into the blood. 


The toxin has a detrimental effect on the mucous membranes of the respiratory tract, causing necrosis of their cells and occurrence of pseudomembranes. The disease manifests with high fever, sore throat, painful swallowing, enlargement of the cervical lymph nodes, swelling of the throat and narrowing of the airways by pseudomembranes resulting in shortness of breath. The victims are at high risk of sudden suffocation. In addition, the toxin can also damage the heart muscle and kidney tissue.


In addition to the symptoms, the patient can be examined by an otolaryngologist, who can confirm the severe inflammation with pseudomembranes in the upper airways. Local swab may confirm the presence of bacteria when examined in a microbiological laboratory and blood tests could be used to detect the toxin in patient's serum.


The most effective way of prevention is a vaccine, which is part of the mandatory vaccination schedule in the majority of developed countries. The classical vaccine promotes immunity to the toxin and not to the bacterial cells.


The infection is treated by antibiotics and the toxin may be disabled by a special antitoxin that may be administered to a patient with ongoing infection. The sooner the antitoxin is applied, the greater is the chance of survival. When the affected person chokes, the airways must be ensured by intubation.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources