Diphtherie: Ursache, Symptome und Behandlung

Diphtheria is a bacterial infection that can be life-threatening. Diphtheria affects both adults and children, and used to be one of the most feared childhood diseases.
Today, diphtheria is rare in Switzerland and other industrialised countries thanks to vaccination. However, there has been an increase in infections again in recent years. The spread of diphtheria occurs predominantly in regions with low vaccination rates, such as Latin America and Africa.
Diphtheria pathogens are usually transmitted via droplets produced when an infected person sneezes, coughs or speaks, and are rarely transmitted via the hands. Around 10% of cases are fatal despite treatment.

There are two kinds of diphtheria:

• Respiratory diphtheria: This kind of diphtheria affects the respiratory tract (pharyngeal diphtheria).
• Cutaneous diphtheria: Here the pathogens attack the skin (skin or wound diphtheria).

There is a reporting obligation for diphtheria in Switzerland. That means doctors are obliged to report any suspected cases of diphtheria to the Federal Office of Public Health. The same applies to confirmed illness or death caused by diphtheria.

Diphtheria in the throat is caused by the bacterium Corynebacterium diphtheriae. Corynebacterium ulcerans and Corynebacterium pseudotuberculosis are responsible for skin diphtheria. If these diphtheria pathogens enter the body, they produce toxins there. These enter the bloodstream and attack the body’s cells and mucous membranes.

These vary depending on the type of diphtheria. The symptoms of pharyngeal diphtheria are:

• Sore throat and difficulty swallowing
• Fever
• Barking cough
• Shortness of breath
• Hoarseness and loss of voice
• Swollen neck lymph nodes
• Paleness
• Weakness
• Sweet, putrid smell to the breath
• Brownish skin in the throat
• Coating on the tonsils

Diphtheria that affects the skin causes the following symptoms:

• Redness
• Swelling
• Sores and ulcers

The incubation period of diphtheria is one to five days. That’s how much time passes between becoming infected with and the symptomatic outbreak of diphtheria. Those affected remain contagious until the pharyngeal secretion or wound no longer contains pathogens, which usually takes two to four weeks.

Respiratory diphtheria

The clinical picture of respiratory diphtheria is characterised initially by complaints in the throat area. Infected individuals have a sore throat, difficulty swallowing and bad breath. They feel generally unwell, have a fever, and often have swelling of the throat that is visible from the outside. They are also hoarse and may temporarily lose their voice. A typical symptom of diphtheria is a brown, leather-like coating that forms in the throat and cannot be detached. Deposits also form on the tonsils; these have a yellowish-white colour and are a typical symptom of diphtheria. They may spread to the throat, windpipe and nose. The resulting narrowing of the airways can lead to shortness of breath and even death from suffocation.

Note: especially at the beginning, respiratory diphtheria resembles angina (tonsillitis). It is therefore important to contact your doctor at an early stage so that the disease can be treated before it leads to serious problems.

Cutaneous diphtheria

Skin diphtheria causes sores and ulcers to develop on the skin and mucous membranes. The bacteria that cause this release only a small amount of toxins. In some cases, infected individuals can infect themselves or others with pharyngeal diphtheria if they already have skin diphtheria.

The following complications and long-term effects of diphtheria are occasionally reported:

• Shortness of breath: Shortness of breath occurs when the disease spreads to the larynx and the mucous membranes swell. If the swelling is particularly severe, infected individuals find it harder to breathe. Diphtheria is life-threatening in such cases.
• Organ complaints: Sometimes the toxins spread to the internal organs. Potential consequences include cardiac arrhythmia, inflammation of the heart, dysphagia and respiratory paralysis, as well as kidney and liver failure. These long-term effects of diphtheria may lead to the death of the infected person, sometimes several months after contracting the disease.

Diphtheria requires immediate medical treatment, even in the case of a suspected diagnosis so as to avoid serious consequences. Diphtheria is treated using three basic measures:

• Antitoxin: This neutralises the diphtheria toxins, i.e. the toxins that have not yet penetrated the cells. Antitoxin treatment is administered on an inpatient basis, as it occasionally leads to an allergic reaction. In the case of skin diphtheria, antitoxin treatment is often not necessary, as the toxins do not spread.
• Antibiotics: Antibiotics do not replace antitoxin treatment. Antibiotic therapy eliminates the pathogens and prevents further infections. The active substances penicillin and erythromycin are usually used, with treatment lasting about two weeks.
• Treatment of complications: Your doctor will also treat complications that can occur with diphtheria. In some cases, intensive care is necessary, such as in the case of cardiac arrhythmia.

You will also be put into quarantine immediately after your diagnosis. You will only be permitted to have personal contact with people who are protected with the diphtheria vaccination.

If there is a chance that you have infected other people before the diagnosis, they will be given a preventive antibiotic following an examination and vaccination will be recommended.

Although it is now rare in industrialised countries, diphtheria has not yet been completely eradicated, which is why it’s important to protect yourself against it. The most effective method is the diphtheria vaccination, which contains a harmless toxin from the diphtheria bacterium. The body responds to this by producing antibodies against the pathogen. In Switzerland, the combined vaccination is usually used, which protects against six diseases:

• Diphtheria
• Hepatitis B
• Haemophilus influenzae type b
• Whooping cough
• Tetanus
• Polio

For primary immunisation, the diphtheria vaccine is administered at 2, 4 and 12 months of age in accordance with the Swiss vaccination plan. In some cases, four doses of the vaccine are also indicated, for example if the child was born before the 32nd week of pregnancy.

Experts also recommend a booster:

• between age 4 and 7
• between age 11 and 15
• at 25 years of age
• at 45 years of age
• at 65 years of age

Those 65 and over are advised to have a diphtheria vaccination every ten years – or at shorter intervals if they have a weakened immune system.

Diphtheria is a serious disease. If diphtheria is suspected, a timely visit to the doctor prevents serious complications. The best way to protect yourself and your loved ones is to get vaccinated regularly. Ask your doctor about your vaccination status and any boosters.