Solutions to curb Diphtheria infection

As the State witnessed recent outbreak of Diphtheria, a serious bacterial infection affecting the nose and throat, medicos talk about the disease and its various prevention. 

Diphtheria is found in the respiratory surfaces and skin commonly. It spreads  by airborne respiratory droplets, direct contact with respiratory secretions or from infected skin lesions, say medicos. Asymptomatic respiratory tract carriage is important in transmission. In a diphtheria endemic region, 3-5 per cent of healthy individuals can carry toxigenic organisms.

Diphtheria includes extensive pseudomembranous pharyngitis, massive swelling of the tonsils. Lymph node enlargement of the cervical and submandibular region gives the classic ‘bull neck’ appearance.  

Following an average incubation period of 2-5 days (range 1-10 days), the onset of disease is gradual and symptoms includes low-grade fever, malaise, neck node enlargement and sore throat. The extent of the pseudo membrane generally correlates with the severity of disease. Localised tonsillar disease is mild, but involvement of extensive areas is often associated with more severe symptoms.

Marked neck node swelling causes the classical ‘bull-neck’ appearance of severe respiratory diphtheria and noisy breathing- respiratory stridor. Hoarseness and barking cough indicate laryngeal involvement, and tracheobronchial involvement is associated with dyspnoea and respiratory compromise. Skin infections like scaling rash or ulcers with clearly demarcated edges and membrane. Chronic skin lesion may harbor Corynebacterium diphtheriae along with other organisms.

Universal immunization may protect antitoxin levels and reduce severity of C. Diphtheria disease, said Dr Subramanian Swaminathan – Senior Consultant -  Infectious Diseases, Gleneagles Global Heath City.  Persons with respiratory diphtheria are contagious even during the incubation period and sometimes during convalescence (when carriage may last many weeks). 

It usually affects children younger than 15 years of age,” added D Subramanian Factors contributing to diphtheria includes a large population of under immunized adults, decreased childhood immunization rates, migration, crowding, and failure to respond  during early phases of the epidemic.

Specific antitoxin is the mainstay of therapy and should be administered on the basis of clinical diagnosis. Equine diphtheria antitoxin is available and administered as a single empirical dose based on the degree of toxicity, site and size of the membrane, and duration of illness.

The role of antimicrobial therapy is to halt toxin production, treat infection, and prevent transmission of the organism to contacts. C. diphtheriae is usually susceptible to penicillins and erythromycin, which are the recommended antimicrobial agents. Elimination of the organism should be documented by negative results of at least 2 successive cultures of specimens from the nose and throat (or skin) obtained 24 hr apart after completion of therapy.

“There are more number of diphtheria cases among children. Patients affected with the disease are instituted with droplet precautions. Bed rest is maintained so that any risk of infection is minimized. It usually takes at least two weeks for the infection to subside,” says Dr Muthu Kumar, paediatrician, Institute of Child Health.