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Diphtheria, also known as whooping cough, is a potentially deadly disease, killing 2 to 10% of children and up to 20% of adults who catch it. And the vaccinations against this potentially deadly disease may not be working as well as they used to.

In the early part of the twentieth century, the bacterial infection known as whooping cough, caused by the diphtheria bacterium, Corynebacterium diphtheria, was the dreaded killer of young children and older adults all over the world. In the United States alone, up to 200,000 children per year caught the infection and as many as 15,000 died.

In Europe, in 1943 alone, over 1,000,000 people caught the disease and at least 50,000 died. And as recently as 1994 in Russia and 2010 in Haiti, diphtheria infections spread to thousands of people causing hundreds of death.

In the United States, diphtheria infections continue to crop up among recent immigrants and travelers, among homeless people, in prisons, and among the poor. The disease has been almost unknown among people who get diphtheria-pertussis-tetanus vaccinations (DPT shots), but scientists now believe that the vaccinations may not be completely effective against a new strain of the bacteria that cause the disease.

What's So Bad About Diphtheria?

Diphtheria is bacterial infection of the upper respiratory tract. Most commonly spread during the late winter and early spring, these bacteria cause symptoms beginning with a mild sore throat, flaring nostrils, and sinus pain.There can be a fever of up to 103 F (about 39 C), hoarseness, laryngitis, loss of appetite, fatigue, and difficulty swallowing.

But as the infection progresses, dead bacteria, dead white blood cells, dead red blood cells, and dead mucous membrane cells can accumulate into a thick, gray film that can settle just about anywhere in the nose, throat, or lungs. When this membrane forms, the resulting cough is diagnosed as pertussis, which is just the disease caused by a diphtheria infection.

It is this gray film that causes the most deadly symptoms of diphtheria. This so-called pseudomembrane can block the passage of air through the nostrils, the throat, or the lungs. It becomes a struggle to breath, with each cough causing an unmistakable "whoop" that is the hallmark of the disease. The infection can also cause extreme swelling in the neck that likewise interferes with breathing. If pieces of the pseudomembrane break off and are aspirated into the lungs, or if they block the breathing passages completely, respiratory failure and death may quickly follow.

How Is Diphtheria Treated?

The mainstay of diphtheria treatment is the administration of an antitoxin. This is not a vaccine. It is a treatment that keeps the toxin released by the diphtheria bacteria from killing tissues that slough off into the sticky pseudomembrane. Since the antitoxin is made from blood plasma from horses, people who are allergic to horse dander may not be able to take it.

Then the infection is treated with antibiotics. Infants can't be given erythromycin, because it can cause a narrowing of the digestive tract. The alternative to erythromycin is penicillin, but people also can be allergic to penicillin, greatly limiting the possibilities for effective treatment after the first few days of the disease. The infection can spread to joints, muscles, and the central nervous system, sometimes causing septic shock, blindness, total paralysis, and death in people who survive the whooping cough and respiratory obstruction induced by the disease. Even today, diphtheria can be fatal.

Continue reading after recommendations

  • Aaby P, Benn C, Nielsen J, Lisse IM, Rodrigues A, Ravn H. Testing the hypothesis that diphtheria-tetanus-pertussis vaccine has negative non-specific and sex-differential effects on child survival in high-mortality countries. BMJ Open. 2012 May 22
  • 2(3). pii: e000707. doi: 10.1136/bmjopen-2011-000707. Print 2012.
  • Valérie Caro, Annika Elomaa, Delphine Brun, Jussi Mertsola, Qiushui He, Nicole Guiso. Bordetella pertussis, Finland and France. Emerg Infect Dis. 2006 June
  • 12(6). 987–989. doi: 10.3201/eid1206.051283.
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