Dr. Clove is here to answer that question.

Diphtheria (diphtheria) is an acute infectious disease caused by the bacterium Corynebacterium diphtheria, in which a white pseudomembrane forms on the mucous membranes of the throat and nasal passages and may be accompanied by fever, malaise, nausea, vomiting, and headache, and in severe cases, complications such as myocarditis and paralysis of the peripheral nerves may occur.

People of all ages can be infected with Corynebacterium diphtheriae and develop the disease, with a greater incidence in the fall, winter, and early spring, and occurring around the globe.

I. Diphtheria is an acute infectious disease

Diphtheria is mainly spread by droplet transmission (e.g., face-to-face talking, sneezing, coughing, etc.) and close contact transmission (e.g., contact with toys, clothes and utensils contaminated by the patient's secretions, etc.).

Diphtheria patients and carriers are the main source of infection, and all people are susceptible, immunocompromised or not.

Second, diphtheria need to do what examination?

(1) Physical examination: white pseudomembrane formation can be found in the lesions of diphtheria (e.g., pharynx, tonsils, larynx, trachea, nasal cavity, ear canal, etc.).

(2) Blood tests: A routine blood test will reveal a significant increase in the percentage of white blood cells and neutrophils.

(3) Pseudomembrane smear examination and bacterial culture: Take pseudomembranes from the pharynx and nose and perform smear examination and bacterial culture to find Corynebacterium diphtheriae.

(4) Corynebacterium diphtheriae toxin test: positive in patients with diphtheria.

(5) Complications: ST-T changes, prolonged QT interval, and first-degree heart block on electrocardiogram, and elevated myocardial enzyme profile on blood sampling suggest that myocarditis may have occurred; leukocytes and tubular pattern on urinalysis, and elevated creatinine on blood sampling suggest that toxic nephropathy may have occurred.

Third, how should diphtheria be treated?

1. Isolation

Isolation is usually required for 1 to 2 weeks. Isolation may be lifted if symptoms disappear and 2 consecutive negative cultures for Corynebacterium diphtheriae are obtained (with an interval of 24 hours or more between cultures).

2. Eliminate the diphtheria bacillus

Antibiotics can destroy Corynebacterium diphtheriae. Penicillin is commonly used and can be stopped after a 14-day course of treatment when symptoms disappear and Corynebacterium diphtheriae cultures turn negative. A skin test should be done before injecting penicillin, and it should only be used if the skin test is negative. Patients who are allergic to penicillin or who are not satisfied with penicillin treatment can also be treated with erythromycin, also for 14 days.

3. Neutralize the toxins produced by Corynebacterium diphtheriae

"Diphtheria antitoxin can neutralize the toxin produced by Corynebacterium diphtheriae and is most effective when administered in the first 3 days of illness, so it should be used as early as possible. Skin test should be done before injecting the antitoxin. Negative skin test can be used directly, while positive skin test needs to be desensitized before use.

4. Treatment of complications of diphtheria

(1) Myocarditis: treatment with oral glucocorticoids (e.g., prednisone).

(2) Peripheral nerve paralysis: Patients with choking on food and water and difficulty in swallowing need to have a nasogastric tube inserted to give fluids and water by nasal feeding.

(3) Laryngeal obstruction: always be prepared for tracheotomy. As soon as severe dyspnea is detected, perform a tracheotomy and forceps to remove the pseudomembrane, or drip trypsin or chymotrypsin to dissolve the pseudomembrane.

Content references to Dr. Clove's science articles

Editor / Lee Bad

On this question, China Science Expo invited Zhang Wei from the Institute of Microbiology, Chinese Academy of Sciences to answer:

Diphtheria (diphtheria) is an acute respiratory infection caused by Corynebacterium diphtheriae.

Symptoms include fever, sore throat, hoarseness, barking cough, and white pseudomembrane in the throat, tonsils and surrounding tissues. In severe cases, the disease can lead to systemic symptoms of poisoning, which can be complicated by myocarditis and peripheral nerve paralysis, and lead to death.

Diphtheria can be categorized into four types depending on the site of infection, and its incidence is pharyngeal diphtheria, laryngeal diphtheria, nasal diphtheria, and diphtheria of other sites, in descending order. Pharyngeal diphtheria is more common in adults and older children, while other types of diphtheria are more common in infants and young children. Clinically, it can be categorized into 3 types: mild, general and severe.

Corynebacterium diphtheriae under a microscope (image via Wikipedia)

The source of infection of diphtheria is diphtheria patients and recovering carriers, the means of transmission is respiratory droplets or contact with infected patients, no infected or unimmunized people are susceptible to the disease.

Corynebacterium diphtheriae causes damage mainly by secreting a bacterial exotoxin, diphtheria toxin. Diphtheria toxin is highly cytotoxic as it causes cell death by inhibiting protein synthesis in eukaryotic cells.

Corynebacterium diphtheriae invades the upper respiratory tract of susceptible individuals, usually grows and multiplies in the pharyngeal mucosa, and secretes exotoxin to penetrate into the local and surrounding tissues, causing necrosis of local mucosal epithelial cells, vasodilatation, granulocyte infiltration, and fibrous exudate, thus forming a grayish-white membrane, called pseudomembrane.

White pseudomembrane in the larynx, a typical feature of diphtheria (image source: https://www.healthline.com/health/diphtheria)

If the lesion further extends into the larynx or trachea, it can cause respiratory obstruction or even asphyxiation. Although Corynebacterium diphtheriae does not generally invade the bloodstream, diphtheria toxin can be dispersed to all tissues of the body through lymph and blood, quickly combined with susceptible tissue cells, causing degenerative lesions in the myocardium, liver, kidney and adrenal gland, and can invade the peripheral nerve cells of palate and pharyngeal muscles, resulting in systemic toxicity symptoms such as cardiomyopathies and soft-palate paralysis, hoarseness, adrenal dysfunction, and decreased blood pressure.

I. What is diphtheria?

1. Diphtheria is an acute respiratory infection caused by the diphtheria bacterium. Diphtheria used to pose a major threat to human health, especially to children. Corynebacterium diphtheriae is a bacterium that is strictly parasitic on the human body and usually has no symptoms. Patients and carriers of diphtheria are the only source of infection. The incubation period for diphtheria is usually 1-7 days, with an average of 2-4 days. Patients are contagious at the end of the incubation period.

2、Diphtheria can occur all year round, but it is more common in fall and winter. The transmission of diphtheria is mainly through proximity droplet transmission, and it can also be transmitted indirectly through toys, clothes and utensils because the diphtheria bacillus can stay in the external environment for a long time. The clinical features of diphtheria are congestion and swelling of the mucous membrane of the pharynx, larynx and nose, accompanied by the formation of grayish-white pseudomembrane, which leads to respiratory obstruction and systemic toxicity caused by bacterial exotoxin, and can be combined with myocarditis and peripheral nerve paralysis in severe cases.

Second, what should be done to prevent diphtheria?

1, diphtheria can be prevented by vaccination. the epidemic of diphtheria has been somewhat controlled after the development of adsorbed diphtheria vaccine in the 1820s and its wide use around the world. The diphtheria vaccine is a vaccine made of toxin-producing diphtheria bacilli, the exotoxin produced in the culture medium, which becomes toxoid after formaldehyde treatment. At present, diphtheria has been rarely reported in China in recent years, and no diphtheria cases have been reported in Beijing for 22 consecutive years since 1996.

2. At present, vaccines against diphtheria in China include acellular pertussis vaccine (combined pertussis, diphtheria and tetanus vaccine) and diphtheria vaccine (combined diphtheria and tetanus vaccine), both of which are combined vaccines.

(1) The vaccination program for acellular DPT vaccine is 1 dose at 3 months of age, 1 dose at 4 months of age and 1 dose at 5 months of age, and a booster dose at 1.5 years of age, for a total of 4 doses.

(2) The vaccination program for DPT is 1 dose at age 6 years.

(3) The vaccination rate of DPT and DPT vaccine in our country is very high and the protection effect is very good. After vaccination, the positive rate of diphtheria antibody is more than 95%, which can protect for about 10 years. Therefore, the risk of diphtheria in China is very low and there is no need to worry too much.

tetanusIt is an acute upper respiratory tract infection caused by Corynebacterium diphtheriae, which is mainly transmitted through respiratory droplets. Corynebacterium diphtheriae can stay in the external environment for a long time, and can also be transmitted through contaminated hands, toys, stationery and so on. The incidence of diphtheria is common in winter and spring, and the susceptibility of children is the highest. The onset of diphtheria is characterized by congestion and swelling of the mucous membranes of the nose, throat and larynx with the formation of gray-white pseudomembrane, which leads to respiratory obstruction and poisoning symptoms caused by exotoxin, and myocarditis and peripheral nerve paralysis can occur in severe cases.

So how do we how do we prevent it?

First of all, vaccination with diphtheria-containing vaccines is an effective measure to prevent diphtheria. Children are vaccinated: one dose of combined pertussis-diphtheria-tetanus vaccine at the age of 3, 4 and 5 months and at the age of 18 to 24 months, and one dose of combined diphtheria-tetanus vaccine at the age of 6 years.

Other preventive measures include:

1 Close contacts of medical observation for 7 days, asymptomatic and nasopharyngeal fluid culture negative, can be released from medical observation; can choose sensitive drugs for prophylactic medication;

2 Isolate and treat patients and carriers;

3 After the patient is released from isolation and discharged from hospital, final disinfection of the patient's home and his/her room is carried out.

Diphtheria is an acute disease caused by Corynebacterium diphtheriae (Corynebacterium diphtheriae), which is capable of producing exotoxins. Diphtheria has historically been one of the dreaded childhood illnesses, with a high morbidity and mortality rate (>10%), despite the fact that most C. diphtheriae infections are occult or have relatively mild clinical symptoms. Prior to the introduction of antitoxins in the 1890s, some diphtheria outbreaks had morbidity and mortality rates of 50% or more. It is estimated that before the extensive use of diphtheria toxoid in the 1980s, there were about 1 million cases of diphtheria per year in developing countries, of which 50,000-60,000 died.

Diphtheria is spread by droplets and close contact and mainly affects preschool and school-age children. Through vaccination, diphtheria is no longer endemic or very rare in most developed countries, but it is still important to maintain high rates of vaccination in children and adults, as evidenced by diphtheria outbreaks in many places.December 6, 2017The World Health Organization has warned that diphtheria is spreading rapidly among Rohingya refugees in Cox's Bazar, Bangladesh, and more than 110 suspected cases have been diagnosed through clinical manifestations, including six deaths. These cases may be just the tip of the iceberg," said Dr. Navaratnasamy Paranietharan, WHO Representative in Bangladesh. This population is very vulnerable, with low vaccination coverage and living in an environment that can be a breeding ground for infectious diseases such as cholera, measles, rubella and diphtheria" . Yesterday (December 12, 2017), the Chinese Embassy in Indonesia issued an announcement, reminding Chinese citizens and organizations in Indonesia to pay attention to the prevention of diphtheria epidemic; the announcement said, according to local media reports, the recent outbreak of diphtheria epidemic in many parts of Indonesia, has led to nearly 600 people were infected, dozens of deaths, densely populated Jakarta and the surrounding provinces there is a higher degree of risk of disease.

When diphtheria occurs, the mortality rate can be significantly reduced by the use of antitoxin, tracheotomy, and modern intensive care medical facilities in places with good medical care, but the mortality rate in developing countries remains high. Diphtheria must be treated promptly, and the mainstay of treatment is diphtheria antitoxin.

Both DPT and DPT vaccine can prevent diphtheria. China routinely arranges for one dose of DPT vaccine at 3 months of age, 4 months of age, 5 months of age and 18 months of age, and one dose of DPT vaccine at 6 years of age. The self-funded DPT5 and DPT4 vaccines both contain DPT vaccine components inside and can be used in place of the free DPT vaccine. The CDC recommends one adult dose of DPT vaccine for 11-64 year olds, and there is no adult dose of DPT vaccine available domestically; adult and adolescent doses of DPT vaccine are available for people 12 years of age and older (and are available domestically as well), and the CDC recommends that adolescents and adults receive DPT vaccine every 10 years for boosters.

Diphtheria is an acute infectious disease with fever, weakness, nausea, headache and other symptoms that can be severe enough to cause death.

In the 80's when medical care was not very advanced, my cousin's husband died of diphtheria at the age of 28. At that time it was thought that the disease was terminal.

I remember that Kiki, the daughter of Jiali Bai in the Big House, had diphtheria, and then had Jiali Bai cured, using Western medicine.

In this day and age, with advanced medicine and technology, diphtheria is a disease that can be treated.

Xinhua News Agency reported: Chinese Embassy in Indonesia on the 12th issued an announcement to remind Chinese citizens and organizations in Indonesia to pay attention to the prevention of diphtheria epidemic. According to local media reports, a diphtheria epidemic broke out in many parts of Indonesia recently, which has led to nearly 600 people infected, dozens of deaths, and there is a higher degree of risk of the disease in the densely populated Jakarta and neighboring provinces, the announcement said.

I. Recognizing diphtheria

Diphtheria is an acute respiratory infectious disease caused by Corynebacterium diphtheriae, clinically characterized by pharyngeal and laryngeal grayish-white pseudomembrane and province-wide toxaemia, and in severe cases, death may be caused by myocarditis and peripheral nerve paralysis; human is the only natural host of Corynebacterium diphtheriae, and the source of infection is diphtheria patients and carriers. The main way of transmission is through respiratory droplet transmission, but also through food, toys and objects indirect transmission, occasionally through the broken skin transmission, the population is generally susceptible, through the vaccine containing diphtheria toxoid components or negative infection can obtain specific immunity.

Historically diphtheria has been one of the most feared childhood diseases, and outbreaks of the disease have been devastating. Although most infections are insidious or have relatively mild clinical symptoms, many patients die from respiratory obstruction or toxic myocarditis caused by laryngeal diphtheria.During the diphtheria pandemics that occurred in Europe and the United States in the 1880s, the case-fatality rate was as high as 50 percent in some places. During World War I, the mortality rate in Europe dropped to 15%, mainly because of the widespread use of antitoxins to treat diphtheria. During World War II diphtheria ravaged Europe; in 1943, one million people were sickened and 50,000 died. It is estimated that before the extensive use of diphtheria toxoid in the 1980s, there were about 1 million cases and 50,000-60,000 deaths per year in developing countries. In recent years, in countries or regions that are lagging behind in development, the reported mortality rate of diphtheria still exceeds 10%.

II. Preventive measures

Maintaining a high vaccination rate of DPT-containing vaccines is the most effective measure to prevent diphtheria outbreaks. There are several diphtheria toxoid-containing combined vaccine products approved for use in China, such as acellular combined vaccine against diphtheria, DPT2 vaccine, adsorbed diphtheria polio and Haemophilus influenzae type B (conjugate) vaccine.Vaccine [referred to as Pentavalent Vaccine], acellular combined vaccine of DPT and Hib [referred to as quadruple vaccine], etc..

China has included the acellular DPT vaccine and the DPT2 vaccine in the first category of vaccines in the immunization programme for children of the appropriate age, with one dose of acellular DPT vaccine for each of the ages of 3, 4, 5 and 18 months, and one dose of the DPT2 vaccine for those who have reached the age of 6 weeks. Guardians of school-age children may also choose to replace the free acellular DPT vaccine with the five-dose or four-dose vaccine.

additionallyIt is worth noting that diphtheria infection does not always induce protective immunity. Therefore, diphtheria patients should be given toxoid to complete active immunization during the recovery period. Vaccination does not preserve lifelong immunity, and WHO recommends booster immunization approximately 10 years after completion of primary immunization in low-endemic or non-endemic areas, and every 10 years thereafter.

III. Incidence of diphtheria epidemic in China

Since the 1970s, when it was incorporated into the immunization programme, the vaccination rate of cell-free DPT and DPT2 vaccine has been maintained at a high level through the joint efforts of the nation's vaccinators. From a summary analysis of the national infectious disease epidemic reports notified by the national health administration, no cases of diphtheria have been reported in China for 10 years, from 2007 to the present.

Therefore, the diphtheria outbreak that occurred in a localized area in Indonesia is not a significant threat to our country at this time.

Completed.

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