Diphtheria

Todar (2008) defines Diphtheriae as a life threatening illness caused by a very contagious bacterial infection. The illness is caused by bacterium referred to as corynebacterium diphtheriae. In most cases it attacks the nose and the throat but in very serious cases, it may attack the nerves and the heart. The illness is very uncommon in the United States of America due to widespread immunization. In most cases, this illness strikes before one turns 15 in almost 1o% of the cases, it is usually fatal.  However the disease is re-emerging in some places, where immunization is slack, across the world. This paper presents a detailed discussion concerning Diphtheriae with special reference to its causative agents, modes of transmission, pathogenesis of its infectious agents, signs/symptoms, treatment and prevention. Finally the research will look at statistics on Diphtheriae’s morbidity and mortality, and ongoing research.

Agents that Cause Disease

“Diphtheriae is caused by toxin-producing strains of the gram-positive bacillus Corynebacterium diphtheriae’’ (Pan American Health Organization, 2005). The bacterium has four biotypes including: mitis, belfanti, gravis, and intermedius. Every biotype varies in the severity it generates. Less rigorous cutaneous diphtheriae is normally brought about by nontoxigenic strains (Todar, 2008).

The ability of the bacteria to create a localized inflammatory response of the cells coating the upper respiratory tract causes respiratory diphtheriae’s signs and symptoms. In some occasions, the illness can become very widespread and severe and could involve other body organs (Robert, 2008).

There are various ways through which Diphtheriae is transmitted. First of all, it spreads by means of respiratory droplets, like those generated by sneeze or cough, of infected individuals or those carrying the bacteria but devoid of symptoms. Additionally Diphtheriae is also transmitted through contaminated food, instance contaminated milk, or objects (Robert, 2008).

Pichichero et al (2005) state that, “Diphtheriae normally transits to close contacts through airborne respiratory droplets or through direct contact with skin lesions or nasopharyngeal secretions.” On rare occasions, it also be transmitted by objects that have been contaminated an infected individual as observed above. Poor living conditions and overcrowding have been established as additional factors that lead to spread of diphtheriae.

Humans are the only identified corynebacterium diphtheriaee’s reservoir. Infected people can develop symptoms of diphtheriae or become the bacteria’s carriers devoid of symptoms, commonly referred to as asymptomatic carriers who can act as active infection’s reservoirs other than transmitting the illness to other people (Gidding et al, 2000).

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The Pathogenesis of the Infectious Agent

The chief pathogenic factor in the diphtheriae’s development is the exotoxin. The toxin is produced only by the corynebacterium diphtheriae that is contaminated by a bacteriophage having the gene tox. The toxin generated at the diphtheritic membrane’s site gets absorbed within the blood stream and is accountable for diphtheriae’s manifestations, for example neuritis, myocarditis and nephrites (Gidding, et al 2000).

Signs and Symptoms

During the early phases of diphtheriae, it can easily be mistaken for an awful sore throat. Additional early symptoms include swollen neck glands and low-grade fever.

The poison or toxicity brought about by the bacteria can cause a thick lining in the airway, throat or nose. The lining is normally black or fuzzy and may cause breathing difficulties and problems in swallowing. The formation of this lining (membrane) within the throat, airway, or nose differentiates a diphtheriae infection from other frequently widespread infections (Pan American Health Organization, 2005).

Gidding et al (2000) add that as the infection continues; an individual may show symptoms such as double vision, experiencing slurred speech, problems with swallowing and breathing. Furthermore, the person may exhibit signs of being shocked, such as having an anxious appearance, cold and pale skin, sweating and hasty heartbeat.

In occasions where it goes past a threat infection, toxins of diphtheriae spread in the bloodstream and could result to possibly life-threatening problems that affect other body organs like kidneys and the heart.  The toxin can cause harm to these organs, for instance it can impede the kidneys’ capacity of clearing waste or the heart’s capacity to pump blood. Moreover the toxin can damage nerves and finally lead to paralysis. Statistics indicate that 40%-505 of individuals with diphtheriae who do not obtain treatment can die (Pichichero et al, 2005).

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Treatment

In the event that anyone is suspected of having diphtheriae, it is important that they undergo prompt treatment even prior to availability of confirmatory lab results. The therapy’s mainstay is diphtheriae antitoxin which neutralizes circulating toxin of diphtheriae and decreases the diseases progression (Gidding, 2000).

The efficiency of diphtheriae antitoxin is highest when it is administered in the early stages of the illness. In the United States of America, the diphtheriae antitoxin can be obtained with the aid of the U.S. Centers for Disease control and Prevention (CDC). It has to be noted the antitoxin is not suggested for asymptomatic carriers and it is normally of no importance when it comes to localized cutaneous diphtheriae as observed by Robert (2008).

Another form of treatment is the antibiotics that have to be administered also immediately the patient is suspected of diphtheriae. They help in eliminating the bacteria, therefore preventing the production of toxin. Additionally antibiotics help to avoid diphtheriae being transmitted to close contacts. The recommended antibiotics are erythromycin and penicillin. All individuals who are possibly exposed to diphtheriae due to close contact together with asymptomatic carriers also need antibiotic treatment.

In cases where patients are unable to breath on their own, supportive measures have to be undertaken, for instance intubation (inserting a tube for breathing) if there is a possibility of airway obstruction. Moreover, possible neurologic and cardiac complications have to be strictly followed and dealt with in consultation with the right specialist.

Prevention

The sole method of prevention of diphtheriae is immunization of the susceptible population. Immunization is done by diphtheriae toxoid. The immunity obtained from diphtheriae toxoid is stays for several months. In most cases diphtheriae toxoid administering is done in children before they turn 1 and presently the vaccination is normally done in a combination shot with pertussis and tetanus vaccines, referred to as DTP (Gidding et al, 2000). Before a child reaches the age of 18 months, they must have obtained four shots of DTP, together with a booster shot, normally at the age of 4-6 years. For sustained protection, tetanus and diphtheriae boosters have to be give once in every 10 years, after the process of administering DTP.

Todar, (2008) explains that due to the fact that one might have had diphtheriae unknowingly, the only way of establishing whether they have had the illness is testing their immunity to it. The Schick test is the widespread test to establish an individual’s status of immunity to diphtheriae. The test works by introducing a little amount of diphtheriae exotoxin into the skin. The person will be said to be susceptible to diphtheriae if the region turns to reddish within the time of 3-4 days. On the other hand, if there is no reaction, it means that there is high antitoxin’s level within the individual’s blood, adequate to prevent the disease.

Statistics on Morbidity and Mortality

The host’s immunization’s state highly determines the illness’s prognosis. Individuals with adequate immunization before hand have considerably higher morbidity and mortality. The rate of mortality is also amplified by the delay in beginning of treatment.” Administering proper treatment on the 1^st day of the illness reduces the mortality rate to be as low as 1%. Delays in treatment up to the 4^th day may elevate the mortality rate up to ≤20-fold high’’ (Robert, 2008)

Statics indicate that vaccination saves millions of lives every year. Estimate that were provided in 2005 by CDC indicate that every 7 of the 12 routine childhood vaccines administered in the U.S alone each year prevents 33, 000 deaths and 14 million cases of disease. This figure is even not accurate as the situation on the ground indicates that vaccination is highly benefiting people. According to study done in 2005, the estimated deaths and cases of diphtheriae stand at 24, 721 and 247, 214 respectively if vaccination was to be discontinued (Todar, 2008).

Additional Information and any Ongoing Research

New molecular typing techniques enable characterization for of strains and closely associated groups (clones) of strains. This will possibly facilitate further epidemiological studies and probably discovery of additional virulence factors. Recent discovery of importunate foci in Canada, the United States of America and Australia could facilitate studies to establish risk factors for perseverance and required control measures (Todar, 2008).

Conclusion

Diphtheria a life a life-threatening illness caused by very contagious bacterium referred to as corynebacterium diphtheriae. The illness mostly attacks the nose and the throat but in severe occasions it could attack the nerves and the heart. Diphtheria is spread through various means but primarily via direct contact with secretions from infected individuals or airborne respiratory droplets. The illness’s symptoms entail problems with breathing, sore throat, difficulty swallowing, malaise and fever.

Diphtheria can result to neurologic and cardiac problems and also death if appropriate measures are not taken. Treatment of diphtheria can be both in the form of antibiotics and antitoxin. The good news is that this illness is preventable through immunization. The sole way is protecting the susceptible population is immunizing them using diphtheriae toxoid. This has greatly reduced the number of deaths that would have otherwise been brought about the illness.