Diphtheria overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diphtheria (Greek διφθερα (diphthera) — “pair of leather scrolls”), is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane (a pseudomembrane) on thetonsils, pharynx, and/or nasal cavity.[1][2] A milder form of diphtheria can be restricted to the skin. It is caused by Corynebacterium diphtheriae, a facultatively anaerobicGram-positive bacterium.[3]
Diphtheria is a highly contagious disease spread by direct physical contact or breathing the aerosolized secretions of infected individuals. Once quite common, diphtheria has largely been eradicated in developed nations through wide-spread vaccination. In the United States for instance, between 1980 and 2004 there have been 57 reported cases of diphtheria (and only five cases since 2000)[4] as the DPT(Diphtheria–Pertussis–Tetanus) vaccine is given to all school children. Boosters of the vaccine are recommended for adults since the benefits of the vaccine decrease with age; they are particularly recommended for those traveling to areas where the disease has not been eradicated.
Historical perspective
Before 1826, diphtheria was known by different names across the world. In 1826, Diphtheria was named in 1826 by French physician Pierre Bretonneau. The name alludes to the leathery, sheath-like membrane that grows on the tonsils, throat, and in the nose.[5][6]
Classification
Diphtheria can be classified according to the type of Corynebacterium that causes it. It can also be divided according to the clinical presentation it results into: respiratory, systemic or cutaneous diphtheria.[7][8]
Causes
C. diphtheriae is a facultatively anaerobic, Gram positive organism, characterized by non-encapsulated, non-sporulated, immobile, straight or curved rods with a length of 1 to 8 µm and width of 0.3 to 0.8 µm, which form ramified aggregations in culture (looking like "Chinese characters"). The bacterium may contain polymetaphosphate aggregates called Volutin granules. It is pathogenic only in humans.[9]
Epidemiology and Demographics
Diphtheria is found worldwide but is rare in the United States. Diphtheria causes significant illness and death in developing countries where vaccination coverage is low.
Risk factors
Common risk factors in the development of Diphtheria are lack of immunisation, travelling to areas endemic for diphtheria, overcrowding poor sanitary conditions, immunocompromised individuals.[10][11][12][13][14]
Screening
There are no screening recommendations for diphtheria. [15]
Natural History, Complications, and Prognosis
Diphtheria is a vaccine preventable disease which can lead to severe complications like respiratory failure, myocarditis, polyneuropathies and death once the disease sets in.[16][17][18][19][20][21] The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age.[22]
Diagnosis
History and Symptoms
Respiratory diphtheria presents with a wide range of systemic and respiratory symptoms.Respiratory diphtheria presents with a wide range of systemic and respiratory symptoms.[16] Additionally, cutaneous diphtheria usually presents with ulcers or pustular lesions, which can involve different parts of the body. Lesion can be covered by a grayish-white pseudomembrane, similar to tonsillar exudates of respiratory diphtheria.[23]
References
- ↑ Diphtheria. Centers for Disease Control and Prevention (2016) http://www.cdc.gov/diphtheria/ Accessed on July 28, 2016
- ↑ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. pp. 299–302. ISBN 0838585299.
- ↑ Office of Laboratory Security, Public Health Agency of Canada Corynebacterium diphtheriae Material Safety Data Sheet. January 2000.
- ↑ Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds. (2007). Diphtheria. in: Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book) (PDF) (10th ed. ed.). Washington DC: Public Health Foundation. pp. 59&ndash, 70.
- ↑ Pierre Bretonneau, Des inflammations spéciales du tissu muqueux, et en particulier de la diphtérite, ou inflammation pelliculaire, connue sous le nom de croup, d'angine maligne, d'angine gangréneuse, etc. [Special inflammations of mucous tissue, and in particular diphtheria or skin inflammation, known by the name of croup, malignant throat infection, gangrenous throat infection, etc.] (Paris, France: Crevot, 1826).
A condensed version of this work is available in: P. Bretonneau (1826) "Extrait du traité de la diphthérite, angine maligne, ou croup épidémique" (Extract from the treatise on diphtheria, malignant throat infection, or epidemic croup), Archives générales de médecine, series 1, 11 : 219-254. From p. 230: " … M. Bretonneau a cru convenable de l'appeler diphthérite, dérivé de ΔΙΦθΕΡΑ, … " ( … Mr. Bretonneau thought it appropriate to call it diphtheria, derived from ΔΙΦθΕΡΑ [diphthera], … ) - ↑ "Diphtheria". Online Etymology Dictionary. Retrieved 29 November 2012.
- ↑ Wong TP, Groman N (1984). "Production of diphtheria toxin by selected isolates of Corynebacterium ulcerans and Corynebacterium pseudotuberculosis". Infect. Immun. 43 (3): 1114–6. PMC 264307. PMID 6321350.
- ↑ Moore LS, Leslie A, Meltzer M, Sandison A, Efstratiou A, Sriskandan S (2015). "Corynebacterium ulcerans cutaneous diphtheria". Lancet Infect Dis. 15 (9): 1100–7. doi:10.1016/S1473-3099(15)00225-X. PMID 26189434.
- ↑ Zeegelaar JE, Faber WR (2008). "Imported tropical infectious ulcers in travelers". Am J Clin Dermatol. 9 (4): 219–32. PMID 18572973.
- ↑ Quick ML, Sutter RW, Kobaidze K, Malakmadze N, Nakashidze R, Murvanidze S; et al. (2000). "Risk factors for diphtheria: a prospective case-control study in the Republic of Georgia, 1995-1996". J Infect Dis. 181 Suppl 1: S121–9. doi:10.1086/315563. PMID 10657203.
- ↑ Vitek CR, Brennan MB, Gotway CA, Bragina VY, Govorukina NV, Kravtsova ON; et al. (1999). "Risk of diphtheria among schoolchildren in the Russian Federation in relation to time since last vaccination". Lancet. 353 (9150): 355–8. doi:10.1016/S0140-6736(98)03488-6. PMID 9950440.
- ↑ Koopman JS, Campbell J (1975). "The role of cutaneous diphtheria infections in a diphtheria epidemic". J Infect Dis. 131 (3): 239–44. PMID 805182.
- ↑ Belsey MA, Sinclair M, Roder MR, LeBlanc DR (1969). "Corynebacterium diphtheriae skin infections in Alabama and Louisiana. A factor in the epidemiology of diphtheria". N Engl J Med. 280 (3): 135–41. doi:10.1056/NEJM196901162800304. PMID 4972946.
- ↑ Favorova LA (1969). "The risk of infection in droplet infections. The influence of overcrowding and prolonged contact on transmission of the diphtheria pathogen". J Hyg Epidemiol Microbiol Immunol. 13 (1): 73–82. PMID 5814141.
- ↑ USPSTF https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=diphtheria Accessed on Oct. 7, 2016.
- ↑ 16.0 16.1 Dobie RA, Tobey DN (1979). "Clinical features of diphtheria in the respiratory tract". JAMA. 242 (20): 2197–201. PMID 490806.
- ↑ MORGAN BC (1963). "CARDIAC COMPLICATIONS OF DIPHTHERIA". Pediatrics. 32: 549–57. PMID 14069096.
- ↑ Sanghi V (2014). "Neurologic manifestations of diphtheria and pertussis". Handb Clin Neurol. 121: 1355–9. doi:10.1016/B978-0-7020-4088-7.00092-4. PMID 24365424.
- ↑ Jain A, Samdani S, Meena V, Sharma MP (2016). "Diphtheria: It is still prevalent!!!". Int J Pediatr Otorhinolaryngol. 86: 68–71. doi:10.1016/j.ijporl.2016.04.024. PMID 27260583.
- ↑ http://www.who.int/immunization/topics/diphtheria/en/index1.html Accessed on October 7, 2016
- ↑ Jayashree M, Shruthi N, Singhi S (2006). "Predictors of outcome in patients with diphtheria receiving intensive care". Indian Pediatr. 43 (2): 155–60. PMID 16528112.
- ↑ http://www.cdc.gov/diphtheria/clinicians.html Accessed on October 7, 2016
- ↑ Rappold LC, Vogelgsang L, Klein S, Bode K, Enk AH, Haenssle HA (2016). "Primary cutaneous diphtheria: management, diagnostic workup, and treatment as exemplified by a rare case report". J Dtsch Dermatol Ges. 14 (7): 734–6. doi:10.1111/ddg.12722. PMID 27373251.