DIPHTHERIA

Diphtheria is a bacterial respiratory infection caused by Corynebacterium diphtheriae, a gram-positive bacillus (1).
Diphtheria affects people of all ages, but most often it strikes unimmunized children. In 2000, 30 000 cases and 3 000 deaths of diphtheria were reported worldwide (2).

Mode of transmission
Diphtheria is transmitted from person to person by respiratory droplets from the throat through coughing and sneezing (2).

Clinical description
Clinical description has an insidious onset after an incubation period of 1 to 5 days, rarely longer (1).
It can cause infection of the nasopharynx, which may lead to breathing difficulties and death.
The major manifestation is a membranous inflammation of the upper respiratory tract, usually by the pharynx but sometimes of the posterior nasal passages, larynx, and trachea, plus widespread damage to other organs including the myocardium, nervous system, and kidneys that is caused by the organism's exotoxin (Plotkins).
When diphtheria affects the throat and tonsils, the early symptoms are sore throat, loss of appetite, and slight fever. Within 2 to 3 days a bluish-white or grey membrane forms in the throat and on the tonsils. This membrane sticks to the soft palate of the throat and may bleed. If there is bleeding, the membrane may become greyish-green or black. The patient may either recover at this point or develop severe weakness and die within 6 to 10 days. Patients with severe diphtheria do not develop a high fever but may develop a swollen neck and obstructed airway (2).