Introduction

Overview

Diphtheria is a preventable respiratory tract infection caused by the bacteria Corynebacterium diphtheriae [also known as Klebs-Löffler bacillus]. 

Diphtheria is preventable in children and adults through vaccination with diphtheria toxoid. It’s an infection common in the winter and spring (the colder months).

History

Hippocrates, modern Medicine’s father, first described Diphtheria in the 5th century BC. 

In the 6th century, Aetius also described the epidemic. 

In the 17th century, Edwin Klebs observed Diphtheria in membranes, and in the following year, 1884, Friedrich Löffler cultivated it. 

Come the early 18th century, a vaccine was developed against Diphtheria called Diphtheria toxoid and was in use as a routine vaccine.

Cause

The causative bacteria is called Corynebacterium diphtheria, a gram-positive and non-motile organism.

Pathophysiology

The causative bacteria, Corynebacterium diphtheriae, has a strain that can form colonies in the nasopharyngeal cavity (a part of the respiratory tract) or the skin. 

In the respiratory tract, the bacteria cause infections such as tonsillopharyngitis and laryngitis. 

The bacteria have the ability also to produce exotoxin. If it does, it results in organ damage, especially myocarditis and neuritis. On the skin, the infectious disease causes ulcerations.

Transmission

Diphtheria spreads easily between people through direct contact with those infected, droplets from coughing or sneezing or contact with contaminated clothing and objects. 

A person is infectious for as long as the bacteria are present in respiratory secretions, usually two weeks without treatment and seldom more than six weeks. 

Chronic carriers may shed organisms for six months or more in rare cases. Effective treatment promptly terminates shedding in about one or two days.

Symptoms

The most common type of Diphtheria is classic respiratory Diphtheria. 

The onset of signs and symptoms is usually from 2 – 5 days (could be as high as ten days) after exposure. 

Initial symptoms may be mild, including fever, runny nose, sore throat, cough, and red eyes (conjunctivitis). 

In severe cases, the bacteria produce an exotoxin that causes a thick grey or white patch (pseudo-membrane) on the tonsils and/or at the back of the throat, which can block the airway making it hard to breathe or swallow and cause a barking cough. 

The neck may swell partially due to enlarged lymph nodes and frequently confer a bull-neck appearance.

If the exotoxin produced by the bacteria also enters the bloodstream, it can cause complications such as inflammation and damage of the heart muscle, inflammation of nerves, kidney problems, and bleeding problems due to decreased blood platelet count. 

The damaged heart muscles may result in an abnormal heart rate, and inflammation of the nerves may result in paralysis. 

The infection can also affect the skin (cutaneous Diphtheria). 

More rarely, it can affect mucous membranes at other non-respiratory sites, such as the genitalia and conjunctiva.

Treatment

Diphtheria is treated with diphtheria antitoxin in conjunction with appropriate antibiotic therapy [erythromycin or penicillin]. Both should be administered immediately following specimen collection. 

People with Diphtheria can no longer infect others 48 hours after taking antibiotics. 

However, it is important to finish taking the full course of antibiotics to ensure the bacteria are completely removed from the body. 

After the patient finishes the complete treatment, the doctor will run tests to ensure the bacteria is no more in the body. 

Complications

Complications due to Diphtheria usually occur in the second and third week following infection; this includes corneal scarring (aggravated by vitamin A deficiency), encephalitis (more common in older children and adults, 0.1%), diarrhoea, pneumonia (a major cause of death) and subacute sclerosing panencephalitis (rare, delayed complication; associated personality changes, seizures, motor disability, progressing to coma and death). 

Case fatality ratios up to 10% have been reported in diphtheria outbreaks and are higher in settings where diphtheria antitoxin (DAT) is unavailable.

Prevention

WHO recommends a 3-dose series of Diphtheria toxoid-containing vaccines in the first year of life beginning at six weeks of age and advises that three booster doses of Diphtheria toxoid-containing vaccine are provided during childhood and adolescence to ensure long-term protection.

In the Nigeria childhood immunization schedule, three doses of pentavalent vaccine (diphtheria toxoid-containing vaccine) are recommended at the 6th, 10th, and 14th week of life. 

In endemic settings and outbreaks, healthcare workers may be at greater risk of Diphtheria than the general population. Therefore, special attention should be paid to immunizing healthcare workers who may have occupational exposure to Corynebacterium diphtheriae.

To reduce the risk of Diphtheria, the NCDC offers the following advice to healthcare workers and the public:

1. Parents should be advised to ensure that their children are fully vaccinated against Diphtheria with the three doses of a pentavalent vaccine.

2. Healthcare workers should maintain a high index of suspicion for Diphtheria, i.e., be vigilant and look out for symptoms of Diphtheria.

3. Once a clinical diagnosis of Diphtheria is made, a laboratory test should be done immediately to confirm the suspected cases. Please send samples to your State and/or NCDC National Reference Laboratory campuses in Abuja or Lagos for diagnosis.

4. Cases of individuals with signs and symptoms suggestive of Diphtheria should be notified to the appropriate surveillance officer and managed in an isolation ward.

5. Practice standard precautions while handling patients and body fluids, i.e., always wear Personal Protective Equipment (PPE) irrespective of the patient’s provisional diagnosis.

6. All healthcare workers (doctors, nurses, laboratory scientists, support staff etc.) with a high level of exposure to cases of Diphtheria should be vaccinated against Diphtheria.

Outbreak in Nigeria

Primarily, Diphtheria is controlled by preventing infection through high population immunity achieved by high vaccination coverage. 

Therefore, Diphtheria outbreaks reflect inadequate vaccination coverage.

In Nigeria, there was an outbreak in Borno, north-eastern Nigeria, in 2011 with 98 cases and 21 deaths (the case-fatality ratio was 21.4%). 

This outbreak and the associated high case fatality were due to low vaccination coverage, delayed clinical recognition and laboratory confirmation, and no antitoxin and antibiotics for treatment.

The Nigeria Centre for Disease Control and Prevention (NCDC) has stated their response to reports of diphtheria cases in Kano and Lagos States, while cases in Osun and Yobe States are being monitored. 

Apart from clinically suspected cases, there have been laboratory-confirmed cases, and the NCDC states they are working with State Ministries of Health and partners to enhance surveillance and response to the outbreak.

Diphtheria Situation Report In Nigeria

An Update of Diphtheria Outbreak in Nigeria

The Nigerian Center for Disease Control recently released the latest update on the Diphtheria outbreak in Nigeria. 

Read below:

References

• Acosta, A. M., Moro, P. L., Hariri, S., Tiwari. T. S. P. (2021). Diphtheria. Centres for Disease Control and Prevention.

• American Academy of Pediatrics. 2021 Red Book: Report of the Committee on Infectious Disease, 32nd Edition. Illinois, Academy of Pediatrics, 2021.

• Bruce, M. L. (2022, August 17). Diphtheria. Medscape.

• Diphtheria Health Advisory for Health Care Workers Amidst Outbreak in Nigeria. https://ncdc.gov.ng/news/436/diphtheria-health-advisory-for-health-care-workers-amidst-outbreak-in-nigeria
• https://www.google.com/amp/outbreaknewstoday.com/nigeria-public-health-advisory-issued-over-diphtheria-outbreak-66556/%3famp=1
• https://www.cdc.gov/diphtheria/about/diagnosis-treatment.html

• Murphy, J. R. (1996). Corynebacterium Diphtheriae. In S. Baron (Ed.), Medical Microbiology. University of Texas Medical Branch.

Anticipate

International Scientific Research Conference [2023]

We are excited to let our community know we are preparing for another international scientific research conference at the Institute of Nursing Research, Nigeria. 

Over the past few years, a lot has happened worldwide, which has directly impacted the healthcare ecosystem. 

The pandemic initiated a mighty wave of transformation in every known industry under the sun, and the healthcare community has had its share.

How has the pandemic affected healthcare, and specifically nursing practice? How has it influenced nursing education, research and practice? 

We will discuss these shifts under the broad theme: New Horizons in Nursing Education, Research and Practice for Healthcare Reforms: Implications for the Post-COVID Era.

DATE: 23rd – 25th November 2023.

VENUE [Hybrid]:

1. Online – Zoom.

2. Onsite – Lagos State.

Other details, like abstract presentation guidelines, conference fees, etc., will be communicated soon. 

Follow us on our social media pages to keep up-to-date, and remember to subscribe to our newsletter below so that you get notified directly in your mail when we publish something new about our forthcoming international scientific conference, new articles, reports and other vital information.