Materiały źródłowe

• #1 Diphtheria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560911/

  Diphtheria is a toxin-mediated infection primarily caused by Corynebacterium diphtheriae, a member of the Corynebacterium species. This infectious disease is characterized by skin and mucosal infections, occasionally progressing to focal infection after bacteremia. The clinical manifestations of C diphtheriae infection are diverse and depend on factors such as the anatomical site of infection, the immune status of the host, and the production and systemic distribution of toxins. […] The infection tends to be more prevalent during the spring or winter months. Without antibiotic intervention, its communicability persists for 2 to 6 weeks. Those with diminished antitoxin antibody levels or incomplete immunization are particularly susceptible to infection and may contract the illness upon exposure to a carrier or an individual already afflicted.

• #1 Diphtheria: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/17870-diphtheria

  Common diphtheria symptoms include: […] Problems breathing due to tissues obstructing your nose and throat. […] Difficulty swallowing (dysphagia). […] An infected person typically shows signs of diphtheria around two to five days after exposure. The length of time for symptoms to show can be anywhere from one to 10 days after exposure. […] Diphtheria is caused by bacteria adhering to the lining of your respiratory system. These bacteria generate a toxin that damages your respiratory tissue cells. Within two or three days, the tissue left behind forms a bulky, grey coating. This coating has the potential to cover tissues in your voice box, throat, nose and tonsils. For the infected person, breathing and swallowing become hard to do. […] Diphtheria treatment begins immediately sometimes even before the lab test results are confirmed. Your healthcare provider will prescribe diphtheria antitoxin to stop damage to your organs.

• #1 Diphtheria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560911/

  The organism’s pathogenicity hinges on the production of exotoxins, which can lead to severe complications, primarily affecting the heart muscle and nervous system. Timely diagnosis plays a pivotal role in achieving favorable clinical outcomes, as initiating antitoxin therapy and appropriate antibiotics early on can significantly impact patient prognosis. […] Patients typically present with a distinctive thick, gray, and adherent pseudomembrane on the tonsils and throats. Diagnosis involves isolating the organism, culturing it, and monitoring toxin production. Management includes patient isolation and the administration of antitoxin and antibiotics. […] Diphtheria typically initiates with nonspecific flu-like symptoms, including fever, sore throat, and cervical lymphadenopathy. The average incubation period spans 2 to 5 days, ranging from 1 to 10.

• #1 Clinical Features of Diphtheria | Diphtheria | CDC

  https://www.cdc.gov/diphtheria/hcp/clinical-signs/index.html

  Respiratory diphtheria has a gradual onset and is characterized by: Mild fever, Sore throat, Difficulty swallowing, Malaise, Loss of appetite, Hoarseness (if the larynx is involved). […] The hallmark of respiratory diphtheria is a pseudomembrane that appears within 23 days of illness. It appears over the mucous lining of the tonsils, pharynx, larynx, or nares and can extend into the trachea. […] Cutaneous diphtheria may present as a scaling rash or ulcers with clearly demarcated edges and membrane. These skin infections are slow to heal. […] Most complications, including death, are attributable to the toxin’s effects. […] Complications include: Myocarditis, Neuritis, Respiratory insufficiency due to airway obstruction. […] Myocarditis and neuritis are the most frequent complications. Respiratory insufficiency due to airway obstruction is more common in infants. […] The overall case-fatality rate for diphtheria is 510%. People younger than 5 years and older than 40 years of age experience higher death rates (up to 20%). […] The systemic complications from cutaneous diphtheria appear to be less than from other sites.

• #1 Diphtheria – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-bacilli/diphtheria

  Symptoms are either nonspecific skin infections or pseudomembranous pharyngitis followed by myocardial and neural tissue damage secondary to the exotoxin. […] After an incubation period, which averages 5 days, and a prodromal period of between 12 and 24 hours, patients develop mild sore throat, dysphagia, low-grade fever, and tachycardia. Nausea, emesis, chills, headache, and fever are more common among children. […] If a toxigenic strain is involved, the characteristic membrane appears in the tonsillar area. It may initially appear as a white, glossy exudate but typically becomes dirty gray, tough, fibrinous, and adherent so that removal causes bleeding. Local edema may cause a visibly swollen neck (bull neck), hoarseness, stridor, and dyspnea. The membrane may extend to the larynx, trachea, and bronchi and may partially obstruct the airway or suddenly detach, causing complete obstruction.

• #1 Diphtheria : symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/diphtheria

  Diphtheria typically manifests as a respiratory infection that causes impairment of the central nervous system, the throat and other organs, resulting in death by suffocation. […] The typical manifestation of diphtheria is an infection of the upper respiratory tract which can result in paralysis of the central nervous system or of the diaphragm and throat, leading to death by suffocation. C. diphtheriae infection is highly contagious. […] Typical symptoms include a sore throat, fever and a swollen neck. Respiratory diphtheria, the most common form of the disease, is characterized by sore throat, fever, a swollen neck and headache.

• #1 Diphtheria – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diphtheria/symptoms-causes/syc-20351897

  One sign of diphtheria is swollen glands (enlarged lymph nodes) in the neck. […] Diphtheria signs and symptoms usually begin 2 to 5 days after a person becomes infected. Signs and symptoms may include: A thick, gray membrane covering the throat and tonsils, A sore throat and hoarseness, Swollen glands (enlarged lymph nodes) in the neck, Difficulty breathing or rapid breathing, Nasal discharge, Fever and chills, Tiredness. […] In some people, infection with diphtheria-causing bacteria causes only a mild illness or no obvious signs and symptoms at all. […] Left untreated, diphtheria can lead to: Breathing problems. Diphtheria-causing bacteria may produce a toxin. This toxin damages tissue in the immediate area of infection usually, the nose and throat. At that site, the infection produces a tough, gray membrane made up of dead cells, bacteria and other substances. This membrane can obstruct breathing.

• #1 Diphtheria – Wikipedia

  https://en.wikipedia.org/wiki/Diphtheria

  Diphtheria can cause a swollen neck, sometimes referred to as a bull neck. The symptoms of diphtheria usually begin two to seven days after infection. They include fever of 38 C (100.4 F) or above; chills; fatigue; bluish skin coloration (cyanosis); sore throat; hoarseness; cough; headache; difficulty swallowing; painful swallowing; difficulty breathing; rapid breathing; foul-smelling and bloodstained nasal discharge; and lymphadenopathy. Within two to three days, diphtheria may destroy healthy tissues in the respiratory system. The dead tissue forms a thick, gray coating that can build up in the throat or nose. This thick gray coating is called a „pseudomembrane.” It can cover tissues in the nose, tonsils, voice box, and throat, making it very hard to breathe and swallow. Symptoms can also include cardiac arrhythmias, myocarditis, and cranial and peripheral nerve palsies.

• #1 Diphtheria (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/diphtheria.html

  Diphtheria is a bacterial infection. It spreads easily and happens quickly, and mainly affects the nose and throat. Children under 5 and adults over 60 years old are particularly at risk for getting it. […] In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms. The toxin, or poison, caused by the bacteria can lead to a thick coating (or membrane) in the nose, throat, or airway. This makes a diphtheria infection different from other more common infections that cause sore throat (such as strep throat). This coating is usually fuzzy gray or black, and can cause breathing problems and trouble swallowing. […] As the infection continues, someone may: have trouble breathing or swallowing, complain of double vision, have slurred speech, show signs of going into shock (skin that’s pale and cold, rapid heartbeat, sweating, and an anxious appearance).

• #1 Clinical manifestations, diagnosis, and treatment of diphtheria – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-diphtheria

  Infection with C. diphtheriae typically presents as respiratory or cutaneous disease. Systemic manifestations involving the heart (myocarditis), nervous system, and kidneys can also occur. Rarely, diphtheria presents as vaginal, conjunctival, or otic infection. […] Respiratory diphtheria is typically caused by toxin-producing strains of C. diphtheriae; rarely, it is caused by toxigenic strains of other Corynebacterium species (C. ulcerans, C. hemolyticum, or C. pseudotuberculosis). Symptoms typically begin two to five days after infection. In addition to respiratory symptoms, absorption and dissemination of diphtheria toxin can lead to toxin damage of the heart (myocarditis), nervous system, and kidneys. […] The onset of symptoms is typically gradual; the most common presenting symptoms are sore throat, malaise, cervical lymphadenopathy, and low-grade fever. The earliest pharyngeal finding is mild erythema, which can progress to isolated spots of gray and white exudate. In at least one-third of cases, local elaboration of toxin induces the formation of a coalescing pseudomembrane (composed of necrotic fibrin, leukocytes, erythrocytes, epithelial cells, and organisms). This membrane adheres tightly to the underlying tissue and bleeds with scraping.

• #1 Diphtheria – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-bacilli/diphtheria

  If a large amount of toxin is absorbed, severe prostration, pallor, tachycardia, stupor, and coma may occur; toxemia may cause death within 6 to 10 days. […] Toxigenic strains of Corynebacterium diphtheriae may cause a thick pharyngeal exudate. The exudate is dirty gray and is tough, fibrinous, and adherent to the mucosae. […] In acute nasopharyngeal diphtheria, local edema may cause a visibly swollen neck (bull neck). […] Skin lesions usually occur on the extremities and are varied in appearance, often indistinguishable from chronic skin conditions (eg, eczema, psoriasis, impetigo). A few patients have nonhealing, punched-out ulcers, occasionally with a grayish membrane. Pain, tenderness, erythema, and exudate are typical. If exotoxin is produced, lesions may be numb. […] The main complications of diphtheria are cardiac and neurologic.

• #1 Diphtheria – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/ddi/diphtheria/

  Diphtheria infection most commonly affects the tonsils and pharynx. Symptoms can also spread from the tonsils and pharynx to the larynx. Upon physical examination, the hallmark finding of diphtheria infection is the formation of a pseudomembrane along the back of the throat. The membrane may change colors over time within the first few days of formation, it is a bluish-white color. By the time the patient presents for treatment, it may be grayish-green, or black if they have experienced bleeding. Attempting to remove the pseudomembrane will cause bleeding. If the pseudomembrane obstructs the airway, it can lead to coma or death. […] Patients with severe diphtheria infection may also develop notable edema along the anterior neck and submandibular area (bull neck). This manifestation is the result of mucosal swelling and cervical lymphadenopathy.

• #1 Diphtheria – Wikipedia

  https://en.wikipedia.org/wiki/Diphtheria

  The disease may remain manageable, but in more severe cases, lymph nodes in the neck may swell, and breathing and swallowing are more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later, and can lead to heart failure. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases are put in a hospital intensive care unit, and given diphtheria antitoxin (consisting of antibodies isolated from the serum of horses that have been challenged with diphtheria toxin). Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration increases risk of death. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation. […] Diphtheria is fatal in 5-10% of cases. In children under five years and adults over 40 years, the fatality rate may be as much as 20%.

• #1 Diphtheria Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/diphtheria

  Symptoms usually occur 2 to 5 days after the bacteria enter your body: Fever and chills […] Sore throat, hoarseness […] Painful swallowing […] Croup-like (barking) cough […] Drooling (suggests airway blockage is about to occur) […] Bluish coloration of the skin […] Bloody, watery drainage from nose […] Breathing problems, including difficulty breathing, fast breathing, high-pitched breathing sound (stridor) […] Skin sores (usually seen in tropical areas) […] Sometimes there are no symptoms. […] Diphtheria may be mild or severe. Some people do not have symptoms. In others, the disease can slowly get worse. Recovery from the illness is slow. […] People may die, especially when the disease affects the heart.

• #1 Diphtheria: Symptoms, Treatment, and How It Spread

  https://www.verywellhealth.com/overview-of-diphtheria-4175810

  Diphtheria is a bacterial infection that commonly affects the nose and throat. A characteristic sign of a diphtheria infection is a thick, hard, grayish coating inside your throat. While diphtheria is rare in the developed world due to vaccination, it can cause serious complications, including death, if left untreated. […] Diphtheria symptoms include difficulty breathing and a thick, gray coating in the upper respiratory tract. […] When someone is infected with diphtheria, respiratory symptoms usually appear within two to five days, although some take up to 10 days to develop. […] Diphtheria can start similarly to a normal respiratory infection with mild flu-like symptoms. In time, however, other, more serious symptoms can develop, including severe fatigue, throat pain, nausea and vomiting, fever and chills, wheezing, shortness of breath, hoarseness and difficulty talking, rapid heartbeats (tachycardia), and difficulty swallowing.

• #1

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/diphtheria.html

  Diphtheria starts like a cold, with sore throat, mild fever (101 degrees Fahrenheit or less), and chills. Next, the diphtheria toxin makes a thick coating on the back of the nose or throat. It may be blue or grayish green. The coating makes it hard to breathe or swallow. […] The coating on the throat can get so thick that it blocks the airway, so the person cannot breathe. […] The diphtheria toxin can attack the heart, causing abnormal heart rhythms and even heart failure. It also can attack the nerves, which leads to paralysis (unable to move parts of the body). […] About one out of 10 people who get diphtheria dies. In children younger than 5 years, as many as one out of five children who get diphtheria dies.

• #1 Diphtheria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560911/

  The pseudomembrane comprises red blood cells (RBCs), white blood cells (WBCs), dead cell debris, and organisms. Attempting to scrape it from the adhering surface often results in bleeding. Typical symptoms and signs of diphtheria encompass low-grade fever, sore throat, malaise, cervical lymphadenopathy, headache, and dysphagia. […] Cervical adenopathy and swollen mucosa often result in a distinctive „bull neck” appearance in many infected patients. The leading cause of mortality is airway obstruction or suffocation, primarily due to the aspiration of the pseudomembrane. […] Cardiac involvement occurs after 1 to 2 weeks of illness after improvement in the pharyngeal phase. Cardiac involvement may manifest as follows: Myocarditis can present acutely with congestive heart failure and circulatory collapse.

• #1 Diphtheria – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/738?locale=en_GB&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bestpracticedx%2Frecent+(Best+Practice+Topic+Updates)

  Diphtheria is a vaccine-preventable, toxin-mediated bacterial disease caused by Corynebacterium diphtheriae. […] Respiratory diphtheria is the main clinical presentation. Local, toxin-mediated inflammation can cause life-threatening upper airway obstruction. Systemic dissemination of toxin can cause delayed mortality from cardiac and neurologic damage. […] It is characterized by sore throat, fever, and an adherent pseudomembrane that can cover tonsils and the mucosa of the pharynx, larynx, and nose. Occasionally, the mucosa of the eyes, ears, or genitals may also be affected. Enlarged anterior cervical lymph nodes and edema of the surrounding soft tissue can cause a characteristic „bull-neck” appearance. The toxin causes tissue necrosis and formation of the pseudomembrane. It also causes the major late complications of myocarditis and neuritis.

• #1

• #1 Diphtheria – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/738

  Diphtheria is a vaccine-preventable, toxin-mediated bacterial disease caused by Corynebacterium diphtheriae. […] Respiratory diphtheria is the main clinical presentation. Local, toxin-mediated inflammation can cause life-threatening upper airway obstruction. Systemic dissemination of toxin can cause delayed mortality from cardiac and neurologic damage. […] Respiratory diphtheria is an upper respiratory tract illness caused by exotoxin-producing strains of Corynebacterium diphtheriae. It is characterized by sore throat, fever, and an adherent pseudomembrane that can cover tonsils and the mucosa of the pharynx, larynx, and nose. […] The toxin causes tissue necrosis and formation of the pseudomembrane. It also causes the major late complications of myocarditis and neuritis. […] Cutaneous diphtheria may be caused by toxigenic or nontoxigenic strains of C diphtheriae and is usually a milder disease, causing cutaneous sores or shallow ulcers. Toxic complications are rare in cutaneous disease.

• #1 Diphtheria Symptoms and Complications | Diphtheria | CDC

  https://www.cdc.gov/diphtheria/symptoms/index.html

  It usually takes 2 to 5 days for symptoms to appear after someone has been exposed to C. diphtheriae. Some people may become infected and have no symptoms. […] The most common symptoms of respiratory diphtheria include: Mild fever, Pseudomembrane in the nose or throat, Sore throat, Swollen glands in the neck, Weakness. […] Symptoms of diphtheria skin infections can include: Open sore or ulcer with a clear edge, Pain, Rash with scales or peeling skin, Redness, Swelling. […] Airway blockage is a deadly complication from respiratory diphtheria. If the toxin gets into the blood stream, it can kill the tissue of other organs and cause: Kidney failure, Myocarditis (damage to the heart muscle), Polyneuropathy (nerve damage). […] Even with treatment, about 1 in 10 people with respiratory diphtheria will die. Without treatment, up to half of people die from the disease. […] Although the wound is slow healing, diphtheria skin infections rarely result in complications, severe disease, or death.

• #1 What to Know About Diphtheria

  https://www.webmd.com/a-to-z-guides/what-to-know-diphtheria-causes

  A second type of diphtheria can also grow on your skin. This type of infection leads to painful, red, and swollen skin. You could also get ulcers with a thick gray coating. […] Without treatment, respiratory diphtheria (the type that infects body parts involved in breathing) can lead to severe health problems, like: Blocked airway, Heart damage (myocarditis), Nerve damage (polyneuropathy), Losing your ability to move (paralysis), Kidney failure. […] If you get treatment, its possible to fully recover from diphtheria. Your recovery time will usually take from 4 to 6 weeks. […] Even with treatment, though, some people dont recover. Children under 5 years old and adults over 60 have worse odds of dying from the disease. […] The CDC says that with treatment, about 9 in 10 people will survive a case of respiratory diphtheria. But up to half of people with the disease who dont get treatment for it can die from it, the agency says.

• #1 Diphtheria

  https://www.nhs.uk/conditions/diphtheria/

  Symptoms usually start 2 to 5 days after becoming infected. […] Symptoms of diphtheria include: a thick grey-white coating that may cover the back of your throat, nose and tongue, a high temperature (fever), sore throat, swollen glands in your neck, difficulty breathing and swallowing. […] If it’s cutaneous diphtheria, it can cause: pus-filled blisters on your legs, feet and hands, large ulcers surrounded by red, sore-looking skin. […] Diphtheria needs to be treated quickly in hospital to help prevent serious complications, such as breathing difficulties or heart problems.

• #1 Diphtheria Symptoms, Treatment, Transmission, Causes & Vaccine

  https://www.medicinenet.com/diphtheria_facts/article.htm

  The initial symptoms of diphtheria are flu-like but worsen to include fever, swallowing problems, hoarseness, enlarged lymph nodes, coughing, and shortness of breath; some patients may have skin involvement, producing skin ulcers. […] Initially, the symptoms of diphtheria may be similar to a viral upper respiratory infection but symptoms worsen over about two to five days. The symptoms may include: a sore throat, fever (low grade), difficulty swallowing, weakness and fatigue, hoarseness, headache, enlarged lymph nodes (swollen glands) producing a thick or „bull” neck (resembling mumps), cough, and difficulty breathing. […] As the disease progresses, an adherent membrane (pseudomembrane) may begin to cover the tonsils, pharynx, and/or nasal tissues. If untreated, the pseudomembrane can extend into the larynx and trachea and obstruct the airway; this can be life-threatening and lead to death. […] Cutaneous diphtheria symptoms include initial reddish lesions that are painful and that may develop into nonhealing ulcers. A gray-colored membrane may cover some ulcers.

• #1 Diphtheria: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/17870-diphtheria

  Diphtheria can result in a number of long-term complications, including: […] Blockage of your air passages. […] Injury to your heart muscle. […] Injury to your nerves. […] Sluggishness or lethargy. […] Paralysis (being unable to move). […] Lung infection or loss of lung function. […] Treatment for diphtheria can be effective. But, even with treatment, roughly 1 out of 10 people might die. For those without treatment, one out of two patients may die. […] For people with diphtheria, it usually takes about two to three weeks for treatment to be effective. Any skin ulcers could take two or three months to fully heal, though scarring may be permanent. […] Yes. When treated immediately, diphtheria is managed successfully with antitoxins and antibiotics. Vaccination can prevent diphtheria altogether.

• #1 Diphtheria – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diphtheria/symptoms-causes/syc-20351897

  Heart damage. The diphtheria toxin may spread through the bloodstream and damage other tissues in the body. For example, it can damage the heart muscle, causing such complications as inflammation of the heart muscle (myocarditis). Heart damage from myocarditis may be slight or severe. At its worst, myocarditis can lead to heart failure and sudden death. […] Nerve damage. The toxin can also cause nerve damage. Typical targets are nerves to the throat, where poor nerve conduction may cause difficulty swallowing. Nerves to the arms and legs also may become inflamed, causing muscle weakness. […] If the diphtheria toxin damages the nerves that help control muscles used in breathing, these muscles may become paralyzed. At that point, you might need mechanical assistance to breathe. […] With treatment, most people with diphtheria survive these complications, but recovery is often slow. Diphtheria is fatal about 5% to 10% of the time. Rates of death are higher in children under age 5 or adults older than age 40.

• #1 Diphtheria: Symptoms, Treatment & Prevention | Diphtheria Vaccine

  https://resources.healthgrades.com/right-care/infections-and-contagious-diseases/diphtheria

  In some cases, the diphtheria toxin can spread through the blood and cause life-threatening complications. This includes damage to the heart, kidneys and nerves. […] Respiratory diphtheria can cause airway obstruction and an inability to breathe due to the pseudomembrane. It can also lead to complications when the toxin spreads through the blood to organs. These complications can be serious and include: Kidney failure, Liver failure, Myocarditis, which is damage to the heart muscle that can lead to heart failure, Paralysis, Polyneuropathy, which is nerve damage. […] Respiratory diphtheria can be fatal. Left untreated, about half of people with diphtheria will die. Even with treatment, up to 10% of people worldwide do not survive. Children and the elderly are more likely to die from the disease.

• #1 Diphtheria (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/diphtheria.html

  In diphtheria cases that progress beyond a throat infection, the toxin spreads through the bloodstream. This can lead to potentially life-threatening problems that affect other organs, such as the heart and kidneys. The toxin can: damage the heart and affect its ability to pump blood, make the kidneys have trouble clearing wastes from the body, cause nerve damage, eventually leading to paralysis. Up to 50% of people whose diphtheria isn’t treated may die. […] With prompt care in a hospital, most patients recover from diphtheria. After the antibiotics and anti-toxin take effect, they will need bed rest for a while (4 to 6 weeks, or until full recovery). Bed rest is particularly important if someone develops myocarditis (inflammation of the heart muscle), which can be a complication of diphtheria.

• #1 Diphtheria – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-bacilli/diphtheria

  Myocarditis is usually evident by the 10th to 14th day but can appear any time during the 1st to the 6th week, even while local respiratory symptoms are subsiding; risk of cardiac toxicity is related to degree of local infection. […] Nervous system toxicity is uncommon (about 5%) and limited to patients with severe respiratory diphtheria. The toxin causes a demyelinating polyneuropathy that affects cranial and peripheral nerves. […] In severe cases, acute renal failure may occur because the toxin damages the kidneys. […] Overall mortality is 3%; it is higher in those with any of the following: Delayed presentation, Acute renal failure, Myocarditis, Age 40 years.

• #1 Diphtheria – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/ddi/diphtheria/

  Most complications from diphtheria infection are caused by the diphtheria toxin. As the bacteria produce the toxin in the upper respiratory tract, it is absorbed into the bloodstream and then distributed to the body tissues. The most common complications associated with diphtheria infections are neuritis, myocarditis, and polyneuropathy. Neuritis typically affects motor nerves. Patients may experience paralysis of the soft palate, limbs, eye muscles, and diaphragm. Diphtheria-associated neuritis often is temporary and resolves completely following treatment. […] Approximately 10% to 25% of patients with diphtheria develop cardiac complications frequently myocarditis during the acute phase or within the weeks following infection. The long-term effects of myocarditis include permanent cardiac damage due to fibrosis and valvular damage leading to heart failure. Some patients with diphtheria may develop polyneuropathy. Diphtheria toxin is adsorbed on Schwann cells (the cells responsible for providing the myelin sheath of nerve cells), which can inhibit myelin synthesis and lead to neurological complications, including polyneuropathy. The effects of diphtheria-associated polyneuropathy can be long-lasting, and recovery may not begin until 2 to 4 months after the onset of symptoms.

• #1 Diphtheria | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/diphtheria

  The onset is indistinguishable from the common cold, usually characterized by a mucopurulent nasal discharge (containing both mucus and pus), which may become blood-tinged. A white to grayish membrane usually forms on the nasal septum and throat in respiratory disease. […] The severity of the disease and complications are generally related to the extent of local disease. When absorbed, the toxin affects organs and tissues distant from the site of invasion. The most frequent complications of diphtheria are myocarditis and neuritis. Myocarditis may present as abnormal cardiac rhythms, and can occur early in the course of the illness or weeks later, and lead to heart failure. If myocarditis occurs early, it is often fatal. Neuritis most often affects motor nerves and usually resolves completely. Paralysis of the soft palate is most frequently seen during the third week of illness. Eye muscles, limbs, and diaphragm paralysis can occur after the first week. Secondary pneumonia and respiratory failure may result from diaphragmatic paralysis. Other complications include otitis media, and respiratory insufficiency due to airway obstruction, especially in infants. The overall case-fatality rate for respiratory diphtheria is 5% – 10%, with higher death rates (up to 20%) in persons 5 and 40 years of age. The case-fatality rate for diphtheria has changed very little during the last 50 years, and is higher for those who have never received vaccine than for those who have been fully immunized.

• #1 Diphtheria Vaccine Guide | Immunization Info

  https://immunizationinfo.com/diphtheria/

  Untreated patients with diphtheria can be contagious for up to 6 weeks, even if they do not have symptoms. […] Diphtheria is a life-threatening medical emergency that requires hospitalization. […] Yes. Past infection with diphtheria does NOT give you lifelong immunity or prevent future infections. […] The symptoms of diphtheria include sore throat, fever, muscle weakness, tiredness, loss of appetite, enlarged lymph nodes in the neck, grayish membrane over the nose, throat, or tonsils, problems breathing, pain when swallowing, cough, hoarseness, nasal discharge, and headache.

• #1 Diphtheria: Symptoms, Causes, Treatment, Vaccine & Transmission

  https://www.emedicinehealth.com/diphtheria/article_em.htm

  As respiratory diphtheria progresses, individuals may develop the classic adherent thick, gray membrane (pseudomembrane) forming over the lining tissue of the tonsils, pharynx, and/or nasal cavity. Extension of this pseudomembrane into the larynx and trachea can lead to obstruction of the airway with subsequent suffocation and death. […] The systemic manifestations of diphtheria are caused by the effects of the diphtheria toxin and its subsequent dissemination to other organs away from the initial area of infection. Commonly affected organs include the heart and nervous system, leading to complications such as inflammation of the heart (myocarditis), cardiac rhythm and conduction disturbances, muscle weakness, numbness (nerve), and vision changes. […] The prognosis for diphtheria depends on the severity of the disease and the presence of systemic involvement. Cardiac involvement and bacteremia (blood infection) are especially associated with a poor prognosis. The fatality rate for respiratory diphtheria is between 5%-10%, although it appears to be higher in patients less than 5 years of age and older than 40 years of age (~20%). Airway obstruction leading to suffocation and cardiac complications are the most common causes of death.

• #1 Diphtheria: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/782051-overview

  Local tissue destruction enables the toxin to be carried lymphatically and hematologically to other parts of the body. Elaboration of the diphtheria toxin may affect distant organs such as the myocardium, kidneys, and nervous system. […] The most widely quoted diphtheria mortality rate is 5-10%. It may reach higher than 20% in children younger than 5 years and adults older than 40 years. […] Most deaths occur on days 3-4 secondary to asphyxia with a pharyngeal membrane or due to myocarditis. Mortality rates of 30-40% have been reported for bacteremic disease. […] Historically, diphtheria has been primarily a disease of childhood, affecting populations younger than 12 years. Infants become susceptible to the disease at age 6-12 months after their transplacentally derived immunity wanes. […] Recently, however, diphtheria has shifted into the adolescent and adult population, most notably those in ages 40 and older accounting for most new cases.

• #1 Diphtheria – NFID

  https://www.nfid.org/infectious-disease/diphtheria/

  Diphtheria is a serious infection caused by strains of bacteria that can lead to difficulty breathing, heart rhythm problems, and death. Diphtheria is an acute bacterial disease that usually affects the tonsils, throat, nose, and/or skin. Diphtheria can lead to breathing problems, heart failure, paralysis, and sometimes death. Signs and symptoms may vary from mild to severe. They usually start two to five days after exposure. Symptoms often come on fairly gradually, beginning with a sore throat and fever. In its early stages, diphtheria may be mistaken for a severe sore throat. Other symptoms include a low-grade fever and enlarged lymph nodes (swollen glands) located in the neck. Diphtheria can cause skin lesions that may be painful, red, and swollen. People carrying diphtheria germs are contagious for up to four weeks without antibiotics, even if they themselves do not develop symptoms. Nearly 1 out of every 10 people who get respiratory diphtheria will die from it, even with treatment. Most cases of diphtheria occur among unvaccinated or inadequately vaccinated people. […] Recovery from diphtheria is not always followed by lasting immunity, so even those persons who have survived the disease need to be immunized.

• #2 Diphtheria – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/738

  Diphtheria is a vaccine-preventable, toxin-mediated bacterial disease caused by Corynebacterium diphtheriae. […] Respiratory diphtheria is the main clinical presentation. Local, toxin-mediated inflammation can cause life-threatening upper airway obstruction. Systemic dissemination of toxin can cause delayed mortality from cardiac and neurologic damage. […] Respiratory diphtheria is an upper respiratory tract illness caused by exotoxin-producing strains of Corynebacterium diphtheriae. It is characterized by sore throat, fever, and an adherent pseudomembrane that can cover tonsils and the mucosa of the pharynx, larynx, and nose. […] The toxin causes tissue necrosis and formation of the pseudomembrane. It also causes the major late complications of myocarditis and neuritis. […] Cutaneous diphtheria may be caused by toxigenic or nontoxigenic strains of C diphtheriae and is usually a milder disease, causing cutaneous sores or shallow ulcers. Toxic complications are rare in cutaneous disease.

• #2

  https://www.who.int/news-room/fact-sheets/detail/diphtheria

  Symptoms of diphtheria usually begin 25 days after exposure to the bacteria. Typical symptoms of the infection include a sore throat, fever, swollen neck glands and weakness. Within 23 from infection, the dead tissue in the respiratory tract forms a thick, grey coating that can cover tissues in the nose, tonsils and throat, making it hard to breathe and swallow. […] Most severe disease and deaths from diphtheria occur as a result of the diphtheria toxin and its effects. Complications can include inflammation of the heart and nerves. For unvaccinated individuals without adequate treatment, diphtheria can be fatal in around 30% of cases, which children younger than 5 years of age at greater risk of dying.

• #2 Diphtheria – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-bacilli/diphtheria

  Symptoms are either nonspecific skin infections or pseudomembranous pharyngitis followed by myocardial and neural tissue damage secondary to the exotoxin. […] After an incubation period, which averages 5 days, and a prodromal period of between 12 and 24 hours, patients develop mild sore throat, dysphagia, low-grade fever, and tachycardia. Nausea, emesis, chills, headache, and fever are more common among children. […] If a toxigenic strain is involved, the characteristic membrane appears in the tonsillar area. It may initially appear as a white, glossy exudate but typically becomes dirty gray, tough, fibrinous, and adherent so that removal causes bleeding. Local edema may cause a visibly swollen neck (bull neck), hoarseness, stridor, and dyspnea. The membrane may extend to the larynx, trachea, and bronchi and may partially obstruct the airway or suddenly detach, causing complete obstruction.

• #2 Diphtheria Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/782051-clinical

  Respiratory diphtheria symptoms typically follow an incubation period of 2-5 days (range, 1-10 d). Symptoms initially are general and nonspecific, often resembling a typical viral upper respiratory infection (URI). Respiratory involvement usually begins with sore throat and mild pharyngeal inflammation. Development of a localized or coalescing pseudomembrane can occur in any portion of the respiratory tract. The pseudomembrane is characterized by the formation of a dense, gray debris layer composed of a mixture of dead cells, fibrin, RBCs, WBCs, and organisms. […] The most frequent cause of death is airway obstruction or suffocation following aspiration of the pseudomembrane. […] Patients with diphtheria may present with the following complaints: Low-grade fever (rarely 103F) (50-85%) and chills, malaise, weakness, prostration, sore throat (85-90%), headache, cervical lymphadenopathy and respiratory tract pseudomembrane formation (about 50%), serosanguineous or seropurulent nasal discharge, white nasal membrane, hoarseness, dysphagia (26-40%), dyspnea, respiratory stridor, wheezing, cough.

• #2 Diphtheria – Wikipedia

  https://en.wikipedia.org/wiki/Diphtheria

  Diphtheria can cause a swollen neck, sometimes referred to as a bull neck. The symptoms of diphtheria usually begin two to seven days after infection. They include fever of 38 C (100.4 F) or above; chills; fatigue; bluish skin coloration (cyanosis); sore throat; hoarseness; cough; headache; difficulty swallowing; painful swallowing; difficulty breathing; rapid breathing; foul-smelling and bloodstained nasal discharge; and lymphadenopathy. Within two to three days, diphtheria may destroy healthy tissues in the respiratory system. The dead tissue forms a thick, gray coating that can build up in the throat or nose. This thick gray coating is called a „pseudomembrane.” It can cover tissues in the nose, tonsils, voice box, and throat, making it very hard to breathe and swallow. Symptoms can also include cardiac arrhythmias, myocarditis, and cranial and peripheral nerve palsies.

• #2 Diphtheria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560911/

  The pseudomembrane comprises red blood cells (RBCs), white blood cells (WBCs), dead cell debris, and organisms. Attempting to scrape it from the adhering surface often results in bleeding. Typical symptoms and signs of diphtheria encompass low-grade fever, sore throat, malaise, cervical lymphadenopathy, headache, and dysphagia. […] Cervical adenopathy and swollen mucosa often result in a distinctive „bull neck” appearance in many infected patients. The leading cause of mortality is airway obstruction or suffocation, primarily due to the aspiration of the pseudomembrane. […] Cardiac involvement occurs after 1 to 2 weeks of illness after improvement in the pharyngeal phase. Cardiac involvement may manifest as follows: Myocarditis can present acutely with congestive heart failure and circulatory collapse.

• #2 Diphtheria

  https://www.nhs.uk/conditions/diphtheria/

  Symptoms usually start 2 to 5 days after becoming infected. […] Symptoms of diphtheria include: a thick grey-white coating that may cover the back of your throat, nose and tongue, a high temperature (fever), sore throat, swollen glands in your neck, difficulty breathing and swallowing. […] If it’s cutaneous diphtheria, it can cause: pus-filled blisters on your legs, feet and hands, large ulcers surrounded by red, sore-looking skin. […] Diphtheria needs to be treated quickly in hospital to help prevent serious complications, such as breathing difficulties or heart problems.

• #2 Clinical Features of Diphtheria | Diphtheria | CDC

  https://www.cdc.gov/diphtheria/hcp/clinical-signs/index.html

  Respiratory diphtheria has a gradual onset and is characterized by: Mild fever, Sore throat, Difficulty swallowing, Malaise, Loss of appetite, Hoarseness (if the larynx is involved). […] The hallmark of respiratory diphtheria is a pseudomembrane that appears within 23 days of illness. It appears over the mucous lining of the tonsils, pharynx, larynx, or nares and can extend into the trachea. […] Cutaneous diphtheria may present as a scaling rash or ulcers with clearly demarcated edges and membrane. These skin infections are slow to heal. […] Most complications, including death, are attributable to the toxin’s effects. […] Complications include: Myocarditis, Neuritis, Respiratory insufficiency due to airway obstruction. […] Myocarditis and neuritis are the most frequent complications. Respiratory insufficiency due to airway obstruction is more common in infants. […] The overall case-fatality rate for diphtheria is 510%. People younger than 5 years and older than 40 years of age experience higher death rates (up to 20%). […] The systemic complications from cutaneous diphtheria appear to be less than from other sites.

• #2

  https://www.health.nsw.gov.au/Infectious/factsheets/Pages/diphtheria.aspx

  Diphtheria is a serious bacterial infection that usually affects the nose and throat, and can also affect the skin. […] Symptoms will depend on the site of infection. The most severe form of diphtheria affects the throat and tonsils. The first symptoms are usually a sore throat, loss of appetite and a mild fever. Within 2 -3 days, a greyish-white membrane forms over the throat and tonsils that can make it hard to swallow and breathe. The infection can also cause the neck to swell. This is known as respiratory diphtheria and is the type of infection which, historically in Australia, resulted in the deaths of many children under five years of age. […] Symptoms usually begin two to five days after being exposed to the bacteria but may take up to 10 days to appear. […] The toxin formed by diphtheria bacteria can cause inflammation of heart muscle and the nerves which can be fatal in 5-10 per cent of people infected. […] Illness can also occur with non-toxin-producing strains of the diphtheria bacteria, but the disease is generally milder.

• #2 Diphtheria – IAFFDiphtheria – IAFF

  https://www.iaff.org/infectious-disease/diseases/diphtheria/

  Diphtheria bacteria infect the nose and throat creating a gray covering (pseudomembrane) that may block the airway. These bacteria produce toxins that may spread from the throat into the bloodstream and lead to life threatening complications. Symptoms start between 2 and 5 days after exposure. […] The signs and symptoms of diphtheria may include: Sore throat (mild to severe), Drainage from the nose (watery or bloody), Breathing difficulties, Barking cough (similar to that seen with Croup), Fever, Skin ulcers are rare but can occur, Painful swallowing, No symptoms at all in some patients. […] Complications from diphtheria depend on the person and recovery is typically a slow process. The illness may be mild in some or life threatening in others. Complications that are more serious include inflammation of the heart muscles, airway obstruction, temporary paralysis and kidney damage. Death occurs in 5-10% of patients with respiratory diphtheria infection.

• #2

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/diphtheria.html

  Diphtheria starts like a cold, with sore throat, mild fever (101 degrees Fahrenheit or less), and chills. Next, the diphtheria toxin makes a thick coating on the back of the nose or throat. It may be blue or grayish green. The coating makes it hard to breathe or swallow. […] The coating on the throat can get so thick that it blocks the airway, so the person cannot breathe. […] The diphtheria toxin can attack the heart, causing abnormal heart rhythms and even heart failure. It also can attack the nerves, which leads to paralysis (unable to move parts of the body). […] About one out of 10 people who get diphtheria dies. In children younger than 5 years, as many as one out of five children who get diphtheria dies.

• #2 Diphtheria: Symptoms, Causes, Treatment, Vaccine & Transmission

  https://www.emedicinehealth.com/diphtheria/article_em.htm

  As respiratory diphtheria progresses, individuals may develop the classic adherent thick, gray membrane (pseudomembrane) forming over the lining tissue of the tonsils, pharynx, and/or nasal cavity. Extension of this pseudomembrane into the larynx and trachea can lead to obstruction of the airway with subsequent suffocation and death. […] The systemic manifestations of diphtheria are caused by the effects of the diphtheria toxin and its subsequent dissemination to other organs away from the initial area of infection. Commonly affected organs include the heart and nervous system, leading to complications such as inflammation of the heart (myocarditis), cardiac rhythm and conduction disturbances, muscle weakness, numbness (nerve), and vision changes. […] The prognosis for diphtheria depends on the severity of the disease and the presence of systemic involvement. Cardiac involvement and bacteremia (blood infection) are especially associated with a poor prognosis. The fatality rate for respiratory diphtheria is between 5%-10%, although it appears to be higher in patients less than 5 years of age and older than 40 years of age (~20%). Airway obstruction leading to suffocation and cardiac complications are the most common causes of death.

• #2 Diphtheria: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/782051-overview

  C diphtheria is responsible for both endemic and epidemic diseases, and it was first described in the 5th century BC by Hippocrates. Diphtheria manifests as either an upper respiratory tract or cutaneous infection and is caused by the aerobic gram-positive bacteria, Corynebacterium diphtheria. The infection usually occurs in the spring or winter months. It is communicable for 2-6 weeks without antibiotic treatment. […] Pathogenic strains can result in severe localized upper respiratory infection, localized cutaneous infections, and rarely systemic infection. […] Exotoxins are associated with both invasive localized and systemic forms of this disease; however, case reports of invasive disease in absence of the exotoxin release have been documented. […] C diphtheria adheres to mucosal epithelial cells where the exotoxin, released by endosomes, causes a localized inflammatory reaction followed by tissue destruction and necrosis.

• #2 Diphtheria Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/diphtheria

  Symptoms usually occur 2 to 5 days after the bacteria enter your body: Fever and chills […] Sore throat, hoarseness […] Painful swallowing […] Croup-like (barking) cough […] Drooling (suggests airway blockage is about to occur) […] Bluish coloration of the skin […] Bloody, watery drainage from nose […] Breathing problems, including difficulty breathing, fast breathing, high-pitched breathing sound (stridor) […] Skin sores (usually seen in tropical areas) […] Sometimes there are no symptoms. […] Diphtheria may be mild or severe. Some people do not have symptoms. In others, the disease can slowly get worse. Recovery from the illness is slow. […] People may die, especially when the disease affects the heart.

• #2 Diphtheria in Children

  https://www.nationwidechildrens.org/conditions/health-library/diphtheria-in-children

  Symptoms occur 2 to 5 days after contact with the bacteria. Symptoms can be a bit different for each child. The most common symptoms are below. […] Common symptoms of respiratory diphtheria may include: Sore throat, Trouble breathing, Low fever, Husky voice, A shrill sound caused when breathing in (stridor), Enlarged lymph glands in the neck, Increased heart rate, Runny nose, Swelling of the roof of the mouth (palate). […] Symptoms of skin diphtheria are often milder. They may include yellow spots or sores on the skin. […] The symptoms of diphtheria can seem like other health conditions. Have your child see their healthcare provider for a diagnosis. […] Infection with the diphtheria bacteria produces a toxin in the blood. This toxin can damage the heart, kidneys, and nervous system. In addition, a child may die from being unable to breathe if the disease blocks the throat.

• #2 Corynebacterium Diphtheriae – Medical Microbiology – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK7971/

  Corynebacterium diphtheriae infects the nasopharynx or skin. Toxigenic strains secrete a potent exotoxin which may cause diphtheria. The symptoms of diphtheria include pharyngitis, fever, swelling of the neck or area surrounding the skin lesion. Diphtheritic lesions are covered by a pseudomembrane. The toxin is distributed to distant organs by the circulatory system and may cause paralysis and congestive heart failure. […] Diphtheria is most commonly an infection of the upper respiratory tract and causes fever, sore throat, and malaise. A thick, gray-green fibrin membrane, the pseudomembrane, often forms over the site(s) of infection as a result of the combined effects of bacterial growth, toxin production, necrosis of underlying tissue, and the host immune response. […] There are two types of clinical diphtheria: nasopharyngeal and cutaneous. Symptoms of pharyngeal diphtheria vary from mild pharyngitis to hypoxia due to airway obstruction by the pseudomembrane. The involvement of cervical lymph nodes may cause profound swelling of the neck (bull neck diphtheria), and the patient may have a fever ( 103 F). The skin lesions in cutaneous diphtheria are usually covered by a gray-brown pseudomembrane. Life-threatening systemic complications, principally loss of motor function (e.g., difficulty in swallowing) and congestive heart failure, may develop as a result of the action of diphtheria toxin on peripheral motor neurons and the myocardium.

• #2 Diphtheria – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/ddi/diphtheria/

  Diphtheria infection most commonly affects the tonsils and pharynx. Symptoms can also spread from the tonsils and pharynx to the larynx. Upon physical examination, the hallmark finding of diphtheria infection is the formation of a pseudomembrane along the back of the throat. The membrane may change colors over time within the first few days of formation, it is a bluish-white color. By the time the patient presents for treatment, it may be grayish-green, or black if they have experienced bleeding. Attempting to remove the pseudomembrane will cause bleeding. If the pseudomembrane obstructs the airway, it can lead to coma or death. […] Patients with severe diphtheria infection may also develop notable edema along the anterior neck and submandibular area (bull neck). This manifestation is the result of mucosal swelling and cervical lymphadenopathy.

• #2 Diphtheria Symptoms and Complications | Diphtheria | CDC

  https://www.cdc.gov/diphtheria/symptoms/index.html

  It usually takes 2 to 5 days for symptoms to appear after someone has been exposed to C. diphtheriae. Some people may become infected and have no symptoms. […] The most common symptoms of respiratory diphtheria include: Mild fever, Pseudomembrane in the nose or throat, Sore throat, Swollen glands in the neck, Weakness. […] Symptoms of diphtheria skin infections can include: Open sore or ulcer with a clear edge, Pain, Rash with scales or peeling skin, Redness, Swelling. […] Airway blockage is a deadly complication from respiratory diphtheria. If the toxin gets into the blood stream, it can kill the tissue of other organs and cause: Kidney failure, Myocarditis (damage to the heart muscle), Polyneuropathy (nerve damage). […] Even with treatment, about 1 in 10 people with respiratory diphtheria will die. Without treatment, up to half of people die from the disease. […] Although the wound is slow healing, diphtheria skin infections rarely result in complications, severe disease, or death.

• #2 Diphtheria – myDr.com.au

  https://mydr.com.au/travel-health/diphtheria/

  The incubation period is 2-5 days. The disease can affect any of the mucous membranes, but usually causes infection in the upper respiratory tract, where it affects the mucous membrane of the pharynx (the back of the throat), and can produce a grey or green membrane which covers the back of the throat and the tonsils and obstructs breathing. […] Respiratory diphtheria has a gradual onset, with symptoms such as mild fever, sore throat, difficulty swallowing, fatigue, hoarse voice, cough, swollen neck glands, smelly discharge from nose and difficulty breathing. […] In addition, toxins produced by the bacteria can affect the nerves and the heart, with life-threatening complications. […] Diphtheria affecting the skin (cutaneous diphtheria) can cause pus-filled spots, which form into larger slow-healing skin ulcers. These usually occur on the legs, feet and hands.

• #2 Cutaneous diphtheria

  https://dermnetnz.org/topics/cutaneous-diphtheria

  Cutaneous diphtheria presents as a slow-healing ulcer. […] Cutaneous diphtheria is typically ulcerative. It begins as a vesicle or pustule which quickly breaks down to form a well-defined superficial ulcer with an overhanging edge. The ulcer is often described as having a punched-out appearance. Ulcers may be solitary or multiple, measuring several millimetres to centimetres in diameter. The hands, feet, and legs are the most common sites involved. The ulcer is initially painful, becoming asymptomatic with time. As the ulcer deepens, a brown-grey adherent membrane or pseudomembrane forms in the base. The surrounding skin is pink to purple in colour and can be swollen with a rolled appearance and possible blisters. Regional lymph nodes may be enlarged. […] Cutaneous diphtheria ulcers usually heal spontaneously in 2-3 months to leave depressed scars.

• #2 Diphtheria Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/782051-clinical

  Respiratory diphtheria may quickly progress to respiratory failure due to airway obstruction or aspiration of pseudomembrane into the tracheobronchial tree. […] Cutaneous diphtheria often develops at a site of previous trauma or a primary dermatologic disease. It follows an indolent course, typically lasting weeks to months. Occasionally, it may cause respiratory diphtheria.

• #2 Diphtheria: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/159534

  Diphtheria is a serious and contagious infection caused when the bacteria Corynebacterium diphtheriae release toxins. Symptoms often appear in the skin or respiratory system. If it enters the bloodstream, it can lead to paralysis, heart failure, difficulty breathing, and fatality. […] Symptoms typically include a thick, gray coating in the nose and throat along with a sore throat, swollen glands, weakness, and mild fever. If the condition affects the skin, ulcers and open sores can appear. […] Respiratory diphtheria can develop gradually, resulting in difficulty swallowing, sore throat, weakness, swollen glands in the neck, mild fever, appetite loss, and hoarseness, if the disease has affected the larynx. […] After 23 days, the released toxin kills the healthy tissue in a person’s respiratory system. This results in a thick, gray coating that develops in the nose or throat. Doctors refer to this coating as a pseudomembrane.

• #2 Diphtheria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560911/

  The primary treatment approaches for diphtheria involve promptly administering antitoxins and antibiotics. Additionally, the patient should undergo a thorough assessment for potential respiratory and cardiovascular instabilities. […] The prognosis of diphtheria is influenced by several factors: High mortality rates are observed in individuals younger than 5 and those older than 40. Cases with an onset duration exceeding 4 days are associated with elevated mortality. […] The primary complications of diphtheria often involve myocarditis and neuritis. Fatality occurs in 5% to 10% of cases. Another critical complication arises from pseudomembrane formation in the upper respiratory tract, potentially causing respiratory obstruction, necessitating urgent mechanical ventilation and intubation.

• #2 Diphtheria (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/diphtheria.html

  In diphtheria cases that progress beyond a throat infection, the toxin spreads through the bloodstream. This can lead to potentially life-threatening problems that affect other organs, such as the heart and kidneys. The toxin can: damage the heart and affect its ability to pump blood, make the kidneys have trouble clearing wastes from the body, cause nerve damage, eventually leading to paralysis. Up to 50% of people whose diphtheria isn’t treated may die. […] With prompt care in a hospital, most patients recover from diphtheria. After the antibiotics and anti-toxin take effect, they will need bed rest for a while (4 to 6 weeks, or until full recovery). Bed rest is particularly important if someone develops myocarditis (inflammation of the heart muscle), which can be a complication of diphtheria.

• #2 Diphtheria – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/ddi/diphtheria/

  Most complications from diphtheria infection are caused by the diphtheria toxin. As the bacteria produce the toxin in the upper respiratory tract, it is absorbed into the bloodstream and then distributed to the body tissues. The most common complications associated with diphtheria infections are neuritis, myocarditis, and polyneuropathy. Neuritis typically affects motor nerves. Patients may experience paralysis of the soft palate, limbs, eye muscles, and diaphragm. Diphtheria-associated neuritis often is temporary and resolves completely following treatment. […] Approximately 10% to 25% of patients with diphtheria develop cardiac complications frequently myocarditis during the acute phase or within the weeks following infection. The long-term effects of myocarditis include permanent cardiac damage due to fibrosis and valvular damage leading to heart failure. Some patients with diphtheria may develop polyneuropathy. Diphtheria toxin is adsorbed on Schwann cells (the cells responsible for providing the myelin sheath of nerve cells), which can inhibit myelin synthesis and lead to neurological complications, including polyneuropathy. The effects of diphtheria-associated polyneuropathy can be long-lasting, and recovery may not begin until 2 to 4 months after the onset of symptoms.

• #2 Diphtheria | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/diphtheria

  The onset is indistinguishable from the common cold, usually characterized by a mucopurulent nasal discharge (containing both mucus and pus), which may become blood-tinged. A white to grayish membrane usually forms on the nasal septum and throat in respiratory disease. […] The severity of the disease and complications are generally related to the extent of local disease. When absorbed, the toxin affects organs and tissues distant from the site of invasion. The most frequent complications of diphtheria are myocarditis and neuritis. Myocarditis may present as abnormal cardiac rhythms, and can occur early in the course of the illness or weeks later, and lead to heart failure. If myocarditis occurs early, it is often fatal. Neuritis most often affects motor nerves and usually resolves completely. Paralysis of the soft palate is most frequently seen during the third week of illness. Eye muscles, limbs, and diaphragm paralysis can occur after the first week. Secondary pneumonia and respiratory failure may result from diaphragmatic paralysis. Other complications include otitis media, and respiratory insufficiency due to airway obstruction, especially in infants. The overall case-fatality rate for respiratory diphtheria is 5% – 10%, with higher death rates (up to 20%) in persons 5 and 40 years of age. The case-fatality rate for diphtheria has changed very little during the last 50 years, and is higher for those who have never received vaccine than for those who have been fully immunized.

• #2 Diphtheria (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/diphtheria.html

  Diphtheria is a bacterial infection. It spreads easily and happens quickly, and mainly affects the nose and throat. Children under 5 and adults over 60 years old are particularly at risk for getting it. […] In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms. The toxin, or poison, caused by the bacteria can lead to a thick coating (or membrane) in the nose, throat, or airway. This makes a diphtheria infection different from other more common infections that cause sore throat (such as strep throat). This coating is usually fuzzy gray or black, and can cause breathing problems and trouble swallowing. […] As the infection continues, someone may: have trouble breathing or swallowing, complain of double vision, have slurred speech, show signs of going into shock (skin that’s pale and cold, rapid heartbeat, sweating, and an anxious appearance).

• #2 Diphtheria: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/diphtheria

  Signs of diphtheria often appear within two to five days of the infection occurring. Some people dont experience any symptoms, while others have mild symptoms that are similar to those of the common cold. […] The most visible and common symptom of diphtheria is a thick, gray coating on the throat and tonsils. Other common symptoms include: a fever, chills, swollen glands in the neck, a loud, barking cough, a sore throat, bluish skin, drooling, a general feeling of uneasiness or discomfort. […] Additional symptoms may occur as the infection progresses, including: difficulty breathing or swallowing, changes in vision, slurred speech, signs of shock, such as pale and cold skin, sweating, and a rapid heartbeat.

• #2 Diphtheria: Symptoms, Treatment & Prevention | Diphtheria Vaccine

  https://resources.healthgrades.com/right-care/infections-and-contagious-diseases/diphtheria

  In some cases, the diphtheria toxin can spread through the blood and cause life-threatening complications. This includes damage to the heart, kidneys and nerves. […] Respiratory diphtheria can cause airway obstruction and an inability to breathe due to the pseudomembrane. It can also lead to complications when the toxin spreads through the blood to organs. These complications can be serious and include: Kidney failure, Liver failure, Myocarditis, which is damage to the heart muscle that can lead to heart failure, Paralysis, Polyneuropathy, which is nerve damage. […] Respiratory diphtheria can be fatal. Left untreated, about half of people with diphtheria will die. Even with treatment, up to 10% of people worldwide do not survive. Children and the elderly are more likely to die from the disease.

• #2 What to Know About Diphtheria

  https://www.webmd.com/a-to-z-guides/what-to-know-diphtheria-causes

  A second type of diphtheria can also grow on your skin. This type of infection leads to painful, red, and swollen skin. You could also get ulcers with a thick gray coating. […] Without treatment, respiratory diphtheria (the type that infects body parts involved in breathing) can lead to severe health problems, like: Blocked airway, Heart damage (myocarditis), Nerve damage (polyneuropathy), Losing your ability to move (paralysis), Kidney failure. […] If you get treatment, its possible to fully recover from diphtheria. Your recovery time will usually take from 4 to 6 weeks. […] Even with treatment, though, some people dont recover. Children under 5 years old and adults over 60 have worse odds of dying from the disease. […] The CDC says that with treatment, about 9 in 10 people will survive a case of respiratory diphtheria. But up to half of people with the disease who dont get treatment for it can die from it, the agency says.

• #2 Department of Health

  https://www.health.ny.gov/diseases/communicable/diphtheria/fact_sheet.htm

  Diphtheria demands immediate medical attention; any delay in treatment can result in death. […] Untreated patients who are infected with the diphtheria germ may be contagious for up to four weeks. If the patient is treated appropriately, the contagious period can be limited to less than four days. […] Recovery from diphtheria is not always followed by lasting immunity.

• #3 Diphtheria Symptoms and Complications | Diphtheria | CDC

  https://www.cdc.gov/diphtheria/symptoms/index.html

  It usually takes 2 to 5 days for symptoms to appear after someone has been exposed to C. diphtheriae. Some people may become infected and have no symptoms. […] The most common symptoms of respiratory diphtheria include: Mild fever, Pseudomembrane in the nose or throat, Sore throat, Swollen glands in the neck, Weakness. […] Symptoms of diphtheria skin infections can include: Open sore or ulcer with a clear edge, Pain, Rash with scales or peeling skin, Redness, Swelling. […] Airway blockage is a deadly complication from respiratory diphtheria. If the toxin gets into the blood stream, it can kill the tissue of other organs and cause: Kidney failure, Myocarditis (damage to the heart muscle), Polyneuropathy (nerve damage). […] Even with treatment, about 1 in 10 people with respiratory diphtheria will die. Without treatment, up to half of people die from the disease. […] Although the wound is slow healing, diphtheria skin infections rarely result in complications, severe disease, or death.

• #3 Diphtheria – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diphtheria/diagnosis-treatment/drc-20351903

  Doctors may suspect diphtheria in a sick child who has a sore throat with a gray membrane covering the tonsils and throat. […] If a doctor suspects diphtheria, treatment begins immediately, even before the results of bacterial tests are available. […] Diphtheria is a serious illness. […] Children and adults who have diphtheria often need to be in the hospital for treatment. […] Recovering from diphtheria requires lots of bed rest. Avoiding any physical exertion is particularly important if your heart has been affected. You may need to get your nutrition through liquids and soft foods for a while because of pain and difficulty swallowing. […] Once you recover from diphtheria, you’ll need a full course of diphtheria vaccine to prevent a recurrence. Unlike some other infections, having diphtheria doesn’t guarantee lifetime immunity. You can get diphtheria more than once if you’re not fully vaccinated against it.

• #4 Diphtheria – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diphtheria/symptoms-causes/syc-20351897

  One sign of diphtheria is swollen glands (enlarged lymph nodes) in the neck. […] Diphtheria signs and symptoms usually begin 2 to 5 days after a person becomes infected. Signs and symptoms may include: A thick, gray membrane covering the throat and tonsils, A sore throat and hoarseness, Swollen glands (enlarged lymph nodes) in the neck, Difficulty breathing or rapid breathing, Nasal discharge, Fever and chills, Tiredness. […] In some people, infection with diphtheria-causing bacteria causes only a mild illness or no obvious signs and symptoms at all. […] Left untreated, diphtheria can lead to: Breathing problems. Diphtheria-causing bacteria may produce a toxin. This toxin damages tissue in the immediate area of infection usually, the nose and throat. At that site, the infection produces a tough, gray membrane made up of dead cells, bacteria and other substances. This membrane can obstruct breathing.

• #5 Diphtheria: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/diphtheria

  Signs of diphtheria often appear within two to five days of the infection occurring. Some people dont experience any symptoms, while others have mild symptoms that are similar to those of the common cold. […] The most visible and common symptom of diphtheria is a thick, gray coating on the throat and tonsils. Other common symptoms include: a fever, chills, swollen glands in the neck, a loud, barking cough, a sore throat, bluish skin, drooling, a general feeling of uneasiness or discomfort. […] Additional symptoms may occur as the infection progresses, including: difficulty breathing or swallowing, changes in vision, slurred speech, signs of shock, such as pale and cold skin, sweating, and a rapid heartbeat.

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