Diphtheria

Diphtheria is a serious bacterial infection of the throat and upper airways that can also affect the skin. It is preventable through vaccination and can be life-threatening if untreated due to airway blockage and toxin-related complications.

• Sore throat and fever
• A thick, greyish membrane forming over the tonsils and throat, which can make swallowing and breathing difficult
• Swollen neck lymph nodes, sometimes causing a "bull neck" appearance
• Difficulty breathing or a hoarse, barking cough if the airway is affected
• Skin sores with a grey membrane can occur in cutaneous diphtheria

• Caused by Corynebacterium diphtheriae bacteria, which produce a toxin responsible for many of the serious complications.
• Spread through respiratory droplets or direct contact with skin sores of an infected person.
• Risk is greatly increased by incomplete or absent diphtheria vaccination.

• Suspected clinically based on the characteristic greyish membrane in the throat together with fever and sore throat, particularly in an unvaccinated or incompletely vaccinated person.
• Throat swab culture confirms the diagnosis, but treatment should not be delayed while awaiting results given the risk of rapid deterioration.

Diphtheria is a medical emergency requiring hospital admission. Diphtheria antitoxin is given as soon as possible to neutralise circulating toxin, ideally before laboratory confirmation given the urgency.

An antibiotic (such as erythromycin or penicillin) is given to eliminate the bacteria and reduce further toxin production and spread.

Close monitoring of the airway is essential, as swelling from the membrane can cause life-threatening obstruction; some patients require airway support.

Close contacts are assessed and may be offered antibiotic prophylaxis and vaccination or a booster dose depending on their vaccination status.

• Complete routine diphtheria-containing vaccination in infancy and childhood, with booster doses as recommended.
• Ensure adults have up-to-date diphtheria booster vaccination, particularly if travelling to areas with lower vaccination coverage.
• Seek prompt medical care for severe sore throat with a visible throat membrane or difficulty breathing.
• Support vaccination campaigns and outbreak response in affected communities.