Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 1, 2016

In the early 1900s, diphtheria was a deadly and much-feared infection particularly for children. Due to the development of an effective vaccine in the early 1920s, rates of those with this disease in the U.S. declined and today, it no longer poses the same threat to the developed world. A life-threatening bacterial infection, diphtheria still afflicts and kills thousands of people each year, mostly in developing countries.


Definition & Facts

Diphtheria usually attacks the mucous membranes that are within the throat and nose. A second type of diphtheria affects the skin. When diphtheria gets into its advanced stages, it can cause damage to a person's nervous system, kidneys, and heart. About three percent of people that end up with diphtheria will die from it. If the person is under the age of 15, the percentage is higher.

Symptoms & Complaints

An infected person will begin to show signs and symptoms within two to five days of infection. These include:

In some cases, diphtheria does not become life threatening and is actually quite mild. In these cases, patients may believe that they have just a common cold or may show no signs or symptoms at all. Even though they may not feel ill, these patients are still carriers of diphtheria. They could transmit the infection to others without even knowing they have it.

The second type of diphtheria affects the skin. The symptoms include swelling, redness, and pain at the site of the infection, along with gray membrane covering ulcers on the skin.


Corynebacterium diphtheriae is the bacterium that causes diphtheria. People with diphtheria are contagious, unless they have been treated, and can transfer the infection to others for up to six weeks. There are several ways that a person can become infected with diphtheria.

The first and most common way is through the air. Much like a cold, if a person is infected with diphtheria and coughs or sneezes, the mist that comes out of their mouth could be inhaled by someone else. This can happen quite easily in an area that is crowded.

Touching the personal items of a contaminated person can also cause transmission. Someone that is contaminated with diphtheria could be leaving germs on many of their own items. Another way that diphtheria is transferred is by touching a contaminated person's infected wound. Touching commonly shared items can also cause transmission of the disease but is rarer.

Diagnosis & Tests

If diphtheria is suspected to be the illness of a patient, a throat culture will need to be done to verify. The culture will come from the membrane of the patient's throat and then sent to the laboratory for testing.

If skin diphtheria is believed to be the illness a patient is suffering from, the doctor will take a sample of the tissue from a wound that they believe is infected. The tissue sample will then be tested to verify whether or not diphtheria is the cause of the skin infection.

If the doctor believes that the patient is suffering from diphtheria or skin diphtheria, they will begin treatment for it immediately. This is even before the doctor is given the results of the laboratory tests.

Treatment & Therapy

Because of the seriousness of diphtheria, doctors will treat their patients immediately and aggressively. Patients are often hospitalized during treatment, placed in the intensive care unit to contain the infection.

There are commonly two different medications that will be used to treat diphtheria. The first medication is an antitoxin. It is a medication that is injected into the muscle or vein of the patient. The antitoxin is used in order to neutralize the toxin of diphtheria that is already within the body.

Before the antitoxin is given to a patient, they will first be tested to determine whether or not the patient is allergic to the antitoxin. If they are found to be allergic to it, doctors will begin to desensitize the patient to it. This is done by giving the patient a series of small doses then gradually increasing the dose. The second medication that is given is an antibiotic. This is used to fight away the infection and kill the bacteria.

Diphtheria can cause a grey membrane along the back of the throat, which can make it difficult for an infected person to breathe. During treatment a doctor may remove some of the membrane in order to make it easier for the patient to breathe.

Prevention & Prophylaxis

In today's world, diphtheria is highly preventable by vaccinating children. The DTap vaccine which also contains vaccines against tetanus and pertussis is administered in a series of five shots that are given at two months, four months, six months, between 12 and 18 months, and between four and six years old.

The immunity that the first series of shots gives will begin to fade away over time. So after the series of shots are given, people should receive booster shots in order to keep up their immunity to the disease. The first booster should be given at age 12 and continued every ten years after that.