The clinical case definition of diphtheria is:
An upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose. A milder form of diptheria can also effect the skin.
Diptheria is a highly contagious disease spread by direct physical contact or breathing the secretions of those infected. Diptheria was once quite common, but has now largely eradicated in developed nations. There have been fewer than 5 cases a year reported in the United States since 1980, as the vaccine DPT (Diptheria-Tetanus-Polio) is given to all school children. Boosters of the vaccine though is recommended to adults, as effects of the vaccine decrease as one gets older, especially travelling abroad to third-world nations.
Diptheria (dif-thir-ee-uh or often dip-thir-ee-uh) takes its name from the Greek word for "leather", dipthera, and was named in 1855 by French physician Armond Trousseau (1801-1867). This coinage alludes to the leathery, sheath-like membrane that grows on the tonsils, throat and in the nose.
The respitory form has an incubation of 1-4 days. Symptoms include a fatigue, a fever, a mild sore throat, problems swallowing. Children infected have symptoms that include nausea, vomiting, chills, and a high fever, although some do not show symptoms until the infection has progressed more.
The disease may remain manageable, but in more severe cases lymph nodes in neck may swell, and breathing and swallowing will be more difficult. People in this stage should seek immediate medical attention, as obstruction in throat may require a tracheostomy. In addition, the increase in heart rate may cause cardiac arrest. Patients with severe cases will be put in ICU's (Intensive Care Units) at hospitals and be given a diptheria anti-toxin and bacterial killing drugs penicillin and erythromycin. Bed rest is important and physcial activity should be limited, especially in cases where there is inflammation of the heart muscles. Recovery is generally slow.
Diphtheria was once one of the most dreaded diseases, with frequent large scale outbreaks. In the 1920's there was and estimated 100,000 to 200,000 cases a year of diphtheria in the United States, with 13,000 to 15,000 deaths. Children represented the large majority of cases and fatalities.
One of the first early effective treatments was in the 1880's by U.S. physician Joseph O'Dwyer (1841-1898). O'Dwyer developed tubes that could be inserted into throat to prevent victims from suffocating to death from the membrane sheath that grew and obstructed the airways. In the 1890's, German physician Emil von Behring developed an anti-toxin that while did not kill the bacteria, it neutralized the toxic poisons that the bacteria released into the body. Effective vaccines were not developed until the discovey and development of sulfa drugs following World War II.
Diptheria remains a serious disease, with 5-10% percent fatalities, and up to 20% in children younger than 5 or adults older than 40. Outbreaks though very rare in world, still can occur worldwide, even in nations one wouldn't suspect. After the break up of the old Soviet Union in the late 1980's, vaccination rates fell so much that it created and explosion of diptheria cases. In 1991 there were 2,000 cases of diphtheria in Russia and its newer independent states, by 1998 there was as much as 200,000 cases, with 5,000 deaths according to Red Cross estimates. (So great in increase it was even cited in the Guinness Book of World Records as "Most Resurgent Disease.") Such statistics show that constant vigilance must be maintained even on largely eradicated diseases, especially since many of these such diseases show greater resistance against drugs that have been used to fight them for decades.
Laboratory criteria for diagnosis
Probable: a clinically compatible case that is not laboratory confirmed and is not epidemiologically linked to a laboratory-confirmed case
Confirmed: a clinically compatible case that is either laboratory confirmed or epidemiologically linked to a laboratory-confirmed case
From the CDC guidelines: Cutaneous diphtheria should not be reported. Respiratory disease caused by nontoxigenic C. diphtheriae should be reported as diphtheria. All diphtheria isolates, regardless of association with disease, should be sent to the Diphtheria Laboratory, National Center for Infectious Diseases, CDC.
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