Diphtheria  is a serious bacterial infection that usually affects the mucous membranes of  nose and throat. Diphtheria is extremely rare in the United States and other developed countries, thanks to widespread vaccination against the disease.

Diphtheria can be treated with medications. But in advanced stages, diphtheria can damage  heart, kidneys and nervous system. Even with treatment, diphtheria can be deadly, especially in children.

Symptoms

Diphtheria signs and symptoms usually begin two to five days after a person becomes infected and may include:

• A thick, gray membrane covering of throat and tonsils
• A sore throat and hoarseness
• Swollen glands (enlarged lymph nodes) in your neck
• Difficulty breathing or rapid breathing
• Nasal discharge
• Fever and chills
• Malaise

In some people, infection with diphtheria-causing bacteria causes only a mild illness — or no obvious signs and symptoms at all. Infected people who remain unaware of their illness are known as carriers of diphtheria, because they can spread the infection without being sick themselves.

Skin (cutaneous) diphtheria

A second type of diphtheria can affect the skin, causing pain, redness and swelling similar to other bacterial skin infections. Ulcers covered by a gray membrane also may be skin diphtheria.

Although it's more common in tropical climates, diphtheria on the skin also occurs in the United States, particularly among people with poor hygiene who live in crowded conditions.

Causes

Diphtheria is caused by the bacterium Corynebacterium diphtheriae. The bacterium usually multiplies on or near the surface of the throat. C. diphtheriae spreads via:

• Airborne droplets. When an infected person's sneeze or cough releases a mist of contaminated droplets, people nearby may inhale C. diphtheriae. Diphtheria spreads easily this way, especially in crowded conditions.
• Contaminated personal or household items. People occasionally catch diphtheria from handling an infected person's things, such as used tissues or hand towels, that may be contaminated with the bacteria. You can also transfer diphtheria-causing bacteria by touching an infected wound.

People who have been infected by the diphtheria bacteria and who haven't been treated can infect people who haven't had the diphtheria vaccine — even if they don't show any symptoms.

Risk factors

People who are at increased risk of contracting diphtheria include:

• Children and adults who don't have up-to-date vaccinations
• People living in crowded or unsanitary conditions
• Anyone who travels to an area where diphtheria infections are more common

Diphtheria rarely occurs in the United States and Western Europe, where children have been vaccinated against the condition for decades. However, diphtheria is still common in developing countries where vaccination rates are low.

In areas where diphtheria vaccination is standard, the disease is mainly a threat to unvaccinated or inadequately vaccinated people who travel internationally or have contact with people from less-developed countries.

Complications

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-colored membrane composed of dead cells, bacteria and other substances. This membrane can obstruct breathing.
• Heart damage. The diphtheria toxin may spread through your bloodstream and damage other tissues in your body, such as your 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 congestive 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 5% to 10% of the time, according to the World Health Organization. Rates of death are higher in children.

Prevention

Before antibiotics were available, diphtheria was a common illness in young children. Today, the disease is not only treatable but also preventable with a vaccine.

The diphtheria vaccine is usually combined with vaccines for tetanus and whooping cough (pertussis). The three-in-one vaccine is known as the diphtheria, tetanus and pertussis vaccine. The latest version of this vaccine is known as the DTaP vaccine for children and the Tdap vaccine for adolescents and adults.

The diphtheria, tetanus and pertussis vaccine is one of the childhood immunizations that doctors in the United States recommend during infancy. Vaccination consists of a series of five shots, typically administered in the arm or thigh, given to children at these ages:

• 2 months
• 4 months
• 6 months
• 15 to 18 months
• 4 to 6 years

Booster shots

After the initial series of immunizations in childhood, you need booster shots of the diphtheria vaccine to help you maintain your immunity. That's because immunity to diphtheria fades with time.

Children who received all of the recommended immunizations before age 7 should receive their first booster shot at around age 11 or 12. The next booster shot is recommended 10 years later, then repeated at 10-year intervals. Booster shots are particularly important if you travel to an area where diphtheria is common.

The diphtheria booster is combined with the tetanus booster — the tetanus-diphtheria (Td) vaccine. This combination vaccine is given by injection, usually into the arm or thigh.

Tdap is a combined tetanus, diphtheria and acellular pertussis (whooping cough) vaccine. It's a one-time alternative vaccine for adolescents ages 11 through 18 and adults who haven't previously had a Tdap booster. It's also recommended once during pregnancy, regardless of previous vaccinations.

Talk to your doctor about vaccines and booster shots if you're unsure of your vaccination status. Tdap also may be recommended as part of the Td s

HOMOEOPATHIC TREATMENT

• Amyl nitrosum: Catarrh and dysphagia (sequelae of a recent attack of diphteria) entirely relieved during the action of the drug, but returned after its effects had passed off.
• Apis Mel– remarkable remedy for diphtheria, first stage of diphtheria; may be given as a preventive, diphtheria insidiously progressing, small amount of pain accompanying intense and extensive inflammation; oedema of throat, uvula edematous and enlarged. Thirstlessness; breathing difficult from oedema of glottis; tonsils especially right sided, studded with deep, gray, angry-looking ulcerations.
• Arsenicum—Great anguish, extreme restlessness and fear of death. Fetid breath and viscid, foul discharge from the nostrils. Constant desire for cold drinks but can take only little. Great prostration, all worse about midnight.
• Belladonna: In forming stage. Great dryness of fauces; tonsil bright red and swollen. Very restless, feels drowsy, yet cannot sleep Congestion to head, with throbbing of carotids; eyes injected; delirium.
• Bromium – has done some wonderful work in diphtheria. The membrane first forms in the bronchi, trachea or larynx running upward .Complaints on the left side of the body. Membranous croup: great rattling of mucus but no expectoration. There seems to be great danger of suffocation from accumulation of mucus in the larynx.
• Capsicum annum: The throat it is of a deep red, purplish, color; dry, except in spots which are ulcerated. Use a good strong pepper tea for a gargle and give the 6^th.
• Chin ars: It has acted just as favorably in malignant diphtheria.
• Crotolus Horridus– Malignant diphtheria or scarlatina; œdema or gangrene of the fauces or tonsils; pain worse from empty swallowing; if vomiting or diarrhœa come on blood oozes from nose and mouth, persistent hemorrhage; difficult swallowing, great thirst; excessive prostration; pulse small and weak.
• Diphtherinum: Diphtheritic membrane, thick, dark gray or brownish black; temperature low or sub-normal; pulse weak and rapid; extremities cold and marked debility; patient lies in a semi-stupid condition; eyes dull, besotted . Swallows without pain but, fluids are vomited or returned by the nose. Epistaxis or profound prostration from very onset of attack. Laryngeal diphtheria. Post-diphtheritic paralysis.e.t.c