Diphtheria kills seven children in Rajasthan: Know all about this deadly disease

In an unfortunate turn of events, seven children lost their lives due to diphtheria in one month in the Deeg district of Rajasthan, and at least 24 others tested positive. According to an IANS report, the children who succumbed to the disease were aged between three to seven years. Teams from the State Health Department and the World Health Organization (WHO) also landed in the area to assess the situation and control the outbreak.

Diphtheria is a highly contagious disease, which affects the upper respiratory tract or skin and can spread by contact with the infected person or through respiratory droplets. It is highly preventable with vaccination. People in some rural areas may be more prone to the disease due to their resistance to administering vaccines.

Given the severity of the disease and its contagious nature, mid-day.com speaks to Dr. ChandraVeer Singh, Consultant Otorhinolaryngologist and Head and neck Onco Surgeon at Wockhardt Hospitals, Mira Road, and Dr. Nikhil Kulkarni, Consultant in Internal Medicine at S.L Raheja Hospital (a Fortis Associate), who highlight the causes, symptoms, treatment options, and prevention tips for diphtheria.

What is diphtheria and how is it caused?

Singh: Diphtheria is a type of bacterial infection. It is an infection of the nose and the throat and is contagious i.e., it can easily spread through respiratory droplets or the touch of an infected person. It is mainly caused by a bacteria called Corynebacterium diphtheriae. This particular bacteria attacks the lining of the respiratory system while releasing harmful toxins. This further leads to a build-up of tissues in the throat making it difficult to breathe or even swallow.

Kulkarni: Diphtheria is a serious bacterial infection caused by the bacterium Corynebacterium diphtheriae. It primarily affects the throat and can lead to difficulty breathing, heart problems and even death if left untreated.

What are some symptoms of diphtheria that one should look out for?

Singh: Individuals infected with diphtheria may experience a range of symptoms, which can vary from person to person. This can include symptoms like sore throat, difficulty in breathing, unable to speak, painful swallowing, hoarseness of the voice, chills, fever, tonsils, cough, drooling, loss of appetite, weakness of the muscles, fatigue, blisters, lesions, skin infection, rashes and discolouration. One should actively look for these symptoms and immediately consult a doctor.

Kulkarni: Some notable symptoms of diphtheria are:

• Sore throat and hoarseness
• Fever and chills
• Swelling in the neck (due to enlarged lymph nodes)
• Thick, grey, or white coating on the throat and tonsils
• Difficulty swallowing or breathing

How does diphtheria affect the body? Can it prove to be life-threatening?

Singh: This bacterial infection tends to affect the respiratory mucous membranes by producing toxins in excess quantity. This leads to the formation of a thick grey layer in the nose, throat and airway passage. This makes it difficult for an individual to even breathe. When these toxins are mixed in the bloodstream, they are more likely to affect various organs while causing severe damage to the nerves and the heart. Diphtheria can be life-threatening in children and the elderly if left untreated or ignored for an extended period.

Kulkarni: Diphtheria spreads through respiratory droplets which are produced when an infected person coughs or sneezes. It can also be contracted by touching contaminated surfaces.

Yes, it can be potentially life-threatening. Swelling in the neck can lead to airway obstruction. As a toxin-mediated disease, the toxins released by the bacteria require a specific antitoxin, which may sometimes be in short supply. This toxin can result in myocarditis (inflammation of the heart tissue), vasculitis (inflammation of blood vessels), and neuropathy (nerve damage) and can lead to kidney issues and multiple organ failure due to vasculitis.

Are kids more prone to diphtheria? If yes, why?

Singh: Kids are more susceptible to diphtheria. It is mostly because their immune system is still yet to develop. Children who have not been vaccinated for this infection are more likely to get infected with diphtheria. Generally, children tend to come in close contact with numerous children in the school, daycare and playground. This can increase the spread of this disease among the children.

Kulkarni: Children are usually vaccinated according to national guidelines, so they are generally protected unless they have not received their vaccinations in due time.

Are there any differences in symptoms for children and adults?

Singh: The symptoms may vary from person to person. It becomes difficult to categorise symptoms according to the age groups. The intensity and the severity of the symptoms may not be the same for everyone.

Kulkarni: Diphtheria is a bacterial infection that can be serious and even fatal in adults. Here are some symptoms of diphtheria that are usually seen in adults:

• A thick, gray membrane that covers the throat, nose, and tonsils
• A sore throat
• A low-grade fever
• Swollen lymph nodes in the neck
• Muscle weakness
• Loss of appetite
• A barking cough
• Hoarseness
• Difficulty breathing or swallowing
• Bluish coloration of the skin

The presentation of symptoms is usually similar in both children and adults.

What are the treatment options for diphtheria?

Singh: If you are diagnosed with diphtheria, it becomes essential to visit a doctor before wasting any time. Delaying the doctor's visit and trying to cure it with home remedies can only worsen your condition. Your doctor may suggest certain antibiotics and antitoxins to effectively combat the bacteria that has caused diphtheria.

Kulkarni: Treatment options for diphtheria include:

• Administration of antitoxin to neutralise the toxin produced by the bacteria
• Antibiotics to eliminate the bacteria
• Supportive care for any complications as and when they arise

Is diphtheria preventable? Please share some tips.

Singh: Diphtheria can be prevented. One of the most effective and easiest ways to prevent the risk of diphtheria is to get vaccinated for it. It becomes crucial to stay up-to-date with your vaccination to safeguard yourself from this disease. Also, practicing good hygiene by frequently washing your hands with soap and water can be helpful. This can help prevent the spread of infectious diseases like diphtheria.

Kulkarni: Vaccination is the most effective method to prevent diphtheria. The diphtheria vaccine is typically administered in combination with vaccines for tetanus and pertussis (DTP or DTaP). Keeping vaccination rates high is essential to prevent outbreaks, as diphtheria can be life-threatening, particularly in unvaccinated groups. The vaccination schedule for children includes doses at 2 months, 4 months, 6 months, 15-18 months and 4-6 years.

Can someone get diphtheria even after taking the vaccine?

Singh: Vaccines are often taken to protect yourself from contracting that particular disease. But there's still a small chance of contracting diphtheria even if you have been vaccinated for it.

Kulkarni: Diphtheria outbreaks were recorded recently among adolescents who have not received booster shots. The Tetanus, Diphtheria, and Pertussis (Tdap) booster is recommended for those aged 11-12 years, and adults should receive a Td or Tdap booster every 10 years.

Are people more at risk of respiratory diphtheria during this time of the year (near Diwali)?

Singh: All respiratory conditions linked to Diwali are more common and usually exacerbated by environmental pollution. Diphtheria is rarer and can be more severe, requiring vaccination and timely antibiotic treatment to prevent complications.

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