Diphtheria

Symptoms usually appear 2 to 5 days after exposure (but can range from 1 to 10 days).

Diphtheria can affect the throat or the skin.

Respiratory diphtheria

• Often starts like a cold with sore throat, fever and chills.
• Can cause a thick greyish-white coating in the back of the nose or throat.
• Can worsen, making it difficult to breathe or swallow.
• May cause swollen, painful glands in the neck.
• Can become life-threatening.

Skin (cutaneous) diphtheria

• Can start from any infected cut or wound.
• Usually appears as sores or ulcers that may be slow to heal, often on the legs.
• May be covered with a grey, moist scab
• Is usually less severe but can still spread to others.

Complications

Complications are mainly caused by the toxin (poison) produced by the bacteria and can include:

• heart inflammation, which can cause abnormal heart rhythms
• nerve damage, which may lead to muscle weakness or temporary paralysis.

In severe cases, paralysis can affect the diaphragm (breathing muscle), leading to pneumonia or severe breathing problems (respiratory failure). Around 5-10% of severe cases are fatal, even with treatment.

Diphtheria spreads through close contact with an infected person:

• breathing in droplets from coughing or sneezing
• direct contact with saliva, respiratory secretions, or infected skin sores
• contact with contaminated items such as bandages, towels or utensils.

People with diphtheria can spread the infection from shortly before symptoms start until they have been treated with antibiotics.

People at higher risk include:

• people who are not vaccinated or not fully vaccinated
• close contacts of someone with diphtheria
• people living in crowded settings where infections can spread more easily
• travellers to countries where diphtheria is more common
• people with weakened immune systems (higher risk of severe illness if infected).

• Seek urgent medical care If you have a sore throat with fever and difficulty breathing or swallowing.
• See a doctor as soon as possible if you have skin sores or ulcers that are not healing.

Diphtheria is confirmed by testing a swab from the throat or skin sore in a laboratory.

• Diphtheria infection is treated with antibiotics.
• In more severe cases, antitoxin may be needed to stop the toxin (poison) from causing further damage.
• Some people may require breathing support, including a breathing tube.
• Skin infections may need regular wound care and dressings until sores or ulcers are healed.

While you have diphtheria

• Respiratory diphtheria: Stay in hospital or at home away from others while you complete your antibiotics. Do not go to work, school, childcare or group gatherings until tests show you are no longer infectious.
• Cutaneous diphtheria: Keep sores covered and avoid close contact with others until sores are improving and you have had at least 3 days of antibiotics.

Vaccination is the most effective protection against diphtheria.

Make sure you and your family are up to date with vaccinations, including booster doses for teenagers and adults. Diphtheria vaccine is usually given with tetanus and pertussis (whooping cough) as DTP or dTpa.

You can also reduce the risk of infection and help prevent spread to others by:

• covering your mouth and nose when coughing or sneezing
• throwing away used tissues in the bin
• washing hands regularly with soap and water, especially before preparing food, after coughing or sneezing, and before and after touching skin sores or dressings
• keeping sores and wounds clean and covered, such as with dressings or large band-aids
• avoiding close contact with people who are unwell
• staying home if unwell and limiting contact with others.