Unpredictable complications of diphtheria

Diphtheria is an acute infectious disease, patients can die within 6-10 days, common complications are myocarditis and neuritis.

On October 1, Head Nurse Ha Thi Thanh Hoa, Department of Infection Prevention and Control, National Children's Hospital, said that diphtheria has pseudomembranes in the tonsils, pharynx, larynx, and nose. The disease can appear on the skin, other mucous membranes such as the conjunctiva or genitals.

This is both an infectious and toxic disease. Severe lesions are mainly caused by exotoxin of diphtheria bacteria. Mortality is usually about 5-10% and can increase to 20% in children under 5 years of age and people over 40 years of age.

Complications

The most common complications are myocarditis and neuritis. Myocarditis complications can occur in the acute phase or delayed for several weeks after the patient recovers. When myocarditis appears early in the first days of the disease, the mortality rate is often very high.

Neuropathy complications usually affect the motor nerves and will recover completely if the patient does not die from other complications.

Palatal paralysis (velopharyngeal paralysis) is another complication that can occur in diphtheria, usually appearing in the third week of the disease.

Oculomotor nerve palsy, limb muscle paralysis, and diaphragmatic paralysis may occur in the fifth week of illness. Pneumonia and respiratory failure may result from diaphragmatic paralysis. Children, especially infants, may develop conjunctivitis or respiratory failure.

Children receive vaccinations at the National Children's Hospital. Photo: Provided by the hospital — Children receive vaccinations at the National Children's Hospital. Photo: *Provided by the hospital*

Transmission

Corynebacterium diphtheriae bacteria of the Corynebacteriaceae family are the cause of diphtheria. The bacteria are highly resistant outside the body and can withstand cold and dryness. If surrounded by mucus, the bacteria can live on objects for several days, even several weeks. In sunlight, the bacteria will die after a few hours. At 58 degrees Celsius, the bacteria can live for 10 minutes, in an environment of 1% phenol and 60-degree alcohol, it can live for one minute.

Bacterial reservoirs in sick people and healthy people carrying bacteria. This is both a reservoir and a source of transmission. The incubation period is usually from 2 to 5 days, possibly longer. The period of transmission is not fixed, it can last about 2 weeks or shorter, at least over 4 weeks. The sick person excretes bacteria from the onset period, or from the end of the incubation period. Healthy people carry diphtheria bacteria from a few days to 3, 4 weeks; there are rare cases of chronic bacterial carriers lasting over 6 months.

The disease is transmitted through the respiratory tract by contact with sick people or healthy people carrying diphtheria bacteria. The disease is also transmitted through contact with objects contaminated with secretions from sick people. People of any age can get the disease.

Symptom

Depending on the location of the bacteria causing the disease, there will be different symptoms. For example, anterior nasal diphtheria: The patient has a runny nose, discharge of pus and mucus sometimes with blood, and a white membrane on the nasal septum. The disease is usually mild because the bacterial toxins rarely penetrate the blood.

Pharyngeal and tonsil diphtheria: The patient is tired, has a sore throat, loss of appetite, and a low fever. After 2-3 days, a necrotic mass appears, forming a white-blue pseudomembrane that is tough and adheres firmly to the tonsils, or can spread to cover the entire pharynx. In some cases, the patient has swelling in the submandibular region and swollen lymph nodes in the neck, making the neck bulge like a cow's neck. In severe poisoning, the patient is lethargic, pale, has a rapid pulse, is lethargic, and is comatose. If not treated actively, the patient will die within 6 to 10 days.

Laryngeal diphtheria: This is a rapidly progressing and dangerous disease. Patients have symptoms of mild fever, hoarseness, cough, and pseudomembranes in the larynx or spreading from the throat down. If not treated promptly, the pseudomembranes can cause airway obstruction, causing respiratory failure and rapid death.

In addition to the above locations, bacteria also cause disease in some other locations but are very rare and have mild disease progression.

Prevent

The disease is effectively prevented by vaccination. Currently, in Vietnam there is no single vaccine to prevent diphtheria, only a combination vaccine that contains diphtheria antigens.

Diphtheria is a disease that spreads quickly, has dangerous complications and a high mortality rate. Therefore, children and adults need to be fully vaccinated and go to the hospital for treatment immediately when symptoms appear.

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