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Diphtheria

REVIEWED_BY  dr. Erlin SpA  
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TABLE OF CONTENTS

What Is Diphtheria?

Diphtheria is a contagious disease transmitted through coughing, sneezing, or contact with open wounds. Common symptoms include a sore throat and breathing difficulties.

The primary cause of diphtheria is infection with the bacterium Corynebacterium diphtheriae, which targets the mucous membranes of the nose and throat, and can also affect the skin.

This disease can affect individuals of all ages and can lead to severe, potentially life-threatening complications. Treatment includes antibiotics and antitoxins to neutralize the bacteria.

One of the most effective ways to prevent diphtheria is through vaccination.

Causes of Diphtheria

Diphtheria is caused by infection with Corynebacterium diphtheriae. The bacteria can spread through airborne droplets, contaminated personal items or household surfaces, and contact with infected wounds.

Transmission can also occur via saliva, and even asymptomatic individuals can spread the bacteria for up to six weeks after the initial infection.

The bacteria most commonly infect the nose and throat, releasing a dangerous toxin that spreads through the bloodstream and forms a thick gray membrane, typically in the nose, throat, tongue, and airways.

In some cases, this toxin can damage other organs, including the heart, brain, and kidneys, potentially leading to life-threatening complications.

Risk Factors for Diphtheria

The risk of diphtheria increases in individuals who are unvaccinated. Other risk factors include:

  • Visiting areas with low diphtheria immunization coverage.
  • A weakened immune system, such as in people with HIV/AIDS.
  • Poor hygiene and sanitation.
  • Children under 5 and adults over 60 years old.
  • Living in overcrowded housing.
  • Traveling to regions where diphtheria is prevalent.

Symptoms of Diphtheria

Symptoms usually appear 2–5 days after infection with Corynebacterium diphtheriae, spreading through the bloodstream and causing the following:

  • A thin, gray membrane covering the tonsils and throat.
  • Fever and chills.
  • Sore throat and hoarseness.
  • Difficulty breathing or rapid breathing.
  • Swollen lymph nodes in the neck.
  • Fatigue and weakness.
  • Runny nose that may become bloody.
  • Persistent cough.
  • Visual disturbances.
  • Confused or slurred speech.
  • Signs of shock, such as pale and cold skin, sweating, and rapid heartbeat.

In some individuals, symptoms may be mild or absent altogether, yet they can still transmit the bacteria to others.

Diagnosis of Diphtheria

Diagnosis involves several steps including clinical evaluations, laboratory tests, and risk assessments:

  1. Clinical examination: Doctors assess primary and secondary symptoms.
  2. Sample collection: A swab from the membrane or throat secretions is collected for lab testing.
  3. Laboratory testing, including:
    • Bacterial culture: Identifies Corynebacterium diphtheriae.
    • PCR Test: Detects bacterial DNA with higher speed and sensitivity.
    • Toxin test: Confirms presence of diphtheria toxin in blood or tissues.
  4. Additional tests: In severe cases, echocardiograms or kidney function tests may be used to detect toxin-related complications.

Treatment of Diphtheria

Diphtheria is potentially fatal and requires urgent, aggressive treatment:

Antitoxin

Administered via injection to neutralize diphtheria toxin. A skin test is done first to check for allergic reactions. If allergic, alternative treatments are considered.

Antibiotics

Penicillin or erythromycin can eliminate the bacteria and prevent further transmission.

Hospital Care

Most patients, especially unvaccinated individuals, need hospitalization and isolation in an intensive care unit due to the disease’s high contagion risk.

Research on Diphtheria Treatment

According to studies from StatPearls, key treatment insights include:

  • Prompt administration of antitoxin and antibiotics is crucial to minimize toxin effects and bacterial spread.
  • Healthcare professionals must thoroughly assess the patient’s respiratory and cardiovascular stability.
  • Early management should involve continuous heart monitoring to detect cardiovascular complications.
  • Timely and appropriate care greatly increases treatment success and reduces the risk of severe complications.

Complications of Diphtheria

Most diphtheria cases require treatment to prevent life-threatening complications, such as:

  1. Respiratory Issues: Toxins can form a membrane that blocks airways, leading to breathing difficulties.
  2. Heart Damage: Toxins may travel through the bloodstream and damage heart tissue, leading to myocarditis. Severe cases can cause heart failure or sudden death.
  3. Nerve Damage: Toxins can affect nerves in the throat (causing difficulty swallowing), as well as those in the arms and legs (leading to muscle weakness).

If respiratory muscles are affected, it can result in respiratory failure.

With treatment, recovery is possible, though prolonged. Approximately 5–10% of cases are fatal, with higher mortality in children under 5 and older adults.

Prevention of Diphtheria

Diphtheria prevention involves several strategies, with vaccination being the most important:

Vaccination

In Indonesia, diphtheria vaccines are mandatory for children and are usually combined with tetanus and pertussis (DPT vaccine).

Booster Shots

Adults should receive booster shots, especially if at high risk (e.g., healthcare workers or residents in endemic areas).

Hygiene and Sanitation

Regular handwashing and avoiding contact with infected individuals or contaminated items.

Monitoring and Isolation

Infected individuals should be isolated to prevent further spread.

When Should Diphtheria Vaccination Be Given?

In addition to vaccination, maintaining a clean environment is critical, especially in densely populated or poorly sanitized areas.

If symptoms occur, seek medical help immediately for an accurate diagnosis. 

Contact our English-speaking doctor directly from your smartphone using the Halodoc app. Doctors are available 24 hours to answer your questions.

Don’t wait, early diagnosis and treatment can prevent worsening and transmission.

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So, what are you waiting for? Download the Halodoc app on Play Store or App Store today!

References:
Centers for Disease Control and Prevention (CDC). Accessed in 2025. Diphtheria.
Indonesian Ministry of Health. Accessed in 2025. Diphtheria Diagnostic and Management Guidelines.
Medical News Today. Accessed in 2025. Diphtheria: Causes, Symptoms, and Treatment.
Mayo Clinic. Accessed in 2025. Diphtheria.
World Health Organization (WHO). Accessed in 2025. Diphtheria.

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