Modern approaches to the diagnosis, treatment and prevention of diphtheria

Diphtheria – is an infectious disease usually caused by toxigenic strains of C. diphtheriae or, less commonly, C. ulcerans and C. pseudotuberculosis.

Today, diphtheria remains endemic in many parts of the world. According to the British Medical Journal, the former USSR countries are also endemic regions in relation to the incidence of diphtheria.

Diphtheria – dangerous disease that can be fatal. Most deaths are associated with myocarditis and mechanical airway obstruction.

In this article on estet-portal.com read about the principles of diagnosis, treatment and prevention of diphtheria of the respiratory tract.

Timely vaccination – the main condition for effective prevention of diphtheria

The only effective method of preventing diphtheria is vaccination of the population. According to the national immunization schedule, children aged 2, 4, 6 and 18 months are vaccinated with DTP or AaDPT.

At 6 years of age, it is necessary to revaccinate with ADS (diphtheria-tetanus toxoid), at 16 years of age and every 10 years thereafter – ADS-M (diphtheria-tetanus toxoid with a reduced amount of antigen).

Pregnant women are recommended to be vaccinated with ADS-M (preferably at 27-36 gestation).

For travelers to countries where diphtheria is endemic, it is important to ensure that a proper vaccination schedule is followed, including a booster dose.

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Diagnosis of diphtheria: bacteriological examination and microscopy

To confirm the diagnosis of diphtheria, bacteriological examination of the material of the nasopharynx and microscopy is used. If possible, swabs should be taken from under the pseudomembrane.

If the suspicion of diphtheria is high, swabs should also be taken from persons who have been in contact with the sick patient.

Today, there is a modified Elek test that allows to determine the toxigenicity of an isolated strain of Corynebacterium. This study is technically complex and is not used in routine diagnostics.
Patients with respiratory diphtheria need hospitalization and timely treatment: diphtheria antitoxin and appropriate antibiotic therapy.

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Principles of diphtheria treatment: diphtheria antitoxin and desensitization

Diphtheria antitoxin should be given as soon as a physician suspects a patient of the condition.

Diphtheria antitoxin aims to bind the exotoxin, which is free in the blood. If the exotoxin has settled in the tissues, then the diphtheria antitoxin can no longer neutralize it.

In modern times, equine diphtheria antitoxin is widely used. Due to the presence of horse serum in the preparation, when an antitoxin is administered to a patient, there is a risk of developing a hypersensitivity reaction or Arthus phenomenon.

It is therefore important to perform a susceptibility test using 0.1 ml of the antitoxin diluted 1:1000 in sodium chloride solution before administration of the antitoxin.

The development of erythema over 10 mm at the injection site for 20 minutes after manipulation is an indication for desensitization. Desensitization precedes the administration of a full dose of antitoxin.

Depending on the severity of the disease, the dose of diphtheria antitoxin ranges from 80 to 120 thousand units. The drug is administered intravenously.

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Modern guidelines for antibiotic therapy in diphtheria

In order to eradicate the causative agent of diphtheria, patients are prescribed antibiotic therapy.

Erythromycin and penicillin are currently the drugs of choice for the treatment of diphtheria, according to CDC recommendations. The duration of treatment is 14 days, after which it is necessary to repeat the bacteriological examination of nasopharyngeal swabs.

Two negative bacteriological tests, taken at least 24 hours apart, indicate successful treatment.

If one of the test results is positive, then a further 10-day treatment with erythromycin or penicillin should be started.

After the second course of antibiotic therapy, bacteriological examination of the nasopharyngeal swab should be repeated again.

It is of great importance to carry out a full course of vaccination against diphtheria. Asymptomatic carriers should be revaccinated if they have not received it within the previous 5 years.

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