Table of ContentsView AllTable of ContentsSymptomsComplicationsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Complications
Causes
Diagnosis
Treatment
Diphtheriais a bacterial infection that commonly affects the nose and throat. A characteristic sign of a diphtheria infection is a thick, hard, grayish coating inside your throat. While diphtheria is rare in the developed world due to vaccination, it can cause serious complications, including death, if left untreated.
The widespread use of diphtheria vaccines has reduced the incidence of the disease worldwide. Between 2017 and 2022, the number of cases reported annually has hovered between around 8,000 and 23,000.
Diphtheria Symptoms and Fatalities
Diphtheria used to be a common cause of illness and death, especially in children, with a mortality rate as high as 69%.The severity of the infection led to its nickname—“the strangling angel”—in the decades before the widespread availability ofdiphtheria vaccines.
Even today, the risk of death overall is between 5% and 10%, while infections in younger children and adults over 40 are closer to 20%.
When someone is infected with diphtheria, respiratory symptoms usually appear within two to five days, although some take up to 10 days to develop.
Diphtheria can start similarly to a normal respiratory infection with mild flu-like symptoms. In time, however, other, more serious symptoms can develop, including:
Hallmark SymptomsOne of the hallmarks of diphtheria is the formation of a thick, hard, gray-colored coating—called apseudomembrane—lining the throat, nose, and tonsils that can block airways. Bleeding will occur if trying to remove or scrape off the dense coating.Another hallmark is swollen lymph nodes in the neck (calledcervical lymphadenopathy). This symptom can become so severe as to create a “bull’s neck” appearance.
Hallmark Symptoms
One of the hallmarks of diphtheria is the formation of a thick, hard, gray-colored coating—called apseudomembrane—lining the throat, nose, and tonsils that can block airways. Bleeding will occur if trying to remove or scrape off the dense coating.Another hallmark is swollen lymph nodes in the neck (calledcervical lymphadenopathy). This symptom can become so severe as to create a “bull’s neck” appearance.
One of the hallmarks of diphtheria is the formation of a thick, hard, gray-colored coating—called apseudomembrane—lining the throat, nose, and tonsils that can block airways. Bleeding will occur if trying to remove or scrape off the dense coating.
Another hallmark is swollen lymph nodes in the neck (calledcervical lymphadenopathy). This symptom can become so severe as to create a “bull’s neck” appearance.
Without treatment, symptoms of diphtheria will usually last one to two weeks. However, people may experience complications for weeks or months after the initialacuteinfection.
Cutaneous Diphtheria
Another, less common type of diphtheria, called cutaneous diphtheria, affects the skin. At first, the infection may look similar to skin conditions likeeczemaorpsoriasis, causing a scaly rash with oozing skin ulcers.
Although less serious than respiratory diphtheria, cutaneous diphtheria can lead to secondary skin infections if bacteria likeStaphylococcus aureusget into the open skin sores.
Approximately 20% to 40% of people with cutaneous diphtheria will develop respiratory diphtheria.
Complications of Diphtheria
Diphtheria can become serious if it spreads (disseminates) beyond the respiratory tract. If this happens, it can lead to potentially life-threatening complications like:
People at High Risk of ComplicationsPeople who are most likely to experience complications from diphtheria include:People who delayed medical treatmentPeople who haven’t had primary diphtheria vaccination or booster shotsPeople withweakened immune systemsChildren under 5 or adults over 40
People at High Risk of Complications
People who are most likely to experience complications from diphtheria include:People who delayed medical treatmentPeople who haven’t had primary diphtheria vaccination or booster shotsPeople withweakened immune systemsChildren under 5 or adults over 40
People who are most likely to experience complications from diphtheria include:
Causes of Diphtheria and How It Is Spread
Generally, the more toxins released, the sicker a person will be. A fatal dose in humans is about 0.1 micrograms (μg) of toxin per kilogram of body weight. Death is most commonly the result ofnecrosis(tissue death) of the heart or liver.
Disease Transmission
Respiratory diphtheria is more common during the winter and spring. It Is also more common in areas where there is a lack of sanitation and people live together in crowded spaces. Travelers toendemicareas (areas where a disease is common) are vulnerable to infection.
Asymptomaticcarriers can also spread the infection. These are people who have been infected but show no signs of the disease. Asymptomatic carriers are usually those who have been vaccinated.
How Is Diphtheria Diagnosed?
If a person has symptoms of diphtheria, a healthcare provider will take a swab of their throat or skin lesion. The sample will be cultured in a lab to detectCorynebacterium diphtheriaand the toxins it produces.
Other tests will be ordered to characterize the severity of the infection and check for possible complications. These include:
Medical professionals need to contact the Centers for Disease Control and Prevention (CDC) if diphtheria is suspected as the CDC is the organization that supplies the diphtheria antitoxin.
How Diphtheria Is Treated
In addition to the antitoxin, theantibioticserythromycin or penicillin would be delivered intravenously. People who have trouble breathing may requireintubationand amechanical ventilator.
People who live with or have had close contact with someone who has diphtheria will also need treatment and isolation until two negative tests for diphtheria are received. This usually occurs 48 hours after receiving the diphtheria antitoxin and starting antibiotic treatment.
Diphtheria is anotifiable disease. This means that public health officials will contact you and ask questions to help determine how you got infected. They will also want to know who you were in contact with after the infection so that they can treated.
People who have recovered from diphtheria are required to get the diphtheria vaccine. Getting diphtheria doesn’t protect you from infection for the rest of your life. Only diphtheria vaccination confers long-lasting immune protection.
Everything You Need to Know About DTap and Tetanus Shots
Summary
Diphtheria is a vaccine-preventable bacterial infection that is rare in the developing world but can turn deadly in young children and older adults.
Symptoms include difficulty breathing and a thick, gray coating in the upper respiratory tract. Prompt treatment with a diphtheria antitoxin and a course of antibiotics can help clear the infection and avoid potentially serious complications like pneumonia, liver failure, and kidney failure.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.World Health Organization.Diphtheria reported cases and incidence.Truelove SA, Keegan LT, Moss WJ, et al.Clinical and epidemiological aspects of diphtheria: a systematic review and pooled analysis.Clin Infect Dis.2020 Jul 1;71(1):89–97. doi:10.1093/cid/ciz808Boghani S, Shah HD, Fancy M, et al.A study on the characteristics and outcomes of reported diphtheria patients in a western state in India.Cureus.2023 Mar;15(3):e35769. doi:10.7759/cureus.35769Centers for Disease Control and Prevention.Signs and symptoms: respiratory diphtheria.Additional ReadingCenters for Disease Control and Prevention.Diphtheria | Causes and Transmission.Centers for Disease Control and Prevention.Manual for the Surveillance of Vaccine-Preventable Diseases.Collier RJ.Studies On The Mode Of Action Of Diphtheria Toxin: I. Phosphorylated Intermediates In Normal And Intoxicated Hela Cells.Journal of Experimental Medicine. 1964;120(6):1007-1018. doi:10.1084/jem.120.6.1007.Pappenheimer AM.The diphtheria bacillus and its toxin: a model system.Journal of Hygiene. 1984;93(03):397-404. doi:10.1017/s0022172400064998.Wilson IE, Menson EN.Cutaneous Diphtheria. New England Journal of Medicine. 2018;378(13):e17. doi:10.1056/nejmicm1701825World Health Organization.Immunization, Vaccines and Biologicals: Diphtheria.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.World Health Organization.Diphtheria reported cases and incidence.Truelove SA, Keegan LT, Moss WJ, et al.Clinical and epidemiological aspects of diphtheria: a systematic review and pooled analysis.Clin Infect Dis.2020 Jul 1;71(1):89–97. doi:10.1093/cid/ciz808Boghani S, Shah HD, Fancy M, et al.A study on the characteristics and outcomes of reported diphtheria patients in a western state in India.Cureus.2023 Mar;15(3):e35769. doi:10.7759/cureus.35769Centers for Disease Control and Prevention.Signs and symptoms: respiratory diphtheria.Additional ReadingCenters for Disease Control and Prevention.Diphtheria | Causes and Transmission.Centers for Disease Control and Prevention.Manual for the Surveillance of Vaccine-Preventable Diseases.Collier RJ.Studies On The Mode Of Action Of Diphtheria Toxin: I. Phosphorylated Intermediates In Normal And Intoxicated Hela Cells.Journal of Experimental Medicine. 1964;120(6):1007-1018. doi:10.1084/jem.120.6.1007.Pappenheimer AM.The diphtheria bacillus and its toxin: a model system.Journal of Hygiene. 1984;93(03):397-404. doi:10.1017/s0022172400064998.Wilson IE, Menson EN.Cutaneous Diphtheria. New England Journal of Medicine. 2018;378(13):e17. doi:10.1056/nejmicm1701825World Health Organization.Immunization, Vaccines and Biologicals: Diphtheria.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
World Health Organization.Diphtheria reported cases and incidence.Truelove SA, Keegan LT, Moss WJ, et al.Clinical and epidemiological aspects of diphtheria: a systematic review and pooled analysis.Clin Infect Dis.2020 Jul 1;71(1):89–97. doi:10.1093/cid/ciz808Boghani S, Shah HD, Fancy M, et al.A study on the characteristics and outcomes of reported diphtheria patients in a western state in India.Cureus.2023 Mar;15(3):e35769. doi:10.7759/cureus.35769Centers for Disease Control and Prevention.Signs and symptoms: respiratory diphtheria.
World Health Organization.Diphtheria reported cases and incidence.
Truelove SA, Keegan LT, Moss WJ, et al.Clinical and epidemiological aspects of diphtheria: a systematic review and pooled analysis.Clin Infect Dis.2020 Jul 1;71(1):89–97. doi:10.1093/cid/ciz808
Boghani S, Shah HD, Fancy M, et al.A study on the characteristics and outcomes of reported diphtheria patients in a western state in India.Cureus.2023 Mar;15(3):e35769. doi:10.7759/cureus.35769
Centers for Disease Control and Prevention.Signs and symptoms: respiratory diphtheria.
Centers for Disease Control and Prevention.Diphtheria | Causes and Transmission.Centers for Disease Control and Prevention.Manual for the Surveillance of Vaccine-Preventable Diseases.Collier RJ.Studies On The Mode Of Action Of Diphtheria Toxin: I. Phosphorylated Intermediates In Normal And Intoxicated Hela Cells.Journal of Experimental Medicine. 1964;120(6):1007-1018. doi:10.1084/jem.120.6.1007.Pappenheimer AM.The diphtheria bacillus and its toxin: a model system.Journal of Hygiene. 1984;93(03):397-404. doi:10.1017/s0022172400064998.Wilson IE, Menson EN.Cutaneous Diphtheria. New England Journal of Medicine. 2018;378(13):e17. doi:10.1056/nejmicm1701825World Health Organization.Immunization, Vaccines and Biologicals: Diphtheria.
Centers for Disease Control and Prevention.Diphtheria | Causes and Transmission.
Centers for Disease Control and Prevention.Manual for the Surveillance of Vaccine-Preventable Diseases.
Collier RJ.Studies On The Mode Of Action Of Diphtheria Toxin: I. Phosphorylated Intermediates In Normal And Intoxicated Hela Cells.Journal of Experimental Medicine. 1964;120(6):1007-1018. doi:10.1084/jem.120.6.1007.
Pappenheimer AM.The diphtheria bacillus and its toxin: a model system.Journal of Hygiene. 1984;93(03):397-404. doi:10.1017/s0022172400064998.
Wilson IE, Menson EN.Cutaneous Diphtheria. New England Journal of Medicine. 2018;378(13):e17. doi:10.1056/nejmicm1701825
World Health Organization.Immunization, Vaccines and Biologicals: Diphtheria.
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