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Diphtheria is a serious bacterial infection, usually affecting your nose and throat. The disease, which can be fatal, typically causes a bad sore throat, fever, swollen glands and weakness.

Today, diphtheria is rare and other developed countries thanks to widespread vaccination against the disease. Most are vaccinated against diphtheria as children, with a combination vaccine that protects against two other serious illnesses - tetanus and whooping cough (pertussis).

Doctors treat diphtheria with antibiotics and an antitoxin to fight the infection and the bacteria's toxin. In advanced stages, diphtheria can cause damage to your heart, kidneys and nervous system. Nearly one out of every 10 people who get diphtheria die of it.

Signs and symptoms

Signs and symptoms of diphtheria may include:

  • A sore throat and hoarseness

  • Painful swallowing

  • Swollen glands (enlarged lymph nodes) in your neck

  • Thick, gray membrane covering your throat and tonsils

  • Difficulty breathing or rapid breathing

  • Nasal discharge

  • Fever and chills

  • Malaise

Signs and symptoms usually begin two to five days after a person becomes infected, but they may take as many as 10 days to appear. You may mistake diphtheria in its initial stages for a bad viral sore throat. Other early symptoms include a mild fever and swollen glands in the neck — signs and symptoms of other, much more common types of infection such as strep throat or mononucleosis.

The bacterium that causes diphtheria attacks mucous membranes that line the nose and throat and cover the tonsils. The throat becomes inflamed. The inflammation may spread to the voice box (larynx) and may make your throat swell, narrowing your airway.

The bacteria may produce a toxin that can lead to a thick, gray covering in your nose, throat or airway — a marker of diphtheria that separates it from other respiratory illnesses. This covering is usually fuzzy gray or black and causes breathing difficulties and painful swallowing.

In more advanced stages, a person with diphtheria may have severe difficulty breathing and may show signs of respiratory distress such as rapid breathing, a rapid heartbeat and cold, clammy skin.

Some people become infected with diphtheria-causing bacteria, but they develop only a mild case of the illness and show no signs or symptoms of the disease. They're said to be carriers of the disease, because they may be contagious without showing signs or symptoms of illness.

One sign of diphtheria is swollen glands (enlarged lymph nodes) in the neck....

Skin (cutaneous) diphtheria

Diphtheria occurs in two types. One type involves your nose and throat, and the other involves the skin. A wound infected with bacteria is typically red, painful and swollen. A wound infected with diphtheria-causing bacteria also may have patches of a sticky, gray material.

Although it's more common in tropical climates, cutaneous diphtheria also occurs particularly among people with poor hygiene who live in crowded conditions.

In rare instances, diphtheria affects the eye.


The bacterium Corynebacterium diphtheriae causes diphtheria. Usually the bacteria multiply on or near the surface of the mucous membranes of the throat, where they cause inflammation. Some types of C. diphtheriae release a toxin, a poison, which can damage the heart, the brain and the nerves.

You contract diphtheria by inhaling airborne droplets exhaled by a person with the disease or by a carrier who has no symptoms. Diphtheria easily passes from an infected person to others through sneezing and coughing, especially in crowded living conditions. Diphtheria can also occasionally spread to others who pick up tissues or drinking glasses that have been used by an infected person. Rarely, the bacteria spreads through contaminated household items, such as towels or toys. You can also come in contact with diphtheria-causing bacteria by touching an infected wound.

People who have been infected by the diphtheria bacteria and who haven't been treated can infect nonimmunized people for up to six weeks — even if they don't show any symptoms.

Risk factors

However, diphtheria is still common in developing countries where immunization rates are low. In particular, large outbreaks of diphtheria occurred in the 1990s throughout Russia and the independent countries of the former Soviet Union, resulting in some 5,000 deaths. Control measures have since been implemented, but a risk of diphtheria remains in those areas.

Children under 5 years old and adults over 60 are particularly at risk of contracting diphtheria, as are people living in crowded or unsanitary conditions, undernourished people, children and adults who don't have up-to-date immunizations, and people who have a compromised immune system.


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