What is it about ?
Diphtheria or croup is an extremely rare, but serious and contagious infectious disease. It is caused by bacteria: most often Corynebacterium diphteriae, even if Corynebacterium ulcerans meets regularly nowadays. These bacteria produce toxins that damage the upper respiratory tract and sometimes also the heart, nervous system and kidneys. Infection with the bacteria C. diphteriae It is spread from person to person through saliva, nasal secretions or contact with a wound of an infected person. For its part, the bacteria C. ulcerans is transmitted mainly from animals to humans, the main animals responsible being cattle and horses.
What is its frequency?
In the past, croup caused many deaths among children and the elderly. But a vaccine was discovered in 1923 and the Belgian government launched a vaccination program against diphtheria in 1959. Since then the disease has become rare in our country. In spite of everything, we must remain vigilant. In 2016, an unvaccinated young child living in Belgium died from diphtheria. Between 2009 and 2014, 142 cases were reported in Europe, most of them in Belarus, Russia, Ukraine and Latvia. When the disease does occur, it often strikes as an epidemic among unvaccinated people. More than 85% of the cases recorded in the world concern Southeast Asia, the two countries most affected being India and Indonesia.
How to recognize it?
If you have contracted diphtheria, symptoms will appear between 1 to 7 days after contact with a sick patient. The time between contamination and the appearance of the first signs of the disease is called the incubation period.
During the first phase of the disease, symptoms are mostly local, usually in the throat (diphtheria angina). The tonsils and mucous membranes of the throat swell and become covered with gray or black sticky membranes. The swelling may be such in small children that they have difficulty breathing (laryngeal diphtheria or croup). When they inhale, they produce a characteristic hissing sound. In addition to a sore throat, there may also be fever (usually below 39 ° C), nausea, vomiting, bloody mucus coming out of the nose (nasal diphtheria) and skin ulcers (cutaneous diphtheria). .
The toxin produced by the bacteria can also cause other physical problems after 1 to 2 weeks: a inflammation of the heart, heart rhythm disturbances and nerve inflammation (neuritis) associated with paralysis. These complications can be fatal: 3 to 12% of unvaccinated people who contract the disease die from it. Those who survive the severe complications of croup usually recover without sequelae. In cases where sequelae persist, the most common isheart failure. Some people are infected with the diphtheria bacteria, but do not get sick. These are asymptomatic carriers, but they can pass the infection on to others.
How is the diagnosis made?
If the doctor suspects diphtheria, he will do a smear of the nose and throat and send it to the laboratory. The sample will be cultured there and analyzed to identify the presence of the pathogenic bacteria.
What can you do ?
Vaccinated people can still be infected, but they are no longer at risk of developing diphtheria angina or croup. Cutaneous diphtheria remains possible, mainly among the homeless or in tropical regions. Among those vaccinated, the number of deaths is very low. So make sure you are in order for vaccination. This is all you can do to protect yourself. For the rest, it is important to have your children vaccinated according to the recommended schedule. Vaccination is automatically included in the ONE program, but it can also be administered by the general practitioner. The government makes vaccines available free of charge. From the age of 30, a booster vaccine should be administered every 10 years. The vaccine used in Belgium for this purpose is a combined vaccine against diphtheria, pertussis and tetanus. If you have never been vaccinated and are going to an area where diphtheria is still prevalent, you should receive the 3 injections that make up the complete regimen to be protected against diphtheria.
What can your doctor do?
Your doctor will assess whether it is diphtheria or not. This will be done by asking if you have been to a country where diphtheria is very common 1 to 7 days before the onset of symptoms. If you are very ill, it is important that you are taken to hospital quickly for treatment and isolation. You will be given antibiotics by infusion there. In addition, we will make sure that the airways remain clear and that you do not risk choking. If necessary, you will be put on oxygen. In addition to an antidote, you may also be given cortisone and heart medication. Isolation is essential to prevent the spread of the disease. Discharge from the hospital will only be considered after at least two checks indicating the disappearance of pathogenic bacteria from the mucous membranes of your throat and nose.
Given the risks, people who have been in close contact with you will be tested. If they are carriers of the bacteria, they will automatically be treated with antibiotics, even if they have no symptoms. This treatment does not require hospitalization.
Doctors have an obligation to report all cases of diphtheria to the competent authorities.
Find out more
- Diphtheria – Vaccination-Info.be
- For the vaccine, I hesitate … Is it serious doctor? – Health question
- The vaccine explained to children – Plaster
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