Diphtheria in Children
What is diphtheria?
Diphtheria, a childhood disease that was common in the 1930s, is an acute bacterial disease that can infect the body in two areas:
The throat, nose, and tonsils (respiratory diphtheria)
The skin (skin or cutaneous diphtheria)
A vaccine against diphtheria has made it very rare today in the U.S. and other developed countries.
How is diphtheria transmitted?
The diphtheria bacterium can enter the body through the nose and mouth. However, it can also enter through a break in the skin. It is transmitted from person-to-person in close contact by aerosol route (breathing in respiratory secretions or droplets that contain diphtheria bacteria from an infected person coughing, sneezing, or laughing). After being exposed to the bacteria, it usually takes two to four days for symptoms to develop.
What are the symptoms of diphtheria?
The following are the most common symptoms of diphtheria. However, each child may experience symptoms differently. Symptoms may include:
Respiratory diphtheria. When a child is infected with diphtheria, the bacterium usually multiplies in the throat, leading to respiratory diphtheria. A membrane may form over the throat and tonsils, causing a sore throat. Other common symptoms of respiratory diphtheria may include:
Low grade fever
Stridor (a shrill breathing sound heard during inspiration, or breathing in)
Enlarged lymph glands of the neck
Increased heart rate
Swelling of the palate (the roof of the mouth)
Children may die from asphyxiation when the membrane obstructs breathing. Other complications of respiratory diphtheria are caused by the diphtheria toxin released in the blood, leading to heart failure.
Skin (cutaneous) diphtheria. With this type of diphtheria, the symptoms are usually milder and may include yellow spots or sores (similar to impetigo) on the skin.
The symptoms of diphtheria may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.
How is diphtheria diagnosed?
A doctor can usually diagnose the illness based on clinical examination. A swab culture of the mouth or affected mucous membrane may also be used to confirm the diagnosis.
What is the treatment for diphtheria?
Specific treatment for diphtheria will be determined by your child's doctor based on:
Your child's age, overall health, and medical history
Extent of the condition
Your child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Antibiotics are usually effective in treating respiratory diphtheria before it releases toxins in the blood. An antitoxin can be given in combination with the antibiotics, if diphtheria is suspected. Sometimes a tracheostomy (a breathing tube surgically inserted in the windpipe) is necessary if the child has severe breathing difficulties.
How is diphtheria prevented?
In their first year of life, children in the U.S. are routinely given a triple vaccine (DTaP) that includes diphtheria. Because diphtheria still prevails in underdeveloped countries, the vaccine remains necessary in case of exposure to a carrier visiting from another country.
What are the facts about immunization against diphtheria, tetanus, and pertussis?
Diphtheria, tetanus, and pertussis vaccines prevent these diseases. Most children who receive all of their shots will be protected during childhood. A combination vaccine is given to babies and children and provides protection against all three diseases. There are several types of the vaccine; however, the newer form is the DTaP:
Protects against diphtheria, tetanus, and pertussis.
Is a newer form of the vaccine and is less likely to cause reactions than earlier types given.
When are DTaP vaccines given?
The CDC recommends that children need five DTaP shots. The first three shots are given at 2, 4, and 6 months of age. Between 15 and 18 months of age, the fourth shot is given, and a fifth shot when a child enters school at 4 to 6 years of age. At regular checkups for 11- or 12-year-olds, a preteen should get a booster dose of another form of this vaccine called Tdap. Always consult your child's doctor for advice.
- MMI board-certified, academically-affiliated clinician
- Trevino, Heather M., BSN, RNC