A “strange disease” disease outbreak has been reported in Kano, Nigeria. What drew the attention of the public was the report of case fatalities. It was initially reported as 25, then 32, then 38 deaths. Alarm!
The Federal Health Authorities responded by despatching a team. The strange disease is Diphtheria.
The Vanguard Newspapers reported “NO fewer than 38 persons have died out of the 123 diphtheria cases recorded in Nigeria so far, the Nigeria Centre for Disease Control, NCDC, has said.
The states currently facing the disease caused by serious infection of the nose and throat that is easily preventable by vaccine,are Kano, Lagos, Yobe and Osun, respectively.
The nation’s disease control and prevention agency,which disclosed this at a ministerial press briefing, organised by the Federal Ministry of Health,said more cases of the disease were being expected in days ahead,as it spreads to other places”.
CAUSES
The disease was first described in the 5th century BC by Hippocrates.
Diphtheria is a highly contagious bacterial infection caused by Corynebacterium Diphtheriae. Majority of cases are asymptomatic or have a mild clinical course, but in some outbreaks more than 10% of those diagnosed with the disease may die.
Corynebacterium Diphtheriae produces a toxin that is responsible for severity of the disease called Diphtheria.
The World Health Organisation states that throughout history, Diphtheria has been one of most feared childhood diseases, characterized by devastating outbreaks. The most important virulence factor of C. diphtheriae is the exotoxin. In addition to this exotoxin, cell-wall components such as the O- and K-antigens are important in the pathogenesis of the disease. Humans are the only natural host for C. diphtheriae.
Transmission occurs through droplets and close physical contact.
- respiratory droplets from coughing or sneezing
- secretions from the nose and throat, such as mucus and saliva
- infected skin lesions
The infection can transmit from a person with the infection to any mucous membrane in another person.
Although most infections are asymptomatic or run a relatively mild clinical course, many patients succumb to airway obstruction caused by laryngeal diphtheria or toxic myocarditis.
SYMPTOMS
Diphtheria disease has two main clinical sub-types, respiratory and cutaneous.
The bacteria most commonly infect the respiratory system where it attaches to the lining of the system. It can cause:
- Weakness
- Sore throat
- Mild fever
- Swollen glands in the neck
The bacteria make a toxin that kills healthy tissues in the respiratory system. The dead tissue forms a thick, gray coating that can build up in the throat or nose thereby causing respiratory difficulty as well as difficulty in swallowing. Medical experts call this thick, gray coating a “pseudomembrane.” There may be hoarseness of voice with a loud barking cough; and the infection of neck lymph glands result in the swelling of the neck thereby resulting in the classical Bull neck picture.
Additionally, the toxin produced by the bacterium can cause heart, nerve, and kidney damage.
A person can develop myocarditis, which is the inflammation of the heart muscles, and neuropathy. Neuropathy is nerve damage that can result in numbness, muscle weakness, pain, and tingling sensations.
Other variants of C. diphtheriae do not produce the toxin. This results in less disease, typically causing a sore throat and, in rare cases, pharyngitis.
In some cases, variants can also result in bacteremia and endocarditis. Bacteremia is the presence of bacteria in the blood. Endocarditis is the inflammation, and sometimes the infection, of the inner lining of the heart chambers and valves. In these instances the clinical illness is marked and the patient is grossly ill in tandem with the level of functional disruption of the affected body system.
The bacteria can also infect the skin, causing open sores or ulcers. However, diphtheria skin infections rarely result in severe disease.
DIAGNOSIS AND TREATMENT
Diagnosis is based on symptoms and a lab test. A swab is used to take a sample from the back of the throat or from a sore. This swab then goes to a lab for diagnosis.
Diphtheria treatment begins immediately — sometimes even before the lab test results are confirmed. Diphtheria antitoxin is given to stop damage to organs. Appropriate antibiotics are prescribed to fight the infection. Supportive treatment are given as indicated by the individual cases.
People with diphtheria are kept in isolation to prevent others from becoming infected. An infected person is no longer contagious around 48 hours after taking antibiotics. Upon recovery, one gets a vaccine to prevent future infections.
PREVENTION
I will place here the preventive protocol in the South African healthcare system because I consider it broad enough as well as easy to implement.
- “People with diphtheria need to be kept in isolation until they are certified to be free of the disease by SA Health’s Communicable Disease Control Branch (CDCB).
- Contacts of people with diphtheria need to be investigated for the disease, receive antibiotics and receive vaccination if required. A contact is any person who has been close enough to an infected person to be at risk of having acquired the infection from that person.
- Family or household contact with diphtheria should be excluded from childcare, preschool, school and work until cleared to return by the CDCB.
- Contacts whose work involves food handling or caring for unimmunised children are excluded from work until they certified to be free of the disease by the CDCB.
- Widespread immunisation against diphtheria is the only effective control. The diphtheria vaccine is administered through the National Immunisation Program. The first dose of diphtheria vaccine, in combination with other vaccines, is now recommended to be given at 6 weeks of age. For adolescents and adults, the combined diphtheria, tetanus, pertussis vaccine is preferred, if not given previously, as it provides additional protection against whooping cough (pertussis).
- People travelling to countries where diphtheria is common should have received a full course of immunisation and consider a booster dose of vaccine in discussion with their doctor”.
You may also like to read my earlier blogs on Cholera, Typhoid Fever, Climate Change, Malaria, Genital Herpes, Head Lice, Scabies, Telemedicine, Success Mindset, Conjuctivitis, Ebola Virus Disease, Hepatitis B, Measles, Ear infecion, Meningitis., Lassa fever, workplace violence, and Digital Healthcare
We encourage active participation in community protection and personalized care.
