Diphtheria: Clinical Manifestations, Diagnosis, and Role of ImmunizationIn Prevention

Diphtheria outbreaks, though very rare, still occur worldwide, in the developed and developing countries. Diphtheria has high mortality in non-vaccinated populations. Corynebacterium diphtheria produce very potent toxin when infected with a bacteriophage that migrates the toxin-encoding genetic elements into bacteria. The R domain binds to a cell surface receptor, permitting the toxin to enter the cell by receptor mediated endocytosis.The toxin elaborated locally induces a dense necrotic coagulum composed of fibrin,leukocytosis,dead respiratory epithelial cells, leading to white-gray brown pseudomembrane.,a common cause of death is suffocation after aspiration of membrane. Complications may include myocarditis, inflammation of nerves, kidney problems, and bleeding due to low blood platelets, Diagnosis by isolation of Corynebacterium diphtheria from gram stain or throat culture, or histopathogic diagnosis. Treatment with metronidazole, erythromycin, procaine penicillin G orally or by injection or rifampin or clindamycin for patients with allergies to penicillin or erythromycin.Prevention by immunization, diphtheria vaccine is on the World Health Organization list of essential medicines, most important needed in the basic health system. Recommendations from the Advisory Committee on Immunization Practices, 2006-2008, published by CDC are useful.Anti-vaccination groups are doing more harm than good to the society.