Related concepts:

Corynebacterium diphtheriae, C. diphtheriae, The Strangling Angel of Children, Bull Neck

Introduction to diphtheria:

Once called “the strangling angel of children,” diphtheria was a dreaded common childhood illness for more than 2,000 years before modern medicine made it a rarity. In areas where diphtheria vaccination is uncommon, diphtheria would meet the criteria to be a powerful weapon of bioterrorism. It has many similarities to anthrax.

What is diphtheria?

Diphtheria is a bacterial illness that has been known to plague children since the 4th century B.C. The bacteria can cause inhalational or cutaneous forms of the disease. They can also enter the body through the eyes, ears, or genitals.

The bacteria multiply and produce a powerful toxin that causes tissue death in the immediate vicinity. In some cases the toxin may be pumped throughout the body in the blood vessels or lymph system.

Behring’s discovery of antitoxin, a little more than a hundred years ago, was one of the most dramatic successes of any single treatment in history. In the country of Germany alone, it saved 45,000 lives every year.

Who gets diphtheria?

Diphtheria is most common in those who are not immunized or who are partially immunized. In the United States, most diphtheria occurs in adults, because almost half of the adults are not adequately immunized.

Native Americans are especially susceptible to diphtheria.

Diphtheria remains common in many areas of Africa, Asia, and South America. After the break-up of the former Soviet Union, deadly epidemics of diphtheria began ravaging many of new independent states and advancing on into Eastern Europe. In some areas, the fatality rate among those infected has been higher than 20 percent.

Epidemics are most common in areas that have crowded living conditions. They tend to occur in the autumn and winter, but can happen at any time especially in this age of global air travel.

Diphtheria causes disease only in humans.

What are the symptoms of diphtheria?

The symptoms depend on where in the body the bacteria entered and on whether or not diphtheria toxin has made it into the blood stream.

If the diphtheria is limited to the nose, it begins as a common cold. Soon, the nasal discharge turns to a foul-smelling pus that can erode the skin of the nose and upper lip. This form is most often seen in young babies.

If the bacteria land in the back of the throat (the most common spot), diphtheria causes a more serious disease. For the first day or two, it seems like a normal sore throat, with a low-grade fever. Treatment at this stage would be effective.

Then a white or gray membrane typically appears in the back of the throat. It may cover the tonsils, the roof of the mouth, and the sides of the throat. It may envelop the uvula hanging in the back of the throat. The membrane may extend down the throat to the larynx or even the windpipe (trachea). Any attempt to remove this membrane results in a bloody mess.

Then the swelling starts. I’ve heard the disease called “bull neck” because the soft tissues of the neck can fill with swelling.