Diphtheria has become rare in Germany. However, it is not completely eradicated, such as smallpox. Mostly it is imported by traveling to Eastern European countries or Third World countries. Diphtheria is a highly contagious bacterial infectious disease that begins with inflammation of the respiratory tract. If not treated in time or left untreated, it can be fatal. It is transmitted by the toxin-forming (toxin-forming) "Corynebacterium diphtheriae" by droplet infection, so when coughing, sneezing and speaking, very rarely also by smear infection. The bacterium causes a local tissue destruction and produces a poison acting on the heart and nervous system (toxin).
Diphtheria in Germany
In Germany, people have not heard of diphtheria for a long time. The last major epidemic (peak between 1942-1945) ended in the 1960s. While 4, 302 people died of diphtheria in the 1950s, there were only 273 in the 1960s. Thanks to the high vaccination rates in childhood, only isolated cases have been reported since 1984.
Due to picking, however, it has appeared more frequently in recent years. It is mostly brought by travelers who have been in Eastern European or Third World countries.
Incubation time of diphtheria
The incubation period is usually two to five days. Those affected are contagious, as long as you can detect the pathogen in secretions and wounds. In the case of untreated, this period is two weeks, the disease is treated with antibiotics, only two to four days.
Symptoms of diphtheria
After an incubation period of one to six days, the disease usually begins in the throat area with sore throat and sore throat, fever and fatigue. On the almonds form the typical white-yellowish deposits, the so-called pseudo-membranes. Characteristic is a sweetish smell, which can already be perceived at some distance.
If the larynx is attacked, barking cough, hoarseness and voicelessness (so-called "real Krupp") and increasing shortness of breath due to swelling of the mucous membranes are added. These swellings are the actual threat to life. Also typical for the laryngeal swelling is a drawing breath (stridor). In infants and toddlers, there is often an attack of the nose (nasal diphtheria) with purulent-bloody cold.
A rarer diphtheria form is skin / wound diphtheria with skin ulcers and injuries. It occurs mainly in the tropics, in western countries especially in certain groups of people, eg the homeless.
With the blood, the toxins can also be transported to organs that are located away from the inflammatory site, such as heart, liver or kidney. This can lead to life-threatening complications. The most important are in addition to the narrowing of the respiratory tract, inflammation of the heart muscle and the nervous system. Less common complications include kidney failure, encephalitis, cerebral infarction and pulmonary embolism.
Diagnosis of diphtheria
Because diphtheria is a very rare disease, many doctors have never seen it before. In the initial stage, it can be easily confused with tonsillitis, bacterial laryngitis, or the pseudo-Krupp. If a person has had contact with people who come from a diphtheria area, or has been there themselves, the doctor must be advised.
Since successful therapy depends on a quick diagnosis, the doctor must first rely on the visible symptoms. In order to secure the diagnosis, a throat swab is made and bacteriologically examined in the laboratory. However, the results of the test are expected at the earliest after 12 hours.
Treatment of diphtheria
The treatment is already initiated on suspicion. In order to neutralize the toxin, an antidote (diphtheria antitoxin) must be given as soon as possible. In addition, antibiotics (penicillin or erythromycin) are used for at least ten days. The patient usually has to maintain strict bed rest for five to six weeks.
Vaccination against diphtheria
The best prevention is vaccination already in infancy. Vaccination Mode: From the beginning of the third month of life three times at intervals of six to eight weeks (depending on the vaccine combination), then the fourth vaccination takes place from the 12th to the 15th month of life. The booster vaccination takes place from the age of 6 and between the ages of 10 and 18.
But even in adulthood a basic immunization (with three vaccinations) or a booster dose can be carried out at any time. However, the disease or vaccine does not leave a lifelong immunity. According to the recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute, the vaccination should be carried out in the case of missing or incomplete primary immunization or if the last booster vaccination was more than 10 years ago.
Vaccination protection when traveling abroad
The vaccination protection among the small and preschool children is very good in Germany with more than 95%. However, the recommended booster doses are often discontinued. And even the adults often do not care about their refreshment every 10 years. Therefore, currently only about one-third of adults have safely protective antibodies. Therefore, vaccinations should be updated before traveling to one of the endemic areas.
Important: With a one-time refresher - in the case of a previous primary vaccination - the complete vaccine protection is restored. If no primary immunization is available, travel to an infected area should begin at the earliest after the second vaccination.