Diphtheria: The Strangling Angel of (Older) Children

Diphtheria, a dreaded disease of childhood which had undergone a dramatic decline in incidence and mortality in the twentieth century as a result of immunisation and effective treatment, has recently been enjoying a minor resurgence especially amongst older children and adolescents, mainly due to waning immunity. Caused by toxigenic Corynebacteria, it is spread by droplet infection from acute cases as well as asymptomatic carriers. The clinical manifestations result from the local infection especially in the upper airways as well as the potent exotoxin which can have long term effect on the heart and nervous system. Management of diphtheria requires administration of antibiotics and anti-toxin as well as effective supportive care for the airway management, myocarditis and neuropathy. Universal immunisation with the five doses of Diphtheria, Pertussis, Tetanus toxoid (DPT) vaccine needs to be augmented by Tetanus, diphtheria, acellular Pertussis (TdaP) at the of 10-12 years for controlling the rising incidence of diphtheria, especially in India.