After several years of being diphtheria-free, the dangerous toxigenic disease has returned to the Kerala State city of Malappuram, which has taken the life of at least one child.

The Times of India reported recently a child at an orphanage was clinically diagnosed with diphtheretic myocarditis and died late last week. The report notes:

India Image/CIA

Two other students of the same orphanage, including a Bengal native are also under the treatment for diphtheria in KMCH and more than fifteen children of the orphanage, who have exhibited symptoms of diphtheria are under the observation of Malappuram district medical authorities. The authorities have already confirmed that these children were not immunized.

This has prompted the state government to send an expert medical team to Malappuram this weekend who requested the state to ensure all children under the age of 16 are vaccinated for diphtheria.

They also maintained that the diphtheria spread in Malappuram is under control.

Diphtheria is caused by a potent toxin produced by certain strains of the bacterium, Corynebacterium diphtheriae.

Diphtheria is extremely contagious through coughing or sneezing. Risk factors include crowding, poor hygiene, and lack of immunization.

Symptoms usually appear within a week of infection. This infection is characterized by a sore throat, coughing and fever very similar to many common diseases like strep throat. Additional symptoms may be bloody, waterydischarge from the nose and rapid breathing. However, a presumptive diagnosis can be made by observing a characteristic thick grayish patch (membrane) found in the throat. In more severe cases, neck swelling and airway obstruction may be observed.

In the tropics, cutaneous and wound diphtheria is much more common and can be a source of transmission.

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The real serious danger is when the toxin that is produced by the bacterium gets into the bloodstream and spreads to organs like the heart and nervous system. Myocarditis, congestive heart failure and neurological illnesses of paralysis that mimic Guillain-Barre syndrome are most severe. Even withtreatment, fatalities are still seen in up to 10% of cases.

Diphtheria can be treated and cured successfully with antitoxin and antibiotics if started early enough.

The prevention of diphtheria is through vaccination. Immunity does wane after a period of time and revaccination should be done at least every 10 years.

Robert Herriman is a microbiologist and the Editor-in-Chief of Outbreak News Today

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