Durban, South Africa has not seen a case of the serious vaccine-preventable disease, diphtheria in more than 20 years.

South Africa/CIA
South Africa/CIA

The last laboratory-confirmed case of respiratory diphtheria in South Africa occurred in February 2010

However, now the dangerous disease has reappeared and one 8-year-old child has died and two others are seriously ill causing health officials to worry that diphtheria may be resurging in the region.

According to health officials:

An 8-year-old boy was referred from a secondary hospital to Inkosi Albert Luthuli Central Hospital in Durban (KwaZulu-Natal Province) on 15 March 2015 for urgent assessment. There was a three-day history of fever and sore throat with progressive difficulty in swallowing and breathing, and a oneday history of swelling of the neck. Clinically, the child was severely ill; he had a massively swollen anterior neck (‘bull neck’) with marked drooling and respiratory distress. On oropharyngeal examination, massive swelling of the tonsils and a whitish membrane covering the uvula was noted.


The child was diagnosed with  Corynebacterium diphtheriae by culture and was treated with several antibiotics. A positive Elek test was confirmed demonstrating the diphtheria toxin.

Diphtheria antitoxin (DAT) therapy was not warranted in this case, given the duration and stage of illness. Despite an initial improvement and subsequent step-down from the intensive care unit, the child developed unexpected complications and died on 22 March 2015.

Because diphtheria is so rare in South Africa, DAT is not available in South Africa. “There are currently few manufacturers of DAT globally and supplies are limited to few facilities/institutions worldwide. South Africa does not stock any supplies of DAT, and it must be sourced from overseas suppliers on a case-by-case basis”, according to health officials.

This child with diphtheria presented with a characteristic swollen neck, sometimes referred to as “bull neck”.  Image/CDC
This child with diphtheria presented with a characteristic swollen neck, sometimes referred to as “bull neck”. Image/CDC

Diphtheria is a dangerous respiratory disease 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, watery discharge 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.

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 with treatment, 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.