Symptoms of Diphtheria

Symptoms usually begin two to five days after infection, often mildly, which is part of what makes diphtheria dangerous - it can look like an ordinary sore throat at first.

Early symptoms:

• Sore throat and difficulty swallowing
• Low-grade fever (often only mildly raised, unlike the high fever of strep throat)
• Hoarseness of voice
• General weakness and feeling unwell

The hallmark sign is the pseudomembrane: a thick, grey or grey-green coating that spreads over the tonsils, the back of the throat and sometimes the soft palate. Unlike the white patches of a simple tonsillitis, this membrane sticks tightly and bleeds when scraped. It can extend into the airway and block breathing.

Other classic signs:

• Bull neck - dramatic swelling of the neck from enlarged glands and tissue inflammation, a sign of severe disease
• Noisy breathing (stridor) or a barking cough, meaning the membrane is narrowing the airway
• Nasal diphtheria - a blood-stained, foul discharge from one nostril, more common in infants

Get emergency help immediately - call 102 or 112 - if a child with a sore throat has any grey coating in the throat, a visibly swollen neck, noisy breathing, drooling or obvious distress.

Later symptoms come from the toxin, not the throat. As it circulates, it can cause:

• Heart injury (myocarditis), usually one to two weeks in - abnormal heart rhythms, breathlessness, sudden collapse; this is the leading cause of death
• Nerve injury, typically from the third week - paralysis of the soft palate (nasal voice, milk coming out of the nose), blurred vision, and later weakness or numbness in the limbs that can mimic paralysis

Skin diphtheria, seen mostly in tropical settings, causes slow-healing ulcers with a greyish membrane, usually on the legs.

Any suspected case is a medical emergency. Do not wait for all these signs to appear.