Diphtheria: Throat Membrane, When It Is Urgent

Key takeaways

What separates diphtheria from an ordinary sore throat is not how much it hurts, but three things: a thick greyish-white membrane stuck inside the throat, a neck swollen out and broadened, and difficulty breathing.
According to CDC, the fever in diphtheria is usually only MILD. Waiting for a high fever before being seen is waiting for the wrong sign.
The membrane — in medicine it is called a pseudomembrane — is firmly attached to the lining. According to CDC's materials, trying to pull it off causes bleeding. Do not scrape at it, do not dab medicine on it, do not put leaves on it.
The illness kills by two routes: the membrane thickens and blocks the airway, and the toxin gets into the blood and causes inflammation of the heart muscle, nerve damage and kidney failure. According to CDC, even with treatment about one in ten people dies.
This is an illness that belongs in hospital — the antitoxin exists only there. Buying antibiotics yourself and waiting at home loses time without touching the toxin at all.
If you suspect diphtheria, CALL AHEAD to the medical facility before you set out. Anyone who has been close to the person needs assessing by the health authorities, even with no symptoms yet.
There is a vaccine against this illness; the schedule, the boosters and who should have them are for a doctor or an immunisation service to advise on. Adults may need a booster too — ask.

Diphtheria is rare, but when it happens it is an emergency. What separates it from an ordinary sore throat is not how much it hurts: it is the thick greyish-white membrane in the throat, the swollen neck, and the difficulty breathing. If you see those, go to hospital — and ring ahead before you set out.

Recognising it: three things that do not belong to an ordinary sore throat

According to CDC, symptoms usually appear about two to five days after exposure, and the commonest signs of respiratory diphtheria are: mild fever, sore throat, swollen glands in the neck, marked tiredness, and a pseudomembrane in the nose or the throat. Note the word MILD where the fever is — many people wait for a high fever before agreeing to be seen.

The most distinctive sign is that membrane. According to CDC, a thick grey layer made of dead tissue can form in the nose and the throat — this is the pseudomembrane — and it can make breathing and swallowing very difficult. The membrane thickens over time, so the breathing can get worse.

An ordinary sore throat	Think of diphtheria when
A red throat, perhaps with scattered white spots or streaks of pus on the tonsils	A thick greyish-white membrane in patches, firmly attached, spreading across the throat or the nose
Fever can be high, with clear pain on swallowing	Fever usually mild, but the neck swollen out and broadened, with swollen glands in the neck
Difficulty swallowing because of pain, breathing normal	Hoarseness getting worse, whistling breathing, difficulty breathing

What to do

RING AHEAD to the medical facility before you set out, and say that you suspect diphtheria. According to CDC the bacteria spread in droplets from coughing and sneezing — the place receiving you needs to know in advance so they can arrange where to put you.
Go with the person; do not let someone who is struggling to breathe travel alone. Let them sit upright or lean slightly forward — keep whichever position makes breathing easiest, and do not make them lie flat on their back.
Write down: the day the sore throat started, when you first saw the membrane in the throat, whether there has been fever, whether the voice has been growing hoarse. Find the vaccination records of the person and of the whole household.
Name everyone who has been close to the person in the past few days. According to CDC, close contacts need antibiotics to prevent the illness, need testing, need monitoring, and need vaccinating if they are not fully vaccinated — all of which is for the health authorities to assess.
While you wait to go: a separate airy room, a mask on whoever is caring for them, separate towels, cups, bowls and chopsticks. Give small sips of water if they can still swallow.

What NOT to do

Do NOT buy antibiotics yourself and wait at home. Medicine bought over the counter cannot touch toxin already in the blood and cannot reopen a narrowing airway, but it is quite enough to make you delay the trip to hospital.
Do NOT try to pull, scrape, dab medicine on or put leaves on the membrane: it is firmly attached, pulling at it causes bleeding, and it erases the very thing the doctor needs to look at.
Do NOT wait until tomorrow to see whether it eases. The membrane thickens and the toxin spreads — there is no safe waiting period in this illness.
Do NOT treat having been vaccinated as ruling it out completely. According to CDC, people who are not up to date with their vaccines are at higher risk of severe illness; but being vaccinated and having a sign from the box below still means being seen.
Do NOT let the person go to school, go to work or into any crowded place, even while there is nothing more than a mild sore throat.

Why this is an emergency: the airway and the toxin

Two routes make diphtheria lethal. One is the airway: according to CDC, airway obstruction is the complication that causes death in respiratory diphtheria. The other is the toxin — according to CDC, if it gets into the blood it can destroy tissue in other organs, causing kidney failure, inflammation of the heart muscle and damage to several nerves. Also according to CDC, even with treatment about one in ten people who catch it dies; without treatment it is as many as half.

That is why this illness cannot be treated at home. According to CDC, antitoxin stops the toxin causing further damage, and it is given in hospital alongside antibiotics. According to CDC's materials, inflammation of the heart muscle can appear early in the illness or as late as several weeks afterwards, and nerve damage can also arrive late. The sore throat ending is not the end of it: the follow-up appointment is set by the doctor.

When you must go to hospital

GO TO EMERGENCY CARE or call 115 (the emergency number in Vietnam) NOW if: there is difficulty breathing, whistling breathing, or they have to lean forward to breathe more easily; you can see a greyish-white membrane in the throat; the neck is swollen out and broadened; they cannot even swallow their own saliva and are drooling; they are very hoarse or have lost their voice; the lips or the fingertips are blue; they are drowsy, hard to wake, confused, or having seizures; they are utterly exhausted, pale, with a fast or irregular heartbeat. In a young child, add: refusing the breast, unable to drink anything, the chest drawing in with each breath. — BE SEEN THE SAME DAY, do not wait until tomorrow, if: a sore throat comes with swollen glands in the neck and marked tiredness and no doctor has looked at it; you have just been close to someone diagnosed with diphtheria, even with no symptoms at all; the person is not fully vaccinated against diphtheria; a sore throat comes with a voice growing hoarse. — When you go, RING AHEAD. If you are unsure, ring and ask; with a sign from the group above, go first and ring afterwards.

What belongs at home, and what belongs in hospital

Put plainly: diphtheria is an illness for hospital; no part of the treatment can be done at home. The role of Y Te Xanh (GreenCare) in a case like this sits at the two ends: hearing your account on a video call so we can say clearly whether this case should go in, and nursing care and recovery at home after discharge as prescribed. With a sign in the box above, go in first and call afterwards.

Prevention: according to CDC, vaccination is the best way to prevent diphtheria, and CDC recommends it for every age group, adults included. The schedule, the boosters and who should have them are for a doctor or an immunisation service to advise on — ask when you are seen.

The points in this article follow the public materials of the US CDC on diphtheria; it passes them on and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

CDC — About Diphtheria

Frequently asked questions

How can I tell whether this is diphtheria or just an ordinary sore throat?

Nobody can be certain by eye, not even someone with training — that needs a doctor's examination and a laboratory sample. But three things push the suspicion towards diphtheria: a thick greyish-white membrane in patches in the throat or the nose, a neck swollen out and broadened, and hoarseness along with difficulty breathing. According to CDC, the fever in diphtheria is usually only mild, so do not use “no high fever yet” as a reason to wait. If one of those three is present, be seen now and ring ahead before you set out.

There are white spots in the throat — does that mean it is diphtheria?

Not necessarily. White spots or scattered streaks of pus on the tonsils occur in many ordinary sore throats, both viral and from streptococcus — which is exactly why a laboratory test is needed rather than a guess. What should worry you more than white spots is a thick membrane in patches, greyish-white, firmly attached and spreading, especially alongside a swollen neck, hoarseness or difficulty breathing. If you are not sure which of the two you are looking at, treat it as not sure and be seen the same day.

How does diphtheria spread, and what should the household do?

According to CDC, the bacteria most commonly spread when someone who is ill coughs or sneezes and produces small droplets containing the bacteria; it can also spread by touching open sores on the skin caused by these bacteria. Also according to CDC, close contacts need antibiotics to prevent the illness, need testing, need monitoring, and need vaccinating if their vaccines are not up to date. So the family's job is not to buy preventive medicine themselves, but to give the medical facility a full list of everyone who has been close to the person and then follow their instructions.

Can I just take antibiotics at home, the way I would for a sore throat?

No. According to CDC, respiratory diphtheria is usually treated with diphtheria antitoxin together with antibiotics, and the antitoxin — the thing that stops the toxin causing further damage — exists only in hospital. Antibiotics from a pharmacy cannot neutralise toxin already in the blood, nor reopen an airway that the membrane has narrowed. The real harm of self-treating this illness is not a drug side effect; it is the hours lost.

If I have already been vaccinated, is there anything to worry about?

Vaccination reduces the risk a great deal, and according to CDC people who are not up to date with diphtheria vaccination are at higher risk of severe illness — but that is not a reason to ignore the signs. If there is a membrane in the throat, a swollen neck or difficulty breathing, still be seen, and tell the doctor clearly whether you have been vaccinated and when. A booster for adults is worth asking a doctor or an immunisation service about; the schedule and who needs one are for them to advise, not something to settle from an article.

Out of hospital and the sore throat has gone — is it over?

Not quite, and this is the part most often missed. According to CDC's materials, inflammation of the heart muscle can appear early in the illness or as late as several weeks afterwards, while weakness and paralysis from the toxin tend to appear late — paralysis of the soft palate, making speech sound nasal and causing choking on drinks, is commonest in the third week. So keep the follow-up appointment the doctor gave you even if you feel well, and come back sooner with chest tightness, an irregular heartbeat, tiredness on walking, choking on water, or a change in the voice.