Diphtheria in the current era of universal vaccination

Diphtheria is a vaccination preventable infectious disease with local and systemic complications predominantly affecting upper respiratory tract in younger (<5-year age) children. Its virulence is due to its ability to produce toxin which can cause fatal complications such as myocarditis and permanent damage in form of peripheral neuropathy. Diagnosis of diphtheria is primarily clinical supported by demonstration of toxin producing bacteria by culture. Early diagnosis and management with diphtheria anti-toxin can prevent mortality and morbidity. Here we present a case of 16-year-old boy managed with azithromycin, amoxycillin-clavulanic acid and diphtheria anti-toxin with complete recovery.This case brings out the importance of recognising the re-emergence of diphtheria in older age groups. Lacunae in the universal immunisation process, rumours on vaccination effects and poor living conditions for refugee population are likely reasons in Asia and Europe. Universal immunisation, early diagnosis, prophylaxis and adequate supportive care are measures to prevent it.