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: