WEBVTT - Ep 16 Scratch and Sniff Diphtheria Membrane 0:00:00.840 --> 0:00:04.760 The disease began in various ways, but commonly with chills 0:00:04.800 --> 0:00:08.000 and heats, pressure and pain in the head, soreness of 0:00:08.080 --> 0:00:13.080 throat and hoarseness, some cough, sickness of the stomach, frequent 0:00:13.200 --> 0:00:18.000 vomiting and purging. These symptoms occurred more frequently in children 0:00:18.079 --> 0:00:21.200 and were then very severe in adults. They were less 0:00:21.239 --> 0:00:27.280 emphatically expressed, commonly on the uvula, tonsils, vellum platinum, and 0:00:27.400 --> 0:00:31.240 back part of the pharynx, several whitish or ash colored 0:00:31.280 --> 0:00:35.880 spots appeared scattered up and down, which oftentimes increased very fast, 0:00:36.080 --> 0:00:39.599 soon covering one or both of the tonsils. These eventually 0:00:39.640 --> 0:00:44.240 proved to be the sluffs of superficial ulcers. The tongue, 0:00:44.280 --> 0:00:47.400 at this time, though only white and moist at the top, 0:00:47.640 --> 0:00:50.479 was very foul at the root and covered with a 0:00:50.600 --> 0:00:56.440 thick yellowish or brown coat. The breath also now began 0:00:56.560 --> 0:01:00.880 to be very nauseous. The offensive smell increased hourly, and 0:01:00.960 --> 0:01:04.880 in some instances became quite intolerable even to the patients themselves. 0:01:05.360 --> 0:01:07.479 By the second or third day, the sleuths were much 0:01:07.600 --> 0:01:10.880 enlarged and of a darker color, and the surrounding parts 0:01:10.959 --> 0:01:14.959 tended much more to a livid hue. The breathing became 0:01:15.000 --> 0:01:18.120 more difficult, with a kind of rattling stirter, as if 0:01:18.120 --> 0:01:22.600 the patient was actually strangling, the voice being exceedingly hoarse 0:01:22.800 --> 0:01:49.560 and hollow. 0:01:56.040 --> 0:01:56.440 Wow. 0:01:56.880 --> 0:02:00.960 Yeah, it's pretty intense. So is the sound like to you? 0:02:01.560 --> 0:02:04.520 Sounds like diphtheria. 0:02:04.360 --> 0:02:08.160 That's right, the topic of today's episode. 0:02:08.360 --> 0:02:13.360 All right, Hi, I'm erin Welsh and I'm erin Almond Updyke, and. 0:02:13.280 --> 0:02:18.560 You are listening to this podcast Will Kill You Dip 0:02:18.639 --> 0:02:19.360 Theory Edition. 0:02:19.800 --> 0:02:22.800 Yep, So I'm really excited. 0:02:22.960 --> 0:02:24.200 I am really thrilled. 0:02:24.240 --> 0:02:26.280 You've been talking about this one for a while now, 0:02:26.520 --> 0:02:26.840 I know. 0:02:26.919 --> 0:02:30.000 And there's also there's been something in my part that 0:02:30.080 --> 0:02:33.760 I have been dying to tell you about, and I've 0:02:33.760 --> 0:02:35.240 been keeping it secret and. 0:02:35.520 --> 0:02:38.960 Keeping it safe, keeping it secret, keeping it safe. I 0:02:39.000 --> 0:02:40.760 can't wait to hear it good. 0:02:42.120 --> 0:02:45.560 I guess though, that we should start first. 0:02:45.480 --> 0:02:47.800 With our quarantines. 0:02:48.520 --> 0:02:50.360 So what do we have to drink tonight? 0:02:50.480 --> 0:02:55.240 Tonight we're drinking the Strangling Angel. Oh that sounds menacing. 0:02:55.400 --> 0:02:59.600 It's a little bit, but it's also quite delicious. It's 0:02:59.600 --> 0:03:02.160 actually quite good. It's a kind of a variation on 0:03:02.200 --> 0:03:04.840 a penicillin which who knew that was a real cocktail. 0:03:05.000 --> 0:03:07.720 Maybe we should have We do, now we do. 0:03:08.320 --> 0:03:14.960 It's got what whiskey, lemon bourbon rye and lemon juice, 0:03:15.320 --> 0:03:21.720 ginger liqueur, and a little maple syrup. And in addition 0:03:21.760 --> 0:03:25.120 to our quarantinies, this episode will also be making what 0:03:25.160 --> 0:03:29.400 are we calling them, plus ey burritos, Yeah, plussy burritos. Guys, 0:03:29.480 --> 0:03:31.720 come up with a better name for that. And we'll 0:03:31.720 --> 0:03:34.400 be posting the full recipe for the quarantinies and the 0:03:34.400 --> 0:03:41.000 plussy bo ritos. We'll be posting those non alcoholic versions 0:03:41.040 --> 0:03:44.880 online as well on all of our social media channels. 0:03:44.880 --> 0:03:47.960 You guys can find those and drink along with us. 0:03:48.240 --> 0:03:52.080 Yeah. So, so now that that's out of the way. 0:03:52.080 --> 0:04:21.479 Let's get started. So, diphtheria is caused by a bacterium 0:04:21.560 --> 0:04:25.880 known as Karini bacterium diphtheria. And I did, in fact 0:04:25.960 --> 0:04:28.120 look up how to pronounce that. Oh good, that's like 0:04:28.160 --> 0:04:30.480 the first time for me. Ever, Well, it's a it's 0:04:30.480 --> 0:04:32.520 a strange spelling. Yeah, I looked at it and I 0:04:32.600 --> 0:04:37.000 was like, I'm gonna look this one up. Karini Bacterium diphtheria. 0:04:37.200 --> 0:04:40.080 It's a gram positive rod so it's shaped like a 0:04:40.080 --> 0:04:42.600 little tube, not a. 0:04:42.560 --> 0:04:44.000 Ball, like a little good and plenty. 0:04:44.080 --> 0:04:48.200 Yeah, good and plenty. That's a great one actually. And 0:04:48.839 --> 0:04:52.240 one thing that's interesting about this disease is that the 0:04:52.279 --> 0:04:56.080 disease that we associate with diphtheria is not caused by 0:04:56.120 --> 0:05:00.040 the bacterium itself. It's caused by a toxin. And this 0:05:00.160 --> 0:05:04.479 toxin is produced by a virus, a bacteria phase that 0:05:04.640 --> 0:05:08.680 actually infects the bacterium. What. Yeah, So a lot of 0:05:08.680 --> 0:05:11.680 the toxins we talked about toxins in the MRSA episode, 0:05:12.040 --> 0:05:14.800 A lot of the toxins that bacteria that quote unquote 0:05:14.800 --> 0:05:18.039 bacteria produce are actually produced by viruses. So it's this 0:05:18.080 --> 0:05:26.360 little mutualism or yeah, commensalism I haven't really seen. I mean, presumably, 0:05:27.000 --> 0:05:28.919 at least in the case of humans, which are the 0:05:29.160 --> 0:05:33.600 pretty much only reservoir for diphtheria, you might be getting 0:05:33.960 --> 0:05:37.279 more sick. So I guess if that's beneficial, then you 0:05:37.320 --> 0:05:39.720 could call it a mutualism. But I don't know if 0:05:39.720 --> 0:05:42.560 that actually, like, I don't know that the bacteria survives 0:05:42.600 --> 0:05:45.159 any better with this bacteria phase or not. Okay, so 0:05:46.279 --> 0:05:48.040 maybe someone else who knows can tell us. 0:05:48.080 --> 0:05:49.640 That's really interesting though, yeah. 0:05:49.480 --> 0:05:53.240 So it's not the bacterium itself. So there are strains 0:05:53.279 --> 0:05:55.960 out there that are what are called non toxogenic strains. 0:05:56.279 --> 0:05:59.520 Those can still infect you. They can still cause some disease, 0:05:59.520 --> 0:06:02.400 but they only don't cause as severe of disease and 0:06:02.480 --> 0:06:06.240 not the type of disease that we might associate with diphtheria. Okay, 0:06:07.440 --> 0:06:12.080 so ready, uh huh, so diphtheria, and from now on, 0:06:12.120 --> 0:06:14.120 whenever I talk about it, will just assume that it's 0:06:14.160 --> 0:06:17.279 a toxogenic strain of the bacterium. So it's making toxin, 0:06:17.440 --> 0:06:21.360 it's trying to kill you, gotcha. It's transmitted via aerosols, 0:06:21.360 --> 0:06:23.839 so coughing, spitting, sneezing, et cetera. 0:06:24.360 --> 0:06:24.720 Lovely. 0:06:25.000 --> 0:06:28.880 The incubation period is two to five days, so if 0:06:28.880 --> 0:06:31.600 I cough on you two to five days later, you're 0:06:31.640 --> 0:06:37.320 going to be getting sick most likely. And historically not 0:06:37.400 --> 0:06:38.839 to step on your toes or anything. 0:06:39.960 --> 0:06:41.560 No worse my toes are saying. 0:06:41.720 --> 0:06:45.760 But historically diphtheria has been a disease of childhood, very 0:06:45.800 --> 0:06:50.200 specifically of childhood, meaning babies didn't usually get it and 0:06:50.279 --> 0:06:52.640 adults didn't usually get it. Do you have a guess 0:06:52.680 --> 0:06:53.320 as to why? 0:06:54.240 --> 0:06:56.960 Hmmm, I'm guessing that in babies it would have to 0:06:57.000 --> 0:06:59.400 do with maternal antibodies from breast milk. 0:07:00.160 --> 0:07:00.800 Nailed it. 0:07:01.000 --> 0:07:05.320 And adults, I would assume that most of the adults 0:07:05.360 --> 0:07:09.080 would have had been asymptomatic and been exposed. 0:07:08.640 --> 0:07:11.240 To it and then developed immunity or just had it 0:07:11.280 --> 0:07:14.840 and survived it. Yeah, exactly, So they definitely were exposed 0:07:14.920 --> 0:07:17.000 and either got the infection and survived it, or they 0:07:17.000 --> 0:07:22.320 were asymptomatic carriers, which is very common in diphtheria, meaning 0:07:22.720 --> 0:07:25.200 just because someone looks healthy doesn't mean they are. 0:07:25.960 --> 0:07:26.680 Dun't dun dull. 0:07:28.720 --> 0:07:32.400 All right, So let's get into what actually happens when 0:07:32.400 --> 0:07:36.320 you get infected. Okay, So the first place that diptheria 0:07:36.400 --> 0:07:39.680 tends to colonize is your naso pharynx, so that means 0:07:39.680 --> 0:07:40.960 your nose and your throat. 0:07:41.160 --> 0:07:41.480 Okay. 0:07:42.280 --> 0:07:46.960 It is possible to only infect your nasal passages, in 0:07:47.000 --> 0:07:49.560 which case the disease that it causes is more like 0:07:49.640 --> 0:07:52.360 the common cold. It's not as severe. You get a 0:07:52.400 --> 0:07:54.800 lot of bloody mucus and puss coming out of your nose. 0:07:57.160 --> 0:07:59.080 Yeah, that's pretty gross. 0:07:58.920 --> 0:08:01.160 But it's less common. More commonly, it's actually going to 0:08:01.240 --> 0:08:02.679 kind of go straight to the back of your throat, 0:08:02.720 --> 0:08:07.480 and that's its sort of favorite spot to infect. So 0:08:07.800 --> 0:08:11.440 the progression of the disease I saw described as insidious, 0:08:12.360 --> 0:08:15.480 which is not a good No. You don't want something 0:08:15.480 --> 0:08:16.360 in your body to. 0:08:16.320 --> 0:08:19.400 Be negative connotation to that word canny negative. 0:08:21.000 --> 0:08:24.840 So here's how it begins. You start with a fever, 0:08:25.720 --> 0:08:28.080 but not like a crazy high fever, so maybe not 0:08:28.120 --> 0:08:29.680 one that makes you go, I need to get to 0:08:29.720 --> 0:08:32.560 the doctor. Right, you're running like one hundred maybe one 0:08:32.600 --> 0:08:37.080 hundred and one max. So you're feeling crappy, You're feeling tired, 0:08:37.760 --> 0:08:41.480 maybe weak, You've got just generally like malaise. You're like, God, 0:08:41.480 --> 0:08:45.400 I'm coming down with something. Maybe it's the flu, I 0:08:45.400 --> 0:08:50.280 don't know. And then your throat, like it really hurts. 0:08:50.360 --> 0:08:53.160 It hurts pretty bad. So then because you're feeling crappy 0:08:53.200 --> 0:08:56.000 and your throat hurts, you've got anorexia. Right, You don't 0:08:56.000 --> 0:08:58.000 want to eat anything, you don't want to swallow, and 0:08:58.040 --> 0:08:59.360 you just feel bad. 0:08:59.440 --> 0:09:02.560 So is just just means not wanting to eat anything? 0:09:02.640 --> 0:09:06.240 Yeah, exactly, you're not eating, and so you're like, Wow, 0:09:06.280 --> 0:09:09.680 maybe it's strub throat. Maybe that is that what I've got. 0:09:09.760 --> 0:09:12.640 I don't know. But then within two to three days 0:09:13.200 --> 0:09:16.920 you're not getting better. And at the back of your 0:09:16.960 --> 0:09:22.960 throat you'll see this thing and it starts out white, 0:09:23.440 --> 0:09:25.719 just sort of attached to like the roof of your 0:09:25.760 --> 0:09:30.200 mouth and like back near your tonsils, and then it 0:09:30.240 --> 0:09:31.120 gets bigger. 0:09:31.240 --> 0:09:32.120 I don't like this. 0:09:32.320 --> 0:09:36.240 It just keeps getting bigger and it starts out white, 0:09:36.800 --> 0:09:40.400 but as it grows to cover your entire soft palate, 0:09:40.679 --> 0:09:48.040 it can turn green or gray or black, god black. Yeah, 0:09:48.080 --> 0:09:51.719 And it's not really puss because puss you can kind 0:09:51.760 --> 0:09:54.800 of spit that out right, like mucus. You could sort 0:09:54.840 --> 0:09:58.280 of put your finger back there and scrape it off. Oh, 0:09:58.320 --> 0:10:00.320 you can't do that with this because it's stuck gone. 0:10:00.360 --> 0:10:03.240 And if you try, like if you really really try 0:10:03.280 --> 0:10:05.720 in there, you're just gonna cause yourself to bleed a 0:10:05.760 --> 0:10:10.640 lot because it's stuck on there. Oh. And at this point, 0:10:11.080 --> 0:10:13.400 it might be getting kind of hard for you to breathe. 0:10:13.559 --> 0:10:15.880 So if you finally were to go to the doctor 0:10:16.000 --> 0:10:19.319 and they put a stethoscope up to you, they'd hear 0:10:19.320 --> 0:10:21.400 a sound something like this. 0:10:28.440 --> 0:10:33.720 Was that good? Oh my god, I am feeling like 0:10:34.000 --> 0:10:37.240 the need to breathe very deeply. This is I'm feeling 0:10:37.320 --> 0:10:38.240 very stressed right now. 0:10:38.320 --> 0:10:41.000 Aaron's really I've made her very anxious. 0:10:41.040 --> 0:10:42.600 I am highly anxious. 0:10:43.320 --> 0:10:46.439 So that sound that I mimicked, I'm pretty proud of 0:10:46.480 --> 0:10:49.000 myself for that I practiced. It was excellent, thank you. 0:10:49.120 --> 0:10:52.720 It's called streider. It's not a good sign. It's a 0:10:52.800 --> 0:10:55.880 very very bad sign. So at this point, if you've 0:10:55.880 --> 0:10:59.840 progressed this far, you have two fates. Either you recover 0:11:00.080 --> 0:11:03.120 somehow or you die. It's pretty much a fifty to 0:11:03.160 --> 0:11:05.160 fifty chance the end. 0:11:05.320 --> 0:11:10.600 Just kidding, I'm just letting this sink in because I 0:11:10.679 --> 0:11:15.760 have read obviously, like it's come across my research about 0:11:15.840 --> 0:11:21.240 sort of the membrane and the dying. But it's it's. 0:11:21.000 --> 0:11:23.079 Ugh when you hear the whole When. 0:11:22.880 --> 0:11:25.160 You hear the whole thing, and you just imagine this. Well, 0:11:25.200 --> 0:11:28.080 first of all, I'm going to be terrified for every 0:11:28.080 --> 0:11:29.800 time I get a cold from here on out, I'm 0:11:29.800 --> 0:11:32.360 gonna be constantly checking the back of my throat. 0:11:32.040 --> 0:11:34.720 You don't need to do that, You've been vaccinated here. 0:11:37.120 --> 0:11:42.040 Some of us are just nervous by nature, yeah, not 0:11:42.160 --> 0:11:43.000 naughty by nature. 0:11:46.200 --> 0:11:49.800 So yeah, So this thing that's on the back of 0:11:49.800 --> 0:11:53.040 your throat is called a pseudo membrane. I don't know 0:11:53.040 --> 0:11:54.640 why they call it that, but that's what they call it. 0:11:54.640 --> 0:11:56.880 It seems like a pretty real membrane and not a 0:11:56.920 --> 0:12:00.400 pseudo one, but that's what they're calling it. And basically 0:12:00.440 --> 0:12:03.400 what happens, and one of the very common ways that 0:12:03.440 --> 0:12:06.040 you end up dying from diphtheria is that this thing 0:12:06.080 --> 0:12:09.439 grows so large and then your surrounding lymph nodes will 0:12:09.440 --> 0:12:12.880 also swell up that basically your airway is blocked off 0:12:12.920 --> 0:12:17.040 and you suffocate. Oh now that's not the only way 0:12:17.160 --> 0:12:20.680 that you can die from diptheria. But before we talk 0:12:20.720 --> 0:12:22.559 about the other ways that you can die, will take 0:12:22.559 --> 0:12:24.559 a step back and let's talk about what's actually going 0:12:24.600 --> 0:12:29.720 on inside your body. Why are these specific symptoms happening. So, 0:12:29.880 --> 0:12:32.480 like I said, the primary thing that's actually causing this 0:12:32.559 --> 0:12:36.520 disease is a toxin, diphtheria toxin, not the bacterium itself. 0:12:37.440 --> 0:12:41.240 So what happens is this, this toxin is released from 0:12:41.240 --> 0:12:45.880 the bacterium made by the bacteria phage inside. Released from 0:12:45.880 --> 0:12:50.520 the bacterium into your body, it enters your cells, so 0:12:50.559 --> 0:12:53.360 it can actually attach to certain receptors on your cell 0:12:53.440 --> 0:12:56.400 and get inside of your cell. And once it's in 0:12:56.440 --> 0:13:01.160 your cells of like the epithelium of your throat, right, 0:13:01.880 --> 0:13:06.800 it basically inhibits protein synthesis. One of the main things 0:13:06.840 --> 0:13:10.000 that cells do is make protein. If your cells cannot 0:13:10.040 --> 0:13:11.920 make protein, they will die. 0:13:12.200 --> 0:13:14.760 Yeah, so inhibiting that seems pretty bad. 0:13:14.840 --> 0:13:17.880 It's not good, So it basically causes cell death. So 0:13:17.960 --> 0:13:21.080 this toxin gets into your cells, stops them from doing 0:13:21.120 --> 0:13:25.040 their job, and then results in their death. The pseudo 0:13:25.040 --> 0:13:27.680 membrane that you're actually seeing on the back of somebody's 0:13:27.720 --> 0:13:30.840 throat is a direct result of this toxin. It's made 0:13:30.920 --> 0:13:33.160 up of a whole bunch of dead cells that have 0:13:33.200 --> 0:13:36.880 been infected by this toxin and then killed. And then 0:13:36.920 --> 0:13:40.120 what happens is because the bacteria are also there, right, 0:13:40.160 --> 0:13:44.880 so there are colonies of bacteria. You've got macrophages and neutrophils, 0:13:44.880 --> 0:13:47.160 which are white blood cells that are coming in to 0:13:47.200 --> 0:13:50.199 try and eat the bacteria and also clean up after 0:13:50.240 --> 0:13:52.880 all these dead cells that are now in the back 0:13:52.920 --> 0:13:55.679 of your throat. And when there's dead cells, what they 0:13:55.720 --> 0:13:58.360 do is they lay down this stuff called fibrine, which 0:13:58.440 --> 0:14:02.120 is like scar tissue. And so that's why it's adherent 0:14:02.160 --> 0:14:04.199 to the back of your throat. It's not like when 0:14:04.240 --> 0:14:07.959 you get sick with another like strep throat, for example, 0:14:07.960 --> 0:14:10.160 and you might have a bunch of mucus. That mucus 0:14:10.400 --> 0:14:14.120 is also just white blood cells and bacteria. The difference 0:14:14.160 --> 0:14:17.040 here is that because you have a bunch of cell death, 0:14:17.480 --> 0:14:20.640 you have fibrin being laid down, and that's everything is 0:14:20.840 --> 0:14:24.080 attached still to your healthy, living tissue. 0:14:24.160 --> 0:14:27.880 That makes sense and is also that much more horrifying. 0:14:28.000 --> 0:14:31.200 Yeah, definitely, yeah, because there's no just like, oh, let 0:14:31.200 --> 0:14:33.480 me just hack cough really hard and hack this thing 0:14:33.560 --> 0:14:36.600 up right. You can't. You can't hack it up, and 0:14:36.680 --> 0:14:38.840 it suffocates you, suffocates you. 0:14:40.000 --> 0:14:41.160 I feel claustrophobic. 0:14:41.240 --> 0:14:46.920 I can tell. It's a small room. But like I said, 0:14:47.360 --> 0:14:50.120 asphyxiation is not the only way that you can die. 0:14:50.200 --> 0:14:50.440 Cool. 0:14:51.400 --> 0:14:54.720 So, the toxin is released into your bloodstream, and your 0:14:54.800 --> 0:14:57.280 naso pharynx, especially the back of your throat is just 0:14:57.680 --> 0:15:01.440 rife with blood supply, which means that this toxin can 0:15:01.440 --> 0:15:03.320 make it into your blood supply and then it can 0:15:03.360 --> 0:15:05.280 go to the rest of your body. 0:15:05.480 --> 0:15:06.560 Cool cool, cool, cool cool. 0:15:06.880 --> 0:15:09.640 It can travel to your heart, where it will do 0:15:09.680 --> 0:15:11.240 the same thing that it does in the back of 0:15:11.280 --> 0:15:14.360 your throat, so it's going to infect your heart cells 0:15:14.920 --> 0:15:19.920 cause sell death and then fibrosis or scarring. And what 0:15:19.960 --> 0:15:22.400 happens when you have scarring on the muscles of your 0:15:22.400 --> 0:15:26.840 heart is the conductance, the electrical activity that controls your 0:15:26.880 --> 0:15:30.200 heart is impaired. So you've got a bunch of scars 0:15:30.240 --> 0:15:33.080 from everywhere where. You've got dead cells because this toxin 0:15:33.600 --> 0:15:36.760 killed your cells, and now your heart can't send impulses, 0:15:36.880 --> 0:15:40.400 so it can't pump correctly, so you end up with arrhythmias. 0:15:40.520 --> 0:15:43.240 Your heart's not beating in sync with itself, so you 0:15:43.280 --> 0:15:47.840 can die because your heart stops beating correctly. You can 0:15:47.880 --> 0:15:49.960 also die. There's more. 0:15:51.480 --> 0:15:54.720 You can you can just you can just your heart 0:15:54.760 --> 0:15:55.920 will just stop beating. 0:15:56.040 --> 0:15:59.200 Yeah, you go into like like a like a tachycardia 0:15:59.400 --> 0:16:03.200 or an a arrhythmia where your heart is not beating correctly, 0:16:03.320 --> 0:16:06.440 like maybe you're gonna have atrial fibrillation, which means the 0:16:06.480 --> 0:16:10.640 top part of your heart is like like, say what 0:16:10.680 --> 0:16:13.520 my hands are doing because I can't what do you 0:16:13.520 --> 0:16:16.280 call this? V I don't know. 0:16:17.600 --> 0:16:19.160 I mean that looked like jellyfish tendrils. 0:16:19.240 --> 0:16:23.200 Okay, so it's kind of like that, like like instead 0:16:23.200 --> 0:16:25.440 of being like dunk dunk, dun't dunk. Your heart's like 0:16:26.120 --> 0:16:30.280 it's fluttering. Yeah, exactly, So that can happen, and that'll 0:16:30.360 --> 0:16:32.480 kill you, right, because if your heart's not dunk dunking, 0:16:32.640 --> 0:16:35.920 it's not pushing blood out. That's what dunk dunk is. Right. 0:16:36.880 --> 0:16:41.160 You also could just become paralyzed. Cool, because it can 0:16:41.200 --> 0:16:44.120 infect your nervous tissue. And if it infects your nerve 0:16:44.200 --> 0:16:46.520 cells and then your nerve cells die, then you can't 0:16:46.560 --> 0:16:51.960 transmit electricity. Yeah, so it's pretty gnarly. You also can 0:16:52.000 --> 0:16:57.680 get cutaneous diphtheria, which is basically a giant ulcer on 0:16:57.720 --> 0:17:01.280 your skin. It's pretty it's pretty gnarly looking. We should 0:17:01.280 --> 0:17:02.720 post a picture, but I don't know if we should 0:17:02.760 --> 0:17:04.000 post a picture because I we. 0:17:03.960 --> 0:17:06.399 Can do like a like to see graphic content. 0:17:06.600 --> 0:17:08.280 Yeah, because it's pretty gross. 0:17:08.920 --> 0:17:11.480 Now, is that again with the fibrine. 0:17:12.000 --> 0:17:15.199 No, it's actually usually a non toxogenic strain that infects 0:17:15.280 --> 0:17:18.240 your arms, well, not just arms, but your skin. Not 0:17:18.320 --> 0:17:21.560 exactly sure why, but I have some good news because 0:17:21.560 --> 0:17:22.840 it looks like you could use it. 0:17:22.960 --> 0:17:26.640 Yeah. I'm very tense right now. My arms are folded. 0:17:27.040 --> 0:17:31.159 She's very well. I feel like my heart is a rhythmic. 0:17:30.880 --> 0:17:35.160 Right now, untreated, I guess I have a little more 0:17:35.160 --> 0:17:38.520 bad and then we'll get to the good. Untreated, the 0:17:38.520 --> 0:17:43.760 mortality rate is up to fifty percent, so about half 0:17:43.880 --> 0:17:46.720 of people who get infected and do not have any 0:17:46.760 --> 0:17:52.000 treatment will die from diptherea high. It's pretty high. Treated, 0:17:53.160 --> 0:17:56.560 so we do have a treatment. Treated, the mortality is 0:17:56.720 --> 0:17:59.440 between five and ten percent, which is still kind of high, 0:18:00.160 --> 0:18:02.919 and in young children it's actually as high as twenty percent. 0:18:04.200 --> 0:18:07.960 And the thing that's really sad is this case fatality 0:18:08.040 --> 0:18:13.320 rate has not improved over the last fifty years, so 0:18:13.359 --> 0:18:16.120 we're not any better at treating it now than we 0:18:16.119 --> 0:18:22.120 were in the nineteen forties and fifties. That's scary, yeah, 0:18:22.480 --> 0:18:23.719 but you want to know how we treat it, it's 0:18:23.800 --> 0:18:24.200 kind of cool. 0:18:24.280 --> 0:18:25.040 Yeah. Yeah. 0:18:25.160 --> 0:18:27.840 So there's two things that you have to do. The 0:18:27.920 --> 0:18:32.080 first is give an anti toxin. You do that to 0:18:32.200 --> 0:18:35.560 actually treat the symptoms. The thing about this treatment, the 0:18:35.600 --> 0:18:39.480 anti toxin, is that it only works on toxin that 0:18:39.600 --> 0:18:43.040 is not already bound to your cells, So you have 0:18:43.160 --> 0:18:45.480 to be treated very very early in the course of 0:18:45.520 --> 0:18:47.879 disease because any cells that are already infected with the 0:18:47.920 --> 0:18:52.919 toxin are screwed. And then on top of that, you 0:18:53.000 --> 0:18:55.280 also treat with an antibiotic, and that's both to kill 0:18:55.320 --> 0:18:58.760 the bacterium itself so it stops making more, and to 0:18:58.920 --> 0:19:01.280 protect those around so to make sure that you don't 0:19:01.320 --> 0:19:06.000 spread this disease to anybody else. And the best news 0:19:06.080 --> 0:19:09.040 is that there is a vaccine, but we'll talk more 0:19:09.040 --> 0:19:15.520 about that later. So tell me how did we get here? 0:19:17.160 --> 0:19:43.160 Excellent question? Diph theory? Where to begin? Before I started 0:19:43.160 --> 0:19:46.960 researching this, the word dip theory didn't really mean much 0:19:47.000 --> 0:19:49.119 to me on its own right. It was more just 0:19:49.320 --> 0:19:52.600 like part of a vaccine, lumped in with other diseases 0:19:52.640 --> 0:19:56.160 that you don't really hear much about it anymore, except 0:19:56.160 --> 0:19:59.680 more recently with the whole anti vaccine movement, which I'm 0:19:59.680 --> 0:20:03.840 sure we'll get into a bit later. Yeah. Anyway, but 0:20:03.880 --> 0:20:06.280 as I read more about the history of this disease, 0:20:06.400 --> 0:20:09.399 I found that the mention of diphtheria in a village 0:20:09.520 --> 0:20:11.840 or a city could cause a huge panic. 0:20:12.160 --> 0:20:13.199 Wow, and it was. 0:20:13.640 --> 0:20:16.439 Yeah, it was one of the most feared diseases in 0:20:16.640 --> 0:20:22.480 pre vaccine times for a few reasons. One, it attacked children, primarily, 0:20:23.000 --> 0:20:27.240 so it causes horrible slow suffocating death that you just 0:20:27.280 --> 0:20:30.960 talked about, Yeah, which just sounds so awful. 0:20:31.040 --> 0:20:34.360 Yeah, you just like watch your kid suffocate. 0:20:35.640 --> 0:20:37.800 Yeah, like I cannot imagine. 0:20:38.520 --> 0:20:39.920 Yeah, it's pretty bad. 0:20:40.400 --> 0:20:44.280 And also too it would show up suddenly and tear 0:20:44.359 --> 0:20:47.240 through an entire town or village and nothing seemed to 0:20:47.240 --> 0:20:50.280 stop it. So let's just check off the etymology of 0:20:50.280 --> 0:20:53.119 this disease before going into any more of its gory 0:20:53.240 --> 0:20:58.160 historical details. Diphtheria didn't get its name until eighteen twenty six. 0:20:58.720 --> 0:21:00.000 WHOA, that seems super late. 0:21:00.400 --> 0:21:05.639 Yeah, and so in this year, a French pathologist named 0:21:06.080 --> 0:21:10.800 Pierre Bretoneau came up with diphtherite or something like that, 0:21:11.200 --> 0:21:16.320 which is from the Greek root diphthera, meaning leather, which 0:21:16.359 --> 0:21:20.440 is of course what that tough membrane in the throat resembled. 0:21:20.240 --> 0:21:24.080 Leather, leather, second football. 0:21:24.880 --> 0:21:27.040 Yeah, and apparently it smelled really bad according to the 0:21:27.040 --> 0:21:27.760 first hand account. 0:21:27.840 --> 0:21:30.720 Okay, I really think that was just poor hygiene. 0:21:30.960 --> 0:21:33.520 I saw every like, there were so many first hand 0:21:33.560 --> 0:21:36.160 accounts that I read that were like it smelled discs. 0:21:36.680 --> 0:21:38.520 It does make sense because it's just like a bunch 0:21:38.560 --> 0:21:40.480 of dead stuff in the back of your throat, But 0:21:40.560 --> 0:21:42.920 like some of that description in the first hand account 0:21:43.080 --> 0:21:46.359 was like its tongue was brown. I'm like, bro, that's 0:21:46.440 --> 0:21:46.960 you man. 0:21:47.320 --> 0:21:51.119 Okay, well, fair enough, but it was one of the 0:21:51.240 --> 0:21:53.120 when in reading some of this it seemed like there 0:21:53.160 --> 0:21:58.440 was a characteristic diphtheria smell. Yeah, but the naming itself 0:21:59.080 --> 0:22:02.359 was really important in the history of diphtheria because before this, 0:22:02.480 --> 0:22:05.040 outbreaks of sore throat were called by a bunch of 0:22:05.040 --> 0:22:09.639 different names, which made tracking and monitoring outbreaks difficult, not 0:22:09.720 --> 0:22:13.520 to mention developing any kind of treatment that was reliable 0:22:13.720 --> 0:22:17.480 or consistent. Right, Okay, so the name didn't come about 0:22:17.560 --> 0:22:20.359 until the nineteenth century, but this wasn't a new name 0:22:20.440 --> 0:22:24.800 given to a new disease. This disease has really characteristic 0:22:24.880 --> 0:22:28.840 signs like extreme sore throat, leathery membrane. So you would 0:22:28.840 --> 0:22:32.760 think that tracing the history of diphtheria would be somewhat easy, 0:22:33.200 --> 0:22:36.640 at least compared to diseases like staff, which was much. 0:22:36.600 --> 0:22:40.760 More right, it's like everywhere and everything and causes so 0:22:40.800 --> 0:22:43.200 many different types of disease exactly. 0:22:43.320 --> 0:22:46.080 Yeah, but it actually doesn't have that much of a 0:22:46.200 --> 0:22:47.800 history before the seventeen hundreds. 0:22:47.840 --> 0:22:47.959 What. 0:22:48.640 --> 0:22:51.240 Yeah, at least that I found, and I could be wrong, 0:22:51.280 --> 0:22:53.359 and I could be looking in the wrong places, But 0:22:53.880 --> 0:22:57.520 there were some mentions. In the fifth century BCE, Hippocrates 0:22:57.600 --> 0:23:00.680 writes about a disease that sounds an awful lot like diptheria. 0:23:01.359 --> 0:23:04.200 And there's another mention a few hundred years later by 0:23:04.400 --> 0:23:08.560 Aretaeus the Cappadocian, in which he describes ulcers in the 0:23:08.640 --> 0:23:11.959 throat and warns that quote, if it spreads to the 0:23:12.000 --> 0:23:15.680 thorax by the windpipe, it occasions death by suffocation within 0:23:15.680 --> 0:23:18.480 the space of a day. Yep. And that quote children 0:23:18.560 --> 0:23:20.879 until puberty especially suffer yep. 0:23:21.200 --> 0:23:22.359 So it does sound a lot. 0:23:22.240 --> 0:23:27.240 Like probably, And that's really more or less the last 0:23:27.320 --> 0:23:30.159 mention of the disease until the late fifteen hundreds and 0:23:30.240 --> 0:23:31.399 early sixteen hundred. 0:23:31.440 --> 0:23:32.080 It's weird. 0:23:32.680 --> 0:23:35.919 And so that's when there was a series of epidemics 0:23:35.920 --> 0:23:39.760 of sore throats resulting in suffocation that swept through Spain 0:23:39.920 --> 0:23:43.320 and parts of the New World. This epidemic was referred 0:23:43.359 --> 0:23:48.360