Diphtheria is a serious bacterial infection caused by strains of bacteria called Corynebacterium diphtheriae that make a toxin. It is highly contagious and can lead to difficulty breathing, heart rhythm problems, and even death. Diphtheria usually affects the mucous membranes of the nose and throat, and signs and symptoms usually begin 2 to 5 days after a person becomes infected. These symptoms may include a thick, gray membrane covering the throat and tonsils, a sore throat and hoarseness, swollen glands in the neck, difficulty breathing or rapid breathing, nasal discharge, fever and chills, and tiredness. In some people, infection with diphtheria-causing bacteria causes only a mild illness or no obvious signs and symptoms at all, and these people are known as carriers of diphtheria. Diphtheria bacteria spread from person to person, usually through respiratory droplets, like from coughing or sneezing, and people can also get sick from touching infected open sores or ulcers. Diphtheria is no longer prevalent in the United States due to a successful vaccine and improved living conditions, but it is still considered an endemic in many areas of the world, including Asia, the Dominican Republic, Eastern Europe, Haiti, the South Pacific, and the Middle East.