Kingdom: Bacteria Phylum: Actinobacteria Order: Actinomycetales Suborder: Croynebacterineae Family: Corynebacteriaceae Genus: Corynebacterium Species: C.

diphtheriae

Corynebacterium
C. diphtheriae
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Gram-positive, nonmotile, rod-shaped bacteria Aerobic or facultatively anaerobic Catalase positive Long chained mycolic acids CMN (weakly acid fast) Resembling V or X or Chinese letters or palisades or club shaped C.Diphtheria- D. toxin Diphtheriods- No D. toxin

History:
Hippocrates first clinical description of diphtheria in the 4th century B.C in ancient Syria and Egypt. Diphtheria was first described Klebs in 1883, cultivated by Loeffler in 1884.
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Corynebacteria

Courtesy by Dr. Leanne Field

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Virulent factors
Pilli, O antigen & K antigen Diphtheria toxin (A&B toxin)
Gravis, intermedius and mitis Two factors have great influence:
(1) low extracellular concentrations of iron and (2) The presence of a lysogenic prophage in the bacterial chromosome Tox gene and iron association to repressor

A unit action:
Adding ADP ribose to elongation EF2 Inhibits protein synthesis cell death.

B unit receptor - heparin-binding epidermal growth factor (HB-EGF)

Lipase: Important in cutaneous lesions. Neuraminidase: Acts on respiratory tract mucosa

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Epidemiology
Oropharynx & Skin Children, elderly pts and unvaccinated pts Transmission : Respiratory route, fomites & carriers Decreased cases in US and developed countries Vaccination incidence

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Pathogenesis
Mainly by D.Toxin. Dissemination leads to systemic conditions D.Toxin A&B units: D toxin protein synthesis cell death pseudo membrane D toxin blood stream heart, motor neurons and kidney effected. Punched out ulcers on skin.
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Dr.Aravind

Courtesy by Dr. Leanne Field

Dr.Aravind

Clinical Conditions
Diphtheria:
Respiratory disease:
Pseudomembranous Necrosis, bull neck (enlargement of cervical lymph nodes)

Systemic complications:
Disseminated toxin myocarditis and peripheral neuritis (paralysis of soft palate, diaphragm muscle effected- irreversible)

Cutaneous diphtheria (extra-respiratory disease):

organism enters through break in subcutaneous tissue, Chronic non-healing ulcer results

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Diphtheria pseudomembrane

Diphtheria Bull neck

Cutaneous diphtheria: note the deep ulcer with welldefined margins

Courtesy by CDC

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Diagnosis
Gram stain
Albert stain or Nisser stain - purple metachromatic granules Tensidile medium black color colonies ( telluite to tellurium) Lofflers medium white moist glistening colonies Shick test - distinguish between individuals who are susceptible and those who are resistant (i.e., immune) to diphtheria toxin and to test for sensitivity to toxoid Eliks test to know potency of toxin

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Corynebacterium diphtheriae taken from an 18-hour culture, using Albert stain Courtesy by CDC

Colonies of corynebacterium diphtheriae grown on selective tellurite medium

On loeffler's serum agar medium, the bacteria out grows as small granular, moist, creamy colonies

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Treatment, Prevention & Control

Antitoxin
Used for neutralizing exotoxin Effective in conjunction with antibiotic therapy

Toxoid

Toxoid preparations are used for vaccines as active immunization for diphtheria Usually given in conjunction with pertussis and tetanus vaccines (DPT vaccine) or as a booster with tetanus (TD) Vaccine shedule
2, 4, 6, 15, & 18 months 4, 6 years Every 10 years (booster)

Antibiotics

Penicillin G Erythromycin if allergic

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C. jeikeium
Hospitals Catheter infections Prosthetic valve infections Resistant to drugs Treat: Vancomycin

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