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Corynebacterium diphtheriae is the etiological agent of diphtheria and occurs in 2 forms, respiratory and cutaneous diphtheria. Respiratory diphtheria may be further classified into pharyngeal, tonsillar, laryngeal, and the less common anterior nasal diphtheria. Due to vaccination programs in the United States, diphtheria is now a rarely reported disease. Corynebacterium diphtheriae is primarily spread by droplets from coughing or sneezing. The incubation period averages 2 to 5 days. The illness is characterized by fever, malaise, and sore throat with a distinguishing thick pseudomembrane present over the involved mucosa. A swab from beneath the pseudomembrane is the preferred specimen for culture. The organisms multiplying at the infection site produce a toxin, diphtheria toxin, which may result in systemic complications affecting the heart, nervous system, etc.
In patients with a clinical diagnosis of possible diphtheria, appropriate specimens should be collected for culture; patients should be placed in appropriate isolation and consideration given to administration of empiric antitoxin (available in the United States through the Centers for Disease Control and prevention) and antibiotics; respiratory and airway support may be required.
Confirmation of the clinical diagnosis of diphtheria
A positive result supports a diagnosis of diphtheria. The pathogenesis of the associated disease relates to production phage-encoded diphtheria toxin. Since isolates of Corynebacterium diphtheriae may or may not harbor genes to produce the toxin, they should be further tested for diphtheria toxin production.
A negative result is evidence against a diagnosis of diphtheria but does not definitively rule out this disease since culture may be negative because of prior antimicrobial therapy or organism present below the limit of detection of the assay.
No growth of Corynebacterium diphtheriae
Mandell GL, Bennett JE, Dolin R: In Principles and Practice of Infectious Diseases. Sixth edition. Philadelphia, PA, Elsevier Inc, 2005, pp 2457-2465