CORYNEBACTERIUM

DIPHTHERIAE
 INTRODUCTION

 Diphtheria is an ancient disease

 The causative organism is toxin-producing
Corynebacterium diphtheriae
 The genus name is derived from the Greek words
koryne, meaning club, and bacterion, little rod
 The Greek word diphthera, means leather or
hide.
 CORYNEBACTERIUM
DIPHTHERIAE

 Corynebacterium diphtheriae, when lysogenised

by certain bacteriophages, produces DT.
 There are four biotypes of C. diphtheriae:
 var. gravis,
 var. mitis,
 var. belfanti
 var. intermedius
 MORPHOLOGY

 Gram-positive bacilli which possess irregular

swellings at one end that give them the "club-
shaped" appearance
 Palisade arrangements “Chinese letter”
 Metachromatic granules
 DIPHTHERIA TOXIN

 Two fragments
 Fragment A inhibits polypeptide chain elongation

(inactivates EF-2)
 Fragment B required for the transport of
fragment A into the cell
 PATHOGENESIS

 C diphtheriae occurs in the respiratory tract, or

on the skin of infected persons or normal carriers
 Spread by droplets
 Bacilli then grow on mucous membranes and
start producing toxin
 Diphtheria toxin is absorbed into the mucous
membranes and causes destruction of epithelium
 “Pseudomembrane" is formed over the tonsils,
pharynx, or larynx
 CLINICAL
MANIFESTATIONS

 Symptoms depend on the location and duration of

the infection
 Faucial Diphtheria
 Anterior Nasal Diphtheria
 Laryngeal and Tracheobronchial Diphtheria
 Systemic Complications
 Cardiac Toxicity
 Neurologic Toxicity
 Cutaneous Diphtheria
DIAGNOSTIC LABORATORY
TESTS

 Specimen Collection and Transport

 Swabs from the nose, throat, or other suspected
lesions
 The swab should be transported to the
laboratory immediately or placed in semisolid
transport media such as Amies
 DIAGNOSTIC LABORATORY
TESTS
Loeffler serum slope
 Isolation/ Culture
 Inoculate a Loeffler serum slope, and a tellurite
plate (eg, cystine-tellurite agar or modified
Tinsdale medium) and incubate all at 37 °C
 Loeffler serum slope : minute smooth colonies
after 6 hours of incubation
 Tellurite medium : Black colonies appear after
48hrs
 Albert staining: “Chinese letter” arrangement and
metachromatic granules

 The four biotypes of C. diphtheriae are classified on

the basis of morphological and biochemical
properties
 DETECTION OF
TOXIGENICITY
Elek’s test
 In vivo toxin test using guinea pigs
D
B  Subcutaneous
C
 Intracutaneous

 In vitro tests
A  Elek’s gel precipitation test

A – Filter paper impregnated with  Tissue culture test

diphtheria antitoxin
B – Toxigenic strain
C – Non-toxigenic strain
D – Test strain showing toxicity
 PROPHYLAXIS

 Immunisation
 Active
 Passive
 Combined
 PROPHYLAXIS

 Active immunisation
 Toxoids are used
 Formol toxoid
 Adsorbed toxoid (adsorbed on aluminium
phosphate)

 Passive immunisation
 Subcutaneous administration of anti-diphtheritic
serum

 Combined immunisation
 Adsorbed toxoid + antidiptheritic serum
 TREATMENT

 Antimicrobial drugs and the early administration

of specific antitoxin
 Treatment with antitoxin is mandatory
 The antitoxin should be given on the day the
clinical diagnosis of diphtheria is made and need
not be repeated
 Antimicrobial drugs (penicillin, erythromycin)
inhibit the growth of diphtheria bacilli