Diphtheria
Diphtheria is a paradigm of an infectious disease caused by the toxigenic bacteria Corynebacterium diphtheriae and Corynebacterium ulcerans. Classical diphtheria of the upper respiratory tract, which is transmitted by breathing or coughing, is characteriz
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Historical Retrospective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
taken into consideration, which has been detected as a commensal in various domestic and wild animals.
Transmission and Clinical Manifestation of Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Historical Retrospective Systemic Infections by C. diphtheriae . . . . . . . . . . . . . . . . . . . . . 240 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Treatment and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Outbreaks of Diphtheria in the Vaccine Era . . . . . . . . . . . . . . 241 Toxigenic Corynebacteria as Etiological Agents of Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 Infections with Non-toxigenic Strains . . . . . . . . . . . . . . . . . . . . . 242 Open Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Abstract Diphtheria is a paradigm of an infectious disease caused by the toxigenic bacteria Corynebacterium diphtheriae and Corynebacterium ulcerans. Classical diphtheria of the upper respiratory tract, which is transmitted by breathing or coughing, is characterized by a thick pseudomembrane, which forms as a result of cell damage and fibrin deposition. In severe cases, obstruction of airways results in suffocation and death. In tropical and subtropical regions respiratory tract diphtheria is outnumbered by diphtheria of the skin. Common sites for this cutaneous form, which is characterized by lesions covered by a smeary coating, are the lower legs, feet, and hands. Today the infection can be eliminated easily using antibiotics and the detrimental exotoxin can be neutralized by an antitoxin. Nevertheless, immunization using a highly effective toxoid vaccine is the mean of choice for diphtheria control. Despite the advances made in diphtheria therapy and control, outbreaks reaching even epidemic proportions have been observed during the last decades. Today, several thousand diphtheria cases per year are reported to the World Health Organization, showing that diphtheria is not completely eradicated and that reservoirs exist. These are, for example, groups of people with insufficient access to medical care and also animals seem to play a role as reservoirs of the infection. Isolation of C. diphtheriae strains were reported from domestic cats and horses and animal reservoirs are even more common, when Corynebacterium ulcerans is
Diphtheria has been frightening people since ancient times due to its high mortality rate and the dreadful death by suffocation caused by this disease. As an additional terror for parents, especially infants up to 5 years of age were preferred victims of this infection, which was also designated as ‘‘strangling angel of children.’’ Documents describing diphtheria are known already from Babylonian and Sume
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