Corynebacteriosis or Diphtheria

In view of the news of the presence of Diphtheria in our region, we made a review and summary of the corynebacteriosis or Diphtheria disease.

Name: Diphtheria. Angina. Klebs and Loeffler's disease.

Discoverers: Klebs and Löeffler. Cause: Corynebacterium diphteriae. Transmission: respiratory by Flügge droplets (microparticles expelled from saliva or nasal or oral secretion when talking, coughing, sneezing expelled up to one and a half meters Species affected: only mankind.

Eradication: difficult, the bacterium may be present in the population, only vaccination against its exotoxin prevents neurological, cardiac or nephrological complications.

Syndromes caused: rhinitis, tonsillitis, pharyngitis, laryngitis, upper airway inflammation, diffuse airway inflammation, otitis, infectious dermatitis and the effects of the toxin: central or peripheral neurological, cardiac or nephrological failures.

Classification according to disease manifestation: respiratory inflammation, dermal inflammation, neurological syndrome, cardiological syndrome, renal syndrome.

The most evident sign is the creamy or whitish membrane closely adherent to the tissues (pseudomembrane) and massive swelling of the neck (bull neck). Severity: mild, moderate, severe or complicated. Other classification: mitis, intermedius, gravis, belfanti. At tonsillar level there may be erythema or with presence of pus or with pseudomembranes or with very severe inflammation of the respiratory tree accompanied with obstructive airway syndrome.

The complication, according to the scientists, is due to the biological association with a bacteriophage, which confers the capacity of a cardiotoxic, neurotoxic and nephrotoxic exotoxin. It can enter the bloodstream and reach target organs. The more bacteria fixed to the tissues or the more inflamed areas, the more toxin is produced and the easier the passage into the blood.

Treatment: respiratory isolation (hospitalization area only for respiratory patients with suspicion of the disease, can be used mouth-covering in the affected person, his visitor and care staff, hospital beds separated two meters), entry broad-spectrum antibiotics with tonsillar effect, adjustment with bacteriology laboratory: direct examination with Gram stain (Gram-positive bacilli in immobile chinese letter), culture and antibiogram (pharyngeal exudate or culture of secretions or pseudomembrane, specialized studies), epidemiological follow-up at the National Institute of Hygiene (send a sample and epidemiological data with the authorities of the Ministry of Health), other complementary tests, hospitalization in respiratory isolation, intermediate care or ICU depending on its severity.

Vaccination: modified exotoxin as diphtheria toxoid. Included in the "triple" (diphtheria toxoid, tetanus toxoid and pertussis vaccine) in the "double" (diphtheria and tetanus toxoids) or as diphtheria toxoid. Protects against C. diphteriae exotoxin, not against the bacterium. Protects the vaccinated person if he/she follows the scheme for ten years in a percentage higher than 90%, WHO recommends boosters every 10 years.

In scientific studies. In Europe, which has less contact with C. diphterae, after the age of 60 years, only half of the population is immune, it is assumed that in Asia, Africa and America the percentage must be higher due to infections or contact with people suffering from the disease or carrying the bacteria.