ulcerans should follow treatment guidelines for patients infected with C. diphtheriae
infections was not clinically suspected in any of these case-patients.
A case was defined as confirmed by a laboratory if the patient had catarrhal symptoms and a culture positive for C. diphtheriae
or if the patient was epidemiologically linked to a case with a culture positive for C.
Staphylococcus aureus and a coryneform isolate (identified as C. diphtheriae
via MALDI-TOF and confirmed as toxin-producing) grew from the wound culture (Table).
Laboratories in South Africa were requested to include selective media for isolation of C. diphtheriae
when processing throat swabs and to submit all potential C.
Interpretation & conclusions: Standard methods revealed the replacement of C. diphtheriae
var mitis with var intermedius and occurrence of diphtheria infections due to other human pathogenic corynebacteria.
Diagnosis was established by isolation of C. diphtheriae
and PCR detection of the toxin gene.
ulcerans should follow clinical guidelines for patients infected with C. diphtheriae
ulcerans or C. diphtheriae
is notifiable in Queensland, regardless of the site of infection (6).
During tracheostomy, a white exudate consistent with C. diphtheriae
infection was observed.
Uncontrolled but large studies of mortality rates from that time suggested effectiveness of equine DAT use; however, double-blinded randomized studies conducted by Adolf Bingel in 1918 concluded that equine DAT offered no benefit over serum from nonhyperimmune horses (not challenged with C. diphtheriae
(*.)Travelers to certain countries may be at substantial risk for exposure to toxigenic strains of C. diphtheriae
, especially with prolonged travel, extensive contact with children, or exposure to poor hygiene.
ulcerans is reported to be substantially lower than that usually seen in toxigenic C. diphtheriae
(8) as was the case in the study patient, it is difficult to estimate the pathogenic contribution of these low amounts of DT detected only in vitro by using a cytotoxicity assay, but not by immunologic precipitation for this patient in vivo.
More recently, a multilocus sequence typing (MLST) scheme for C. diphtheriae
was developed (5).
Additional doses of diphtheria toxoid-containing vaccine beyond those recommended in the childhood immunization schedule are associated with an increase in local reactions and should be considered only for children vaccinated with [Tripedia.sup.TM] lot number 0916490 who may be at increased risk for exposure to toxigenic strains of C. diphtheriae
. CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians have developed recommendations for children who received one or more doses of [Tripedia.sup.TM] lot number 0916490.