J Clin Microbiol 33(5):1318–1321, Mattos-Guaraldi AL, Sampaio JL, Santos CS, Pimenta FP, Pereira GA, Pacheco LG, Miyoshi A, Azevedo V, Moreira LO, Gutierrez FL, Costa JL, Costa-Filho R, Damasco PV, Camello TC, Hirata Jr R (2008) First detection of, Maximescu P, Fîciu S (1980) Slide agglutination assay in the, Maximescu P, Oprişan A, Pop A, Potorac E (1974) Further studies on, McNamara PJ, Cuevas WA, Songer JG (1995) Toxic phospholipases D of, Meers PD (1979) A case of classical diphtheria, and other infections due to, Mikhailovich VM, Melnikov VG, Mazurova IK, Wachsmuth IK, Wenger JD, Wharton M, Nakao H, Popovic T (1995) Application of PCR for detection of toxigenic, Mina NV, Burdz T, Wiebe D, Rai JS, Rahim T, Shing F, Hoang L, Bernard K (2011) Canada’s first case of a multidrug-resistant, Mokrousov I, Narvskaya O, Limeschenko E, Vyazovaya A (2005) Efficient discrimination within a, Mothershed EA, Cassiday PK, Pierson K, Mayer LW, Popovic T (2002) Development of a real-time fluorescence PCR assay for rapid detection of the diphtheria toxin gene. In the United Kingdom, other parts of Europe, the United States, and the NIS, it is mandatory to report all toxigenic C. diphtheriae isolates. This service is more advanced with JavaScript available, Corynebacterium diphtheriae and Related Toxigenic Species Tellurite medium is very useful for isolation of, may be identified as mitis, intermedius, or gra-vis biotype on the basis of their (. Androulla Efstratiou, Kathryn H. Engler, Izabella K. Mazurova, Tatiana Glushkevich, Jaana Vuopio-Varkila, Tanja Popovic, Current Approaches to the Laboratory Diagnosis of Diphtheria, The Journal of Infectious Diseases, Volume 181, Issue Supplement_1, February 2000, Pages S138–S145, https://doi.org/10.1086/315552. There are four biotypes of C. diphtheriae (var. dup 53 /G35 put dup 249 /GF9 put dup 49 /G31 put For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The major role of the laboratory is the provision of simple, rapid, and reliable methods to assist clinicians in confirming a clinical diagnosis. Further characterization of the isolate by ribotyping demonstrated clearly that the pattern produced was indistinguishable from the “epidemic pattern” D1 currently circulating within Eastern Europe. dup 254 /GFE put In cases of suspected respiratory diphtheria, samples should be obtained from the throat or nasopharynx (or both). Unless a clinical diagnosis of diphtheria is suspected, laboratory diagnosis may be difficult because C. diphtheriae is not easily identified on blood agar. dup 63 /G3F put version of this document in a more accessible format, please email [email protected]. dup 220 /GDC put The control animal is given 500 U of antitoxin the previous day. Collective Cancer Cell Invasion in Contact with Fibroblasts via Integrin-α5β1/Fibronectin Interaction in Collagen Matrix. dup 36 /G24 put In addition, swabs with specimens from asymptomatic carriers or contacts may contain only small numbers of organisms, which may be obscured by the overgrowth of normal throat flora. dup 35 /G23 put dup 77 /G4D put dup 105 /G69 put J Antimicrob Chemother 50 (1):125–128, Wagner KS, Stickings P, White JM, Neal S, Crowcroft NS, Sesardic D, Efstratiou A (2009) A review of the international issues surrounding the availability and demand for diphtheria antitoxin for therapeutic use. 27-3). dup 89 /G59 put dup 234 /GEA put Not surprisingly, the overall, contemporary approach to the laboratory diagnosis of diphtheria is not very different from that used in the 1920s. mitis, var. dup 92 /G5C put dup 191 /GBF put 139.59.89.178. dup 72 /G48 put dup 221 /GDD put Therefore, a rapid and accurate result is essential. dup 64 /G40 put dup 214 /GD6 put In cases of cutaneous disease, samples should be obtained from any wound or skin lesions. dup 69 /G45 put /FontInfo 12 dict dup begin Consequently, the number of laboratories within nonepidemic or nonendemic areas using this test unfortunately has declined over the years. dup 76 /G4C put J Med Microbiol 4(3):366–369, Jellard CH (1980) Toxigenic and non-toxigenic, Katsukawa C, Kawahara R, Inoue K, Ishii A, Yamagishi H, Kida K, Nishino S, Nagahama S, Komiya T, Iwaki M, Takahashi M (2009) Toxigenic, Katsukawa C, Komiya T, Yamagishi H, Ishii A, Nishino S, Nagahama S, Iwaki M, Yamamoto A, Takahashi M (2012) Prevalence of, Khamis A, Raoult D, La Scola B (2005) Comparison between, Kneen R, Pham NG, Solomon T, Tran TM, Nguyen TT, Tran BL, Wain J, Day NP, Tran TH, Parry CM, White NJ (1998) Penicillin vs. erythromycin in the treatment of diphtheria. The rarity of cases and the expense and complexity associated with laboratory diagnosis provided many countries with the indication to cease screening throat specimens for C. diphtheriae; therefore, expertise and recognition of the organism declined. dup 133 /G85 put These methods are, therefore, particularly applicable to epidemic situations. EIA, enzyme immunoassay; PCR, polymerase chain reaction. dup 39 /G27 put The first case was in a 40-year-old man who acquired a cutaneous infection with C. diphtheriae var. dup 117 /G75 put 0000100974 00000 n Don’t include personal or financial information like your National Insurance number or credit card details. Laboratory Diagnosis. Swabs were used to obtain nose and throat specimens from close family contacts, who were given antibiotic prophylaxis and low-dose diphtheria boosters. One of these is protected with 500 U of diphtheria antitoxin, which is injected intraperitoneally before 18–24 hours of the test. 0000001900 00000 n dup 65 /G41 put This is important when only a few organisms are present; to perform the test by the “dot method,” one colony is adequate. dup 108 /G6C put 2008. During the peak epidemic periods, isolates that belonged to only one predominant biotype circulated at specific periods of time: In the first peak (1984–1985), biotype mitis predominated (80.3% and 83.1% of the total for each year), and during the second peak (1993–1995), biotype gravis predominated (71.5%, 78.6%, 79.3%, respectively). [PHLS], personal communication). Recent reports from Russia and Ukraine suggest an increase in the number of nontoxigenic strains that are positive by PCR [25, 26]. J Clin Pathol 45(1):46–48, Coyle MB, Minshew BH, Bland JA, Hsu PC (1979) Erythromycin and clindamycin resistance in, Coyle MB, Nowowiejski DJ, Russell JQ, Groman NB (1993) Laboratory review of reference strains of, De Zoysa AS, Efstratiou A (1999) PCR typing of, De Zoysa AS, Efstratiou A (2000) Use of amplified fragment length polymorphisms for typing, De Zoysa AS, Efstratiou A, George RC, Jahkola M, Vuopio-Varkila J, Deshevoi S, Tseneva G, Rikushin Y (1995) Molecular epidemiology of, De Zoysa A, Hawkey PM, Engler K, George R, Mann G, Reilly W, Taylor D, Efstratiou A (2005) Characterization of toxigenic, De Zoysa A, Hawkey P, Charlett A, Efstratiou A (2008) Comparison of four molecular typing methods for characterization of, Dias AA, Santos LS, Sabbadini PS, Santos CS, Silva FC Jr, Napoleão F, Nagao PE, Villas-Bôas MH, Hirata R Jr, Guaraldi AL (2011), Dixon JMS (1984) Diphtheria in North America. Probable. In addition to the speed of the test, interpretation of results is simple, and PCR facilities are becoming increasingly available in many laboratories throughout the world. Laboratory diagnostics within the Newly Independent States (NIS) of the former Union of Soviet Socialist Republics are based upon the work of several generations of microbiologists and are in accordance with the WHO recommendations. Physical examination of the throat and tonsil regions of infected patients for pseudomembrane appearance also aids diagnosis. The EIA is a simple, rapid, accurate, and specific phenotypic method for the detection of toxigenicity. [15], a distance of 7 mm was shown to be the best membrane (containing the antitoxin)-to-inoculum distance, resulting in the appearance of specific precipitin bands after 24 h of incubation, even for the weakly toxigenic control strain. In 1994, for example, 2 US citizens contracted diphtheria while living in Russia and Ukraine. As a result of these dangers and the likelihood that toxigenic strains of C. diphtheriae may still be circulating in some US communities, various strategies have been undertaken to enhance surveillance for respiratory diphtheria [8]. Shape – Corynebacterium diphtheriae is a Thin, slender rod-shaped (bacillus) bacterium with a tendency to clubbing at one or both the ends due to the presence of metachromatic granules which may present at one or both the ends.. In the UK National External Quality Assessment Scheme exercises, which were conducted between 1993 and 1995, a small number of laboratories (<25% of participating laboratories) reported toxin results. It will take only 2 minutes to fill in. dup 125 /G7D put Many modified and new methodologies are now used widely within laboratories for diphtheria diagnosis. dup 31 /G1F put The Elek test, therefore, replaced the in vivo test as the first-line test for toxigenicity in most laboratories. Intradermal test: In this test, 0.2 mL of the emulsion obtainedfrom 18 hours’ growth of test bacteria cultured on Loeffler’s serum slope is injected intradermally into shaven sites of two albino guinea pigs (or rabbits), so that each animal receives 0.1 mL into two different sites. Despite the success of mass immunization in many countries, diphtheria continues to play a major role as a potentially lethal resurgent infectious disease. Laboratory Criteria for Diagnosis. 0000059946 00000 n The test is performed on a Petri dish containing horse serum agar. 0000101072 00000 n Eur J Clin Microbiol Infect Dis 7(2):190–193, Young PS, Smith DD (1976) The detection of toxin production by, Zapardiel J, Nieto E, Gegúndez MI, Gadea I, Soriano F (1994) Problems in minimum inhibitory concentration determinations in coryneform organisms. If present, membranous material should also be examined. 0000160333 00000 n Other methods for detecting toxin have also been described; these are primarily phenotypic tests based on complex techniques, such as immunoblotting, other EIAs, Vero cell bioassays, passive hemagglutination, immunofluorescence, and the use of latex immunologic techniques, but they have not found widespread use [12, 29]. All conventional and commercial methods are described fully in the WHO manual [3]. dup 59 /G3B put dup 171 /GAB put NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. dup 67 /G43 put 0000227058 00000 n dup 70 /G46 put Don’t worry we won’t send you spam or share your email address with anyone. Classic diphtheria is characterized by the formation of a pseudomembrane on respiratory mucous membranes. Laboratory confirmation of suspected diphtheria has to aim for the isolation of the etiologic pathogen (including species identification and antibiotic susceptibility testing) as well as for differentiation of toxigenic from non-toxigenic strains (by using tox gene detection and toxigenicity testing). Zentralbl Bakteriol 274(1):61–69, Pike RM (1976) Laboratory-associated infections: summary and analysis of 3921 cases. dup 75 /G4B put The only exception would be in a situation where clinical samples were held in transport media for an extended period of time, as demonstrated by Kobaidze et al. dup 216 /GD8 put Clin Microbiol Infect, Diphtheria: current status and laboratory procedures for diagnosis, Control of diphtheria: guidelines for consultants in communicable disease control, Guidelines for the laboratory diagnosis of infections caused by, Diphtheria acquired during a cruise in the Baltic Sea, © 2000 by the Infectious Diseases Society of America, Rotavirus Genotypes in Hospitalized Children with Acute Gastroenteritis Before and After Rotavirus Vaccine Introduction in Blantyre, Malawi, 1997 – 2019, Functional Evaluation and Genetic Evolution of Human T-cell Responses after Vaccination with a Conditionally Replication-Defective Cytomegalovirus Vaccine, Establishing the Value and Strategies for Respiratory Syncytial Virus (RSV) Control: The European RSV Consortium (RESCEU), Upper respiratory tract levels of SARS-CoV-2 RNA and duration of viral RNA shedding do not differ between patients with mild and severe/critical COVID-19, About the Infectious Diseases Society of America, Role of the Laboratory in the Diagnosis of Diphtheria, Methods for the Laboratory Diagnosis of Diphtheria, Proposed Recommendations to Diagnostic Laboratories, Receive exclusive offers and updates from Oxford Academic, The Strengthening of Laboratory Systems in the Meningitis Belt to Improve Meningitis Surveillance, 2008–2018: A Partners’ Perspective, Clinical and Laboratory Diagnosis of Dengue Virus Infection, Laboratory Diagnosis of Chikungunya Virus Infections and Commercial Sources for Diagnostic Assays.

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