PRIMEVIEW

DIPHTHERIA
For the Primer, visit doi:10.1038/s41572-019-0131-y

Diphtheria is a respiratory infection MANAGEMENT

EPIDEMIOLOGY Non-toxigenic
caused by toxigenic strains of
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Corynebacterium diphtheriae or, less strains are a reservoir Diphtheria can be effectively treated with the
frequently, Corynebacterium ulcerans for the disease if they timely administration of diphtheria antitoxin
or Corynebacterium pseudotuberculosis. are infected by a tox- (DAT), which neutralizes circulating DT. Antibiotic
Its pathological effects are due to bearing bacteriophage, therapy with oral penicillin V or erythromycin (or
diphtheria toxin (DT), which, in severe CPFCTGQȎGPCUUQEKCVGF parenteral drugs if the throat infection prevents
cases, can spread systemically and lead to with invasive the patient from swallowing) for at least 2 weeks
myocarditis and polyneuropathy. infections is recommended. Airway management and
conventional cardiac treatment reduce mortality
and, as polyneuropathy can have a late onset,
DIAGNOSIS RCVKGPVUUJQWNFDGHQNNQYGFWRHQTs|OQPVJU
Diphtheria
mostly Case
Clinical diagnosis is based on the typical signs affects children fatality
of enlarged lymph nodes in the neck (bull neck) of <15 years rate is still
CPFVJGRTGUGPEGQHCRUGWFQOGODTCPG
C|VJKEM QH|CIG 5-17% in non-
layer of bacteria and cellular debris) in the throat. vaccinated
Microbiological confirmation is obtained by individuals
DCEVGTKCNEWNVWTGQHUYCDUCORNGUHQNNQYGF|D[
identification of the causative species and
toxigenicity tests; the Elek test (which is based
DAT

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on immunodiffusion — an antigen–antibody
immunoprecipitation reaction) is the most
commonly used test to assess the production of DT
by the cultured bacterial colonies. Molecular
Global
typing to
coverage
identify similarities OUTLOOK
with the DTP
and differences
vaccine is
MECHANISMS between clinical isolates
>85%
enables mapping of the Diphtheria is still a public health threat in
Coverage geographical spread
DT is an exotoxin secreted by Corynebacterium rates in some countries where the vaccination programmes
of the strains
spp. that have acquired the DT-encoding gene countries are are not successfully implemented. Even in
(tox) from a bacteriophage (a virus). DT enters quite low, owing to countries where the coverage is above the
host cells by endocytosis; the catalytic subunit socioeconomic factors threshold for herd immunity, the disease could
is then released into the cytosol, where it that hamper healthcare resurface, owing to the emergence of new
inhibits protein synthesis, leading to systems and result toxigenic strains or declining immunization
cell death. in delayed or no levels in adults. Thus, surveillance, both
T vaccination microbiological and epidemiological, is
DT A B PREVENTION necessary for early detection of outbreaks.
Cell Prevention through vaccinations should be a
Effective vaccines are available. the first 6 months of life, provide followed by immunization (the priority, but improved DAT formulations are
Clathrin Cell Three doses of a trivalent vaccine full protection. Close contacts of complete protocol or a booster also required, as horse serum DAT might cause
coated death against diphtheria, tetanus and individuals with diphtheria should dose, depending on the individual’s sensitization reactions, and its production
pit 4KDQUQOG pertussis (DTP), to be given within receive prophylactic treatment immunization history). KU|NCDQTKQWU

doi:10.1038/s41572-019-0139-3; Article citation ID: (2019) 5:82 Written by Lucia Brunello; designed by Laura Marshall
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