Corynebacterium diphtheriae - Revision history

Aidan: Text replacement - " species]]" to "]]"

2022-02-18T19:35:10Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 19:35, 18 February 2022
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	**Notify lab, who will use modified Tinsdale agar or cystine-tellurite blood agar		**Notify lab, who will use modified Tinsdale agar or cystine-tellurite blood agar
	**Gram stain should show classic coryneform "Chinese letter" appearance, which may be dismissed as normal respiratory flora unless specific testing for diphtheria is requested		**Gram stain should show classic coryneform "Chinese letter" appearance, which may be dismissed as normal respiratory flora unless specific testing for diphtheria is requested
	*Culture requires Tinsdale medium (contains teluride and cysteine), inhibits non-pathogenic [[Corynebacterium ~~species~~]]		*Culture requires Tinsdale medium (contains teluride and cysteine), inhibits non-pathogenic [[Corynebacterium]]
	*PCR for the toxin gene exists, and is followed by serology to demonstrate toxin production		*PCR for the toxin gene exists, and is followed by serology to demonstrate toxin production
	*Serology is done for ''tox'' gene positive strains using the Elek test		*Serology is done for ''tox'' gene positive strains using the Elek test

Aidan at 14:50, 26 November 2020

2020-11-26T14:50:57Z

← Older revision		Revision as of 14:50, 26 November 2020
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	*Can range from acute heart failure and cardiogenic shock to more subacute heart failure and dilatation		*Can range from acute heart failure and cardiogenic shock to more subacute heart failure and dilatation
	**Can be monitored with AST (?and troponin?)		**Can be monitored with AST (?and troponin?)
	*ECG may show ST-T wave changes and first-degree heart block, which can progress to complete heart block		*ECG may show ST-T wave changes and [[first-degree heart block]], which can progress to [[complete heart block]]
	**Mortality is higher with ECG changes, and highest with AV blocks and LBBB		**Mortality is higher with ECG changes, and highest with AV blocks and LBBB
	**Can be permanent		**Can be permanent
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	**Followed by cranial nerve defects		**Followed by cranial nerve defects
	*After 10 days to 3 months, can develop a peripheral motor neuropathy from demyelination		*After 10 days to 3 months, can develop a peripheral motor neuropathy from demyelination
			**Typically descending paralysis by can still be confused with [[Guillain-Barré syndrome]]
	**Generally fully resolves with time		**Generally fully resolves with time

	=====Tubular Necrosis=====		=====Acute Tubular Necrosis=====

	*Caused by both the toxin itself and the septic shock		*Caused by both the toxin itself and the septic shock
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	*Suffocation from aspiration of the pseudomembrane		*Suffocation from aspiration of the pseudomembrane
	*Rarely, bacteremia, endocarditis, and arthritis from hematogenous spread		*Rarely, bacteremia, endocarditis, and arthritis from hematogenous spread
			*Can have post-infectious, autoimmune-mediated complications including neuropathy and carditis
	*Mortality 3-12% even now, usually from asphyxiation or myocarditis, but is rare in immunized patients		*Mortality 3-12% even now, usually from asphyxiation or [[myocarditis]], but is rare in immunized patients

	===Cutaneous Diphtheria===		===Cutaneous Diphtheria===

			*Usually caused by non-toxigenic strains
	*Can also cause chronic non-healing ulcers with dirty-gray membrane, often with concomitant [[Staphylococcus aureus]] or [[Streptococcus pyogenes]]		*Can also cause chronic non-healing ulcers with dirty-gray membrane (or not), often with concomitant [[Staphylococcus aureus]] or [[Streptococcus pyogenes]]
	*Generally not invasive and can cause immunity, but also ~~contribute~~ to the organism's reservoir		*Generally not invasive and can cause immunity, but also contributes to the organism's reservoir

	===Asymptomatic Carrier State===		===Asymptomatic Carrier State===
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	*Common in areas that do not vaccinate, as well as inner cities and rural areas		*Common in areas that do not vaccinate, as well as inner cities and rural areas

	=== Non-Toxigenic Strains ===		===Non-Toxigenic Strains===

	* ~~Can~~ cause [[bacteremia]] and [[endocarditis]], particularly in those with chronic alcohol use, dental disease, and intravenous drug use		*As well as cutaneous diphtheria, these strains can also cause [[bacteremia]] and [[endocarditis]], particularly in those with chronic alcohol use, dental disease, and intravenous drug use

	==Differential Diagnosis==		==Differential Diagnosis==
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	**Can also collect a piece of pseudomembrane		**Can also collect a piece of pseudomembrane
	**Notify lab, who will use modified Tinsdale agar or cystine-tellurite blood agar		**Notify lab, who will use modified Tinsdale agar or cystine-tellurite blood agar
	**Gram stain should show classic coryneform "Chinese letter" appearance		**Gram stain should show classic coryneform "Chinese letter" appearance, which may be dismissed as normal respiratory flora unless specific testing for diphtheria is requested
		⚫	*Culture requires Tinsdale medium (contains teluride and cysteine), inhibits non-pathogenic [[Corynebacterium species]]
	*PCR for the toxin gene exists
			*PCR for the toxin gene exists, and is followed by serology to demonstrate toxin production
	*Culture
			*Serology is done for ''tox'' gene positive strains using the Elek test
⚫	**Tinsdale medium (contains teluride and cysteine), inhibits non-pathogenic [[Corynebacterium species]]

	==Management==		==Management==
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	**Preemptive intubation is recommended in most situations		**Preemptive intubation is recommended in most situations
	**May require tracheotomy if severe		**May require tracheotomy if severe
			**May be useful to add [[carnithine]] to improve myocardial function
	*If concern for pharyngeal diphtheria, then need to treat presumptively with antitoxin and penicillin while awaiting confirmation of the diagnosis		*If concern for pharyngeal diphtheria, then need to treat presumptively with antitoxin and penicillin while awaiting confirmation of the diagnosis
	*Start with with equine-derived diphtheria antitoxin (DAT)		*Start with with equine-derived diphtheria antitoxin (DAT)
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	*Also treat with a 14-day course of an appropriate antibiotic		*Also treat with a 14-day course of an appropriate antibiotic
	**[[Is treated by::Procaine penicillin G]] 600,000 units IM q12h (300,000 units if weight ≤10 kg)		**[[Is treated by::Procaine penicillin G]] 600,000 units IM q12h (300,000 units if weight ≤10 kg)
	***Can switch or oral penicillin once able to take oral medication		***Can switch or oral [[penicillin]] once able to take oral medication
	**[[Is treated by::Erythromycin]] 40 mg/kg/day (max 2 g) PO/IV divided qid		**[[Is treated by::Erythromycin]] 40 mg/kg/day (max 2 g) PO/IV divided qid
	*Test of cure should be done at least 24 hours after completing treatment, with two cultures from both nose and throat at least 24 hours apart		*Test of cure should be done at least 24 hours after completing treatment, with two cultures from both nose and throat at least 24 hours apart
			**If still positive, extend treatment for another 10 days
			*After acute illness, still need to vaccinate since infection does not generate long-term immunity

	===Cutaneous Diphtheria===		===Cutaneous Diphtheria===
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	*Indicated for healthcare workers exposed to nasopharyngeal secretions, household contacts, other habitual close contacts, people sharing utensils or kitchen facilities, and childcare workers		*Indicated for healthcare workers exposed to nasopharyngeal secretions, household contacts, other habitual close contacts, people sharing utensils or kitchen facilities, and childcare workers
	**Indicated ''regardless of'' immunization status		**Indicated ''regardless of'' immunization status
			**Even if the contact is transient, but excludes those who were wearing appropriate PPE at the time
	*Procedure		*Procedure
	**Monitor for symptoms for 7 days		**Monitor for symptoms for 7 days

Aidan at 01:45, 26 November 2020

2020-11-26T01:45:00Z

← Older revision		Revision as of 01:45, 26 November 2020
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	===History===		===History===

	*~~Derived~~ from the Greek word for leather		*The name diphtheria is derived from the Greek word for leather, based on the appearance of the pseudomembrane that the organism produces

	===Microbiology===		===Microbiology===
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	===Pathophysiology===		===Pathophysiology===

	*~~Contains~~ a polypeptide exotoxin that is cleaved into ~~segment~~ ~~A, the active segment, and segment B~~, which ~~binds receptors on susceptible cells (heparin-binding epidermal growth~~ ~~factor~~ ~~receptor)~~		*Toxigenic strains produce a polypeptide exotoxin that is cleaved into two segments, which comprise three domains
	*Segment A ~~enters~~ the ~~cytosol~~ ~~after~~ B ~~binds~~, and ~~inactivates~~ ~~mammalian~~ ~~tRNA~~ ~~translocase~~ ~~(elongation~~ factor ~~2), which stops protein synthesis~~		**Segment B contains the receptor-binding and transmembrane domains, and facilitates binding to heparin-binding epidermal growth factor receptor
			**Segment A is the active segment, which enters the cytosol after B binds and inactivates mammalian tRNA translocase (elongation factor 2), thus stopping protein synthesis and killing the cell
⚫	**Affects all cells, but heart, nerves, and kidneys are particularly sensitive
			***A single molecule is enough to kill a cell
⚫	*In the respiratory tract, causes the formation of a necrotic coagulum of fibrin, WBCs, RBCs, and epithelial cells
		⚫	*The exotoxin affects all cells, but heart, nerves, and kidneys are particularly sensitive
		⚫	*In the respiratory tract, exotoxin causes the formation of a necrotic coagulum of fibrin, WBCs, RBCs, and epithelial cells
	**Appears clinically as a pseudomembrane		**Appears clinically as a pseudomembrane
			*The lethal dose may be as low as 100 ng/kg body weight

	===Epidemiology===		===Epidemiology===
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	**May also be carried by horses, cattle, and domestic cats		**May also be carried by horses, cattle, and domestic cats
	*Disease is rare in immunized populations		*Disease is rare in immunized populations
			*Risk factors include travel or residence within an epidemic or endemic setting, and a history of inadequate vaccination
	*Currently, the highest rates are seen in India, and particularly in Kerala state in people older than 10 years		**Currently, the highest rates are seen in India, and particularly in Kerala state in people older than 10 years
	*Maternal antibodies provide immunity until about 6 months		*Maternal antibodies provide immunity until about 6 months

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	===Diphtheria===		===Diphtheria===

	*Clinical syndrome of pharyngeal infection with systemic toxicity caused by ''C. diphtheriae'' and ''C. ulcerans''		*Clinical syndrome of pharyngeal infection with systemic toxicity caused by ''C. diphtheriae'' and ''[[Corynebacterium ulcerans\|C. ulcerans]]''
	*Incubation period of [[Usual incubation period::2 to 4 days]]		*Incubation period of [[Usual incubation period::2 to 4 days]]
	*Low-grade fever, hoarseness, pain, and laryngeal pseudomembrane that can cause stridor and obstruction		*Low-grade fever, hoarseness, pain, and laryngeal pseudomembrane that can cause stridor and obstruction
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	=====Myocarditis=====		=====Myocarditis=====

	*10-25% of cases		*Occurs in 10-25% of cases
	*Can range from acute heart failure and cardiogenic shock to more subacute heart failure and dilatation		*Can range from acute heart failure and cardiogenic shock to more subacute heart failure and dilatation
	**Can be monitored with AST (?and troponin?)		**Can be monitored with AST (?and troponin?)
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	*''C. diphtheriae'' not particularly invascive and can colonize the respiratory tract and skin		*''C. diphtheriae'' not particularly invascive and can colonize the respiratory tract and skin
	*Common in areas that do not vaccinate, as well as inner cities and rural areas		*Common in areas that do not vaccinate, as well as inner cities and rural areas

			=== Non-Toxigenic Strains ===

			* Can cause [[bacteremia]] and [[endocarditis]], particularly in those with chronic alcohol use, dental disease, and intravenous drug use

	==Differential Diagnosis==		==Differential Diagnosis==
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	*[[Vincent angina]]		*[[Vincent angina]]
	*[[Acute epiglottitis]]		*[[Acute epiglottitis]]
			*Retropharyngeal space infection
			*Oropharyngeal candidiasis
			*Acute HIV syndrome

	==Diagnosis==		==Diagnosis==
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	*Should be treated to prevent transmission to others		*Should be treated to prevent transmission to others
	*[[Benzathine penicillin G]] 600,000 (<6 years) to 1,200,000 (≥6 years) ~~units~~ IM once, or [[erythromycin]] 40 mg/kg/day (max 1 g) for 7 to 10 days		*[[Benzathine penicillin G]] 600,000 units (<6 years) to 1,200,000 units (≥6 years) IM once, or [[erythromycin]] 40 mg/kg/day (max 1 g) for 7 to 10 days
	*If cultures still positive after treatment, do another 10-day course of [[erythromycin]] (more effective than [[penicillin]])		*If cultures still positive after treatment, do another 10-day course of [[erythromycin]] (more effective than [[penicillin]])

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	===Infection Control===		===Infection Control===

	*Contact precautions for cutaneous diphtheria, droplet precautions for pharyngeal diphtheria		*Contact precautions for cutaneous diphtheria, contact and droplet precautions for pharyngeal diphtheria
	*Must be in isolation until treatment is completed ''and'' until two negative cultures at 24 ~~hour~~ ~~intervals~~		*Must be in isolation until treatment is completed ''and'' until two negative cultures collected at least 24 hours apart

	===Prophylaxis===		===Prophylaxis===

	*Indicated for healthcare workers exposed to nasopharyngeal secretions, household contacts, other habitual close contacts, people sharing utensils or kitchen facilities, and childcare workers		*Indicated for healthcare workers exposed to nasopharyngeal secretions, household contacts, other habitual close contacts, people sharing utensils or kitchen facilities, and childcare workers
	*Indicated regardless of immunization status		**Indicated ''regardless of'' immunization status
	*Procedure		*Procedure
	**Monitor for symptoms for 7 days		**Monitor for symptoms for 7 days
	**Collect culture specimens before treatment		**Collect culture specimens before treatment
	**Antimicrobial prophylaxis with either [[benzathine penicillin G]] 600,000 (<30 kg) to 1,200,000 (≥30 kg) ~~units~~ IM once, or [[erythromycin]] 40 mg/kg/day (max 1 g) for 7 to 10 days		**Antimicrobial prophylaxis with either [[benzathine penicillin G]] 600,000 units (<30 kg) to 1,200,000 units (≥30 kg) IM once, or [[erythromycin]] 40 mg/kg/day (max 1 g) for 7 to 10 days
	**Repeat culture after treatment, and repeat a 10-day course of [[erythromycin]] if still positive (more effective than [[penicillin]])		**Repeat culture after treatment, and repeat a 10-day course of [[erythromycin]] if still positive (more effective than [[penicillin]])
	*If previously vaccinated, give a Td/Tdap booster if it's been more than 5 years from last dose		*If previously vaccinated, give a Td/Tdap booster if it's been more than 5 years from last dose
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	**Asymptomatic carriage still occurs, though at a lower population level		**Asymptomatic carriage still occurs, though at a lower population level
	*Diphtheria toxoid vaccine is given as a ≥3-dose series in childhood		*Diphtheria toxoid vaccine is given as a ≥3-dose series in childhood
	**Typically in combination with others (e.g. DTaP-IPV-HiB at 2, 4, 6, and 18 months		**Typically in combination with others (e.g. DTaP-IPV-HiB at 2, 4, 6, and 18 months)
	**Adult catch-up schedule would be Tdap followed 4 weeks later by Td followed 6 to 12 months later by another Td		**Adult catch-up schedule would be Tdap followed 4 weeks later by Td followed 6 to 12 months later by another Td
	*Adults should get a Tdap booster in adulthood at least once, and Td booster every 10 years		*Adults should get a Tdap booster in adulthood at least once, and Td booster every 10 years

Aidan at 01:22, 26 November 2020

2020-11-26T01:22:56Z

← Older revision		Revision as of 01:22, 26 November 2020
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	===Microbiology===		===Microbiology===

	*Non-spore-forming, pleomorphic, unencapsulated, nonmotile [[Stain::Gram-positive]] [[Shape::bacillus]] with clubbed ends		*Non-spore-forming, [[Shape::pleomorphic]], unencapsulated, nonmotile [[Stain::Gram-positive]] [[Shape::bacillus]] with clubbed ends
	*Needs to be cultured on special media, so notify the lab		*Needs to be cultured on special media, so notify the lab
	**On Loeffler medium, outgrows other throat flora by 12 to 18 hours		**On Loeffler medium, outgrows other throat flora by 12 to 18 hours
	*Classic "Chinese character" appearance on Gram stain (pallisading) of all [[Corynebacterium species\|corynebacteria]]		*Classic "Chinese character" appearance on Gram stain (pallisading) of all [[Corynebacterium species\|corynebacteria]]
	*Metachromatic granules on methylene blue		*Metachromatic granules on methylene blue
	*Four biovars: gravis, intermedius, mitis, and belfanti		*Four biovars: ''gravis'', ''intermedius'', ''mitis'', and ''belfanti''
	**Based on morphology, fermentation, and hemolysis, but now more often based on PCR ribotyping		**Based on morphology, fermentation, and hemolysis, but now more often based on PCR ribotyping
	**Not clinically significant		**Not clinically significant
			*Exotoxin production is provided by the ''tox'' gene
			**The gene is carried by bacteriophages, which convert non-toxigenic strains into toxigenic ones
			**Toxin production is not necessary for the life cycle

	===Pathophysiology===		===Pathophysiology===

	*Contains a polypeptide exotoxin that is cleaved into segment A, the active segment, and B, which binds receptors on susceptible cells (heparin-binding epidermal growth factor receptor)		*Contains a polypeptide exotoxin that is cleaved into segment A, the active segment, and segment B, which binds receptors on susceptible cells (heparin-binding epidermal growth factor receptor)
	*Segment A enters the cytosol after B binds, and inactivates mammalian tRNA translocase (elongation factor 2), which stops protein synthesis		*Segment A enters the cytosol after B binds, and inactivates mammalian tRNA translocase (elongation factor 2), which stops protein synthesis
	**Affects all cells, but heart, nerves, and kidneys are particularly sensitive		**Affects all cells, but heart, nerves, and kidneys are particularly sensitive
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	*Mostly occurs in colder months		*Mostly occurs in colder months
	*Asymptomatic carriage is an important reservoir for the organism, with 3-5% carriage rates in endemic areas		*Asymptomatic carriage is an important reservoir for the organism, with 3-5% carriage rates in endemic areas
			**May also be carried by horses, cattle, and domestic cats
			*Disease is rare in immunized populations
			*Currently, the highest rates are seen in India, and particularly in Kerala state in people older than 10 years
			*Maternal antibodies provide immunity until about 6 months

	==Clinical Manifestations==		==Clinical Manifestations==
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	===Cutaneous Diphtheria===		===Cutaneous Diphtheria===

	*Can also cause chronic non-healing ulcers with dirty-gray membrane, often with ~~concommitant~~ ~~''Staph.~~ aureus'' or ~~group~~ ~~A streptococci~~		*Can also cause chronic non-healing ulcers with dirty-gray membrane, often with concomitant [[Staphylococcus aureus]] or [[Streptococcus pyogenes]]
	*Generally not invasive and can cause immunity, but also contribute to the organism's reservoir		*Generally not invasive and can cause immunity, but also contribute to the organism's reservoir

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	**Adult catch-up schedule would be Tdap followed 4 weeks later by Td followed 6 to 12 months later by another Td		**Adult catch-up schedule would be Tdap followed 4 weeks later by Td followed 6 to 12 months later by another Td
	*Adults should get a Tdap booster in adulthood at least once, and Td booster every 10 years		*Adults should get a Tdap booster in adulthood at least once, and Td booster every 10 years

	{{DISPLAYTITLE:''Corynebacterium diphtheriae''}}		{{DISPLAYTITLE:''Corynebacterium diphtheriae''}}
	[[Category:Gram-positive bacilli]]		[[Category:Gram-positive bacilli]]

Aidan: Text replacement - "[[Has cell shape::" to "[[Shape::"

2020-10-15T04:28:18Z

Text replacement - "[[Has cell shape::" to "[[Shape::"

← Older revision		Revision as of 04:28, 15 October 2020
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	===Microbiology===		===Microbiology===

	*Non-spore-forming, pleomorphic, unencapsulated, nonmotile [[Stain::Gram-positive]] [[~~Has cell shape~~::bacillus]] with clubbed ends		*Non-spore-forming, pleomorphic, unencapsulated, nonmotile [[Stain::Gram-positive]] [[Shape::bacillus]] with clubbed ends
	*Needs to be cultured on special media, so notify the lab		*Needs to be cultured on special media, so notify the lab
	**On Loeffler medium, outgrows other throat flora by 12 to 18 hours		**On Loeffler medium, outgrows other throat flora by 12 to 18 hours

Aidan at 14:25, 8 October 2020

2020-10-08T14:25:28Z

← Older revision		Revision as of 14:25, 8 October 2020
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	*Needs to be cultured on special media, so notify the lab		*Needs to be cultured on special media, so notify the lab
	**On Loeffler medium, outgrows other throat flora by 12 to 18 hours		**On Loeffler medium, outgrows other throat flora by 12 to 18 hours
	*Classic "Chinese character" appearance on Gram stain (pallisading) of all ~~Corynebacteria~~		*Classic "Chinese character" appearance on Gram stain (pallisading) of all [[Corynebacterium species\|corynebacteria]]
	*Metachromatic granules on methylene blue		*Metachromatic granules on methylene blue
	*Four biovars: gravis, intermedius, mitis, and belfanti		*Four biovars: gravis, intermedius, mitis, and belfanti
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	**Gram stain should show classic coryneform "Chinese letter" appearance		**Gram stain should show classic coryneform "Chinese letter" appearance
	*PCR for the toxin gene exists		*PCR for the toxin gene exists
			*Culture
			**Tinsdale medium (contains teluride and cysteine), inhibits non-pathogenic [[Corynebacterium species]]

	==Management==		==Management==

Aidan: /* Tubular necrosis */

2020-09-18T23:39:23Z

Tubular necrosis

← Older revision		Revision as of 23:39, 18 September 2020
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	*Asymptomatic carriage is an important reservoir for the organism, with 3-5% carriage rates in endemic areas		*Asymptomatic carriage is an important reservoir for the organism, with 3-5% carriage rates in endemic areas

	== Clinical Manifestations ==		==Clinical Manifestations==

	===Diphtheria===		===Diphtheria===
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	**Generally fully resolves with time		**Generally fully resolves with time

	=====Tubular ~~necrosis~~=====		=====Tubular Necrosis=====

	*Caused by both the toxin itself and the septic shock		*Caused by both the toxin itself and the septic shock
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	*Common in areas that do not vaccinate, as well as inner cities and rural areas		*Common in areas that do not vaccinate, as well as inner cities and rural areas

	== Differential Diagnosis ==		==Differential Diagnosis==

	*[[Infectious mononucleosis]]		*[[Infectious mononucleosis]]
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	==Management==		==Management==

	=== Pharyngeal Diphtheria ===		===Pharyngeal Diphtheria===

	*Supportive management, with a focus on airway protection		*Supportive management, with a focus on airway protection
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	*Test of cure should be done at least 24 hours after completing treatment, with two cultures from both nose and throat at least 24 hours apart		*Test of cure should be done at least 24 hours after completing treatment, with two cultures from both nose and throat at least 24 hours apart

	=== Cutaneous Diphtheria ===		===Cutaneous Diphtheria===

	* Treated with a 14-day course of antibiotics, as above		*Treated with a 14-day course of antibiotics, as above
	* Test of cure should be done at least 24 hours after completing treatment, with two cultures from cutaneous lesions at least 24 hours apart		*Test of cure should be done at least 24 hours after completing treatment, with two cultures from cutaneous lesions at least 24 hours apart

	=== Asymptomatic Carrier State ===		===Asymptomatic Carrier State===

	* Should be treated to prevent transmission to others		*Should be treated to prevent transmission to others
	* [[Benzathine penicillin G]] 600,000 (<6 years) to 1,200,000 (≥6 years) units IM once, or [[erythromycin]] 40 mg/kg/day (max 1 g) for 7 to 10 days		*[[Benzathine penicillin G]] 600,000 (<6 years) to 1,200,000 (≥6 years) units IM once, or [[erythromycin]] 40 mg/kg/day (max 1 g) for 7 to 10 days
	* If cultures still positive after treatment, do another 10-day course of [[erythromycin]] (more effective than [[penicillin]])		*If cultures still positive after treatment, do another 10-day course of [[erythromycin]] (more effective than [[penicillin]])

	== Prevention ==		==Prevention==

	===Infection Control===		===Infection Control===
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	===Vaccination===		===Vaccination===

	* The available vaccine is against diphtheria toxin, so protects against the harmful effects of infection but does not directly prevent infection		*The available vaccine is against diphtheria toxin, so protects against the harmful effects of infection but does not directly prevent infection
	** Asymptomatic carriage still occurs, though at a lower population level		**Asymptomatic carriage still occurs, though at a lower population level
	* Diphtheria toxoid vaccine is given as a ≥3-dose series in childhood		*Diphtheria toxoid vaccine is given as a ≥3-dose series in childhood
	** Typically in combination with others (e.g. DTaP-IPV-HiB at 2, 4, 6, and 18 months		**Typically in combination with others (e.g. DTaP-IPV-HiB at 2, 4, 6, and 18 months
	** Adult catch-up schedule would be Tdap followed 4 weeks later by Td followed 6 to 12 months later by another Td		**Adult catch-up schedule would be Tdap followed 4 weeks later by Td followed 6 to 12 months later by another Td
	* Adults should get a Tdap booster in adulthood at least once, and Td booster every 10 years		*Adults should get a Tdap booster in adulthood at least once, and Td booster every 10 years
	{{DISPLAYTITLE:''Corynebacterium diphtheriae''}}		{{DISPLAYTITLE:''Corynebacterium diphtheriae''}}
	[[Category:Gram-positive bacilli]]		[[Category:Gram-positive bacilli]]

Aidan at 11:20, 17 August 2020

2020-08-17T11:20:19Z

Show changes

Aidan: /* Pathophysiology */

2020-08-17T09:31:32Z

Pathophysiology

Show changes

Aidan: /* Clinical Manifestations */

2020-08-05T14:05:43Z

Clinical Manifestations

← Older revision		Revision as of 14:05, 5 August 2020
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	=== Clinical Manifestations ===		=== Clinical Manifestations ===
	* Incubation period of 2-4 days		* Incubation period of [[Usual incubation period::2 to 4 days]]
	* Low-grade fever, hoarseness, pain, and laryngeal pseudomembrane that can cause stridor and obstruction		* Low-grade fever, hoarseness, pain, and laryngeal pseudomembrane that can cause stridor and obstruction
	** Pseudomembrane starts white but later dirty gray with patches of green or black		** Pseudomembrane starts white but later dirty gray with patches of green or black