Affiliation:
1. Department of Infectious and Tropical Diseases, Villeneuve St. Georges Hospital, France.
Abstract
Diphtheria is a disease with a long history that almost completely disappeared from developed countries. In addition, until 1987, systemic infections involving Corynebacterium diphtheriae were rare. However, in 1990, an epidemic occurred in Russia. These two circumstances have provided the stimulus to gain insight into the situation in France. In fact, between 1987 and 1993, a total of 59 C. diphtheriae strains were isolated. Epidemiological data were collected for patients from whom 40 strains were isolated from normally sterile sites, including 34 from blood cultures, and half of the bacteremic patients developed endocarditis. Osteoarticular involvement was noted in 11 of these 40 patients, including 5 bacteremic patients. The fatality rate following bacteremia was 36%, despite specific antibiotic treatment (beta-lactams and aminoglycosides). The mean age of the participants was 38 years, with half of the patients subsisting under low socioeconomic conditions and suffering from homelessness or alcoholism. Apparently, the skin turned out to be the major route of transmission in this reemerging disease. Eighty-eight percent of the isolates belonged to the C. diphtheriae biotype mitis. These were found predominantly in the Paris area, and most were of the same ribotype. Those isolates originating from the overseas territories (Guyana and New Caledonia) belonged to C. diphtheriae biotype gravis. No strains were positive for the tox gene by PCR. This study attests to the persistent circulation in France of C. diphtheriae in the form of systemic infections. The matter is especially significant since these strains are nontoxigenic and are of a unique ribotype. The strains are, however, sensitive to most antibiotics, although 20% are rifampin resistant.
Publisher
American Society for Microbiology
Reference29 articles.
1. Le point sur la diphtérie en France de 1984 à 1987;Bacou J.;Bull. Epidemiol. Heb.,1987
2. An atypical case of Corynebacterium diphtheriae endocarditis and subsequent outbreak control measures;Booth L. V.;J. Infect.,1995
3. Molecular epidemiology of Corynebacterium diphtheriae from northwestern Russia and surrounding countries studied by using ribotyping and pulsed-field gel electrophoresis;De Zoysa A.;J. Clin. Microbiol.,1995
4. Efstratiou A. and P. A. C. Maple. 1994. Manual for the laboratory diagnosis of diphtheria. World Health Organization publication no. ICP/EPI 038 (C). World Health Organization Copenhagen Denmark.
5. Resurgence of diphtheria;Galaska A. M.;Eur. J. Epidemiol.,1995
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