CORYNEBACTERIUM DIPHTHERIAE. Objectives.

At the end of the session you should be able to Describe diphtheria and explain its transmission and pathogenesis. State the imp. diagnostic criteria. State methods of prevention and control. Corynebacterium diphtheria

C. diphtheria

Pathogenesis of Diphtheria Transmission Corynebacterium diphtheriae is transmitted from carriers through aerosolized droplets; fomites. Entry respiratory droplets; organism colonizes pharynx spreads. Can also colonize the skin. . Pathogenesis of Diphtheria Multiplication iron is a likely factor Evasion of host immune response Toxin inhibits protein synthesis by ADP Ribosylation of elongation factor 2 (EF-2). may kill phagocytes contributing to pseudomembrane inflammation; circulating toxin

MORPHOLOGY OF DIPHTHERIAE Inhaled diphtheriae proliferate at the site of attachment on the mucosa of the nasopharynx,oropharynx, larynx or trachea. Release of exotoxin causes necrosis of epithelium with outpouring of dense fibrinosuppurative exudate.

Synthesis of Diphtheria Toxin Structural gene for toxin is part of genome of beta bacteriophage Phage causes lysogenic conversion Toxin synthesized as a single polypeptide chain Low iron concentration induces synthesis.

Action of Diphtheria Toxin B unit binds to heparin binding receptor H B Entire molecule is endocytosed A unit is released into cytoplasm that acts as enzyme to ADP-ribosylation of Elongation factor 2 (EF2) NAD and EF2 are substrates ADP ribose added to diphthamide residue in EF2 Protein synthesis stops and cells die.

Diphtheria

Symptoms Sore throat Low grade fever Swollen lymph glands (Bull neck) Trachael obstruction due to pseudomembrane Heart and kidney damage.

LABORATORY DIAGNOSIS Immune status of a person can be assessed by Schiks test. Grams and methylen blue stain from smear of throat swab. Culture can be done on 1-Lofflers medium. 2-Tellurite medium. 3-Blood agar. Gel diffusion precipitin test. Dicks test PCR.

Treatment and Prevention of Diphtheria Treatment Horse anti-toxin Antibiotics Prevention DPT / DTaP vaccine at 2,4 and 6 months of age and a booster at 10 years.

COMPLICATION OF DIPHTHERIA

Life threatening syndrome that includes Tough pharyngeal membrane and toxin mediated damage to the heart, nerves and other organ.

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