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which is a gram positive aerobic non motile rod shape bacteria (Amies 2005, Colin Campbell Foundation 2008). The patient in question is susceptible to this infection due to lack of immunization since birth. The diphtheria actually develops when toxigenic bacteria lodge in the upper airway or on the skin of the patient, then an intense inflammatory reaction develops leading to characteristic greyish coloured pseudo membrane that is adherent to underlying tissues and the systemic effect that follows is caused by the release of diphtheria toxin carried by a lysogenic corynebacteriophage which will be critically analysed therein (Amies 2005, Lowe et al 2011). According to Amies (2005), before diphtheria can be considered pathogenic, it must able to colonize the nasopharyngeal cavity or skin and produce the infectious diphtheria toxin. Generally, evidences have stated that diphtheria is caused by a strain of corynebacterium diphtheriae which contains a bacteriophage encoding diphtheria toxin. Interaction between exotoxin produced and cellular protein synthesis leads to tissue necrosis. Normally, chain A and B are the two components of exotoxin. Chain B is responsible for the entry of diphtheria toxin into the host cells by binding to the extracellular EGF domain of the heparin binding epidermal growth factor precursor, and the binding initiates hydrophobic domain of B fragment resulting to formation of a channel across the membrane for the passage of A fragment to cytoplasm while chain A inhibits protein synthesis and causes cell death (Pappenheimer 2009, Pottie 2011). Regarding this patient, the infection developed by the colonization of local lesion in the upper respiratory tract by corynebacterium and this results to secretion of toxin by the bacteria that causes necrotic injury to epithelial cells (CDC 1996).
Meanwhile, Corynebacterium diphtheria is responsible for the production of diphtheria toxin which is a bacteria exotoxin mainly of A and B prototype which is synthesized as a single polypeptide chain that contains a molecular of about 60,000 Daltons (Pottie 2011). Consequently; subunit A and B are the two main parts to which the function of the protein produced by the bacteria classified into. Subunit A is catalytically active and is the sole source of toxicity of diphtheria toxin while subunit B lacks enzymatic activity and less stable than the active A fragment. Each subunit plays a different role in the toxins entry into the cell (Lowe et al 2011). However, the toxicity of diphtheria comes from blocking protein synthesis in the host cell by inactivating EF-2 or cellular elongation factor which is an essential part of the translation process. As a result, free fragment A in the cytoplasm catalyses the reaction to form a covalent bond between ADP-ribose transferase and EF-2 which blocks the functional site that interacts with RNA in translation and consequently preventing all protein synthesis at a particular ribosome which eventually lead to the upper respiratory infection suffered by the boy under consideration (Pappenheimer 2009). Conclusively, before diphtheria can be considered pathogenic, it must able to colonize the nasopharyngeal cavity or skin and produce the infectious diphtheria toxin and children are most susceptible if immunization has not been administered before 2 years of age (Amies 2005, Pottie 2011).
References Amies CR (2005). The Pathogenesis of Diphtheria. Journal of Pathology and Bacteriology 67:25-41. CDC Respiratory diphtheria caused by Corynebacterium ulcerans Terre Haute, Indiana, (1996). MMWR 46:3302. Lowe CF, Bernard KA and Romney MG (2011). Cutaneous diphtheria in the Urban Poor Population of Vancouver, British Columbia. J Clin Microbiol 10:345-352. Pottie KC (2011). Diphtheria Outbreak. Clinical Vistas 167:57-65 Pappenheimer JR (2009). Diphtheria Toxin. Annual Review of Biochemistry 46:6994. Saika L, Naith R, Choudhury G and Sarkar M (2010). A Diphtheria Outbreak in Assam, India. Indian J Med Res 41:1-12 Todar, K (2011). Diphtheria Development (Online) accessed on 05.11.11 at C:\Users\bamisayobam\Documents\Lawrence\Corynebacterium diphtheria and Diphtheria.mht Colin Campbell Foundation (2008). Upper Respiratory Infection (Online) accessed on 04.11.11 at http://www.tcolincampbell.org/courses-resources/article/upperrespiratory-infection/category/infectious-diseases