CORYNEBACTERIA

QUIAMBAO, JERIKA C.
MD2
AUGUST 7, 2015

LEARNING OBJECTIVES
Describe th morphology of

Corynebacterium
Enumerate the important
members of the genus
Corynebacteria
C. diphtheriae
C. xerosis
C. hofmanii

LEARNING OBJECTIVES
Discuss the

characteristics/virulence factors
of Corynebacterium diphtheriae
by relating it to the following:
Diseases produced
Host response
Laboratory identification
Treatment
Preventive and control
Epidemiological features

Corynebacterium
Morphology:
From the Greek word karyne which means club
0.5-1.0 um in diameter and several micrometers long
Gram-positive pleomorphic rods
Palisade form (picket fence appearance)
Irregularly distributed within the rods, usually near
the poles that give them club-shaped appearance
With metachromatic granules as storage granules
Once stained with methylene blue, staining does not
appear uniform
Most metachromatic granules made of phosphates
Beaded appearance
Resembles Chinese letters

Corynebacterium
Other Characteristics:
Aerobic or facultative
Non-motile; Non-sporeforming
Non-acid fast
Positive reaction for catalase
Positive reaction for cytochrome
oxidase
Widely distibuted in nature, commonly
found in soil and water
Reside on the skin and mucous
membranes of humans

Corynebacterium
diphtheriae
Causative agent of Respiratory or

Cutaneous Diphtheria
Incubation period: 2-4 days
Spread by droplets or contact with a
susceptible carrier
Grow on mucous membranes or in skin
abrasions
Primary target cells are upper
respiratory tracts, heart, and nerves
In vitro production depends on the iron
concentration

Diphtheria Toxin
Heat labile polypeptide (MW 62,000)
Fragment B- required for:
Binding to the receptor of the toxin (receptor
domain)
Transfer of A into the cell (translocation
domain)
Fragment A active site
Inhibits polypeptide elongation by

inactivating EF-2 (Elongation Factor-2) by

NAD-riboxylation

Diphtheria
Diphtheria toxin is absorbed into the

mucous membranes and causes

destruction of epithelium and a
superficial inflammatory response
Results in a firmly adherent, dirty, gray,
spreading pseudomembrane composed
of inflammatory necrosis, fibrin,
epithelial cells, neutrophils, monocytes,
and bacteria

Diphtheria
Wound or skin diphtheria
occurs chiefly in the tropics, among

alcoholics, homeless individuals and

other impoverished groups
A membrane may form on an
infected wound
Absorption of toxin is usually slight
and the systemic effect is negligible

Diphtheria
Virulence
Attributable to their capacity for

establishing infection, growing

rapidly, and then quickly elaborating
toxin that is effectively absorbed
C. diphtheriae does not actively
invade deep tissues

DIAGNOSTIC LABORATORY
TESTS
Clinical
NO rapid laboratory tests
Direct smears
Alkaline methylene blue
Gram stain
Beaded rods in typical

arrangement

DIAGNOSTIC LABORATORY
TESTS
Specimen
Swab

Pseudomembrane nasal swabs

Tonsillar fossae, posterior pharynx
Retriuvular areas, nares
Other involved sites, cutaneous

lesions
Transport Medium: Semi-solid
transport media
Swab specimen easily dehydrated

Less than 24 hours Amies or

Stuart

DIAGNOSTIC LABORATORY
TESTS
Media

Blood Agar Plate (BAP)

Used to rule out hemolytic streptococci
Colonies appear small, granular, and

gray with a small zone of hemolysis

DIAGNOSTIC LABORATORY
TESTS
Media

Tellurite Agar Plate

e.g. Cystine-tellurite blood agar
(CTBA); modified Tinsdales medium
Reduces tellurite to tellurium
Inhibits most normal flora
Black or brownish colonies
Biotypes: gravis, intrmedius, and mitis

DIAGNOSTIC LABORATORY
TESTS
Elek Test
Commercially prepared strips of filter
paper containing diphtheria antitoxin
are in the agar medium perpendicular
to the streaks of the patients strain,
a known toxin-producing strain and a
non-producing strain
Where diffused toxin (if produced y
the growth) and antitoxin meet at
optimal concentrations, a precipitin
line is seen in the agar

TREATMENT
Antitoxin
From horses, sheep, goat, and rabbits
Antitoxin should be given intravenously on
the day of clinical diagnosis of diphtheria
is made and need not to be repeated
Intramuscular antitoxin: mild cases
Erythromycin or Penicillin
Inhibit growth of organisms
Eliminate coexistent streptococci and

C. diphtheriae in carriers

PREVENTION
Diptheria toxoid immunization
DPT - Diphtheria, Pertussis, Tetanus
DT Diphtheria and Tetanus (for children
younger than 7 years old
Td Diphtheria and Tetanus (for
adolescents and adults)

PRIMARY PREVENTION: limit

the distribution of toxigenic
diphtheria bacilli and
maintain high level of active
immunization

CONTROL
Strict isolation for pharyngeal

diphtheria
Contact isolation for cutaneous

diphtheria
Until 2 negative cultures or
after 14 days of antibiotic
therapy

Other Coryneform bacteria

Classification
Nonlipophilic Corynebacteria
Lipophilic Corynebacteria

Other Coryneform bacteria

Nonlipophilic Corynebacteria
C. ulcerans
C. pseudotuberculosis
C.xerosis
C. striatum
C. minutissimum
C. aycolatum
C. auris ear infection in children
C. pseudodiphtheriticum - respiratory

tract infection
C. uronalyticum urinary tract pathogen

Other Coryneform bacteria

Lipophiilic Corynebacteria
C. jikeium nosocomial infections
C. Urealyticum urinary tract infection

Other Coryneform bacteria

Corynebacterium xerosis
Commonly encountered in

conjucntival sacs
Recovered from patients with
prosthetic-valve endocarditis

Corynebacterium hofmanii
Normal inhabitant of pharynx
Recovered from the blood of

patients with subacute bacterial

endocarditis

References:
Jawetz, Melnick & Adelbergs Medical Microbiology, 26th Edition
Burrows Textbook of Microbiology, 22nd Edition
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Thank you for

listening!