• Andreas Burkovski


Diphtheria is a paradigm of an infectious disease caused by the toxigenic bacteria Corynebacterium diphtheriae and Corynebacterium ulcerans. Classical diphtheria of the upper respiratory tract, which is transmitted by breathing or coughing, is characterized by a thick pseudomembrane, which forms as a result of cell damage and fibrin deposition. In severe cases, obstruction of airways results in suffocation and death. In tropical and subtropical regions respiratory tract diphtheria is outnumbered by diphtheria of the skin. Common sites for this cutaneous form, which is characterized by lesions covered by a smeary coating, are the lower legs, feet, and hands.

Today the infection can be eliminated easily using antibiotics and the detrimental exotoxin can be neutralized by an antitoxin. Nevertheless, immunization using a highly effective toxoid vaccine is the mean of choice for diphtheria control. Despite the advances made in diphtheria therapy and control, outbreaks reaching even epidemic proportions have been observed during the last decades. Today, several thousand diphtheria cases per year are reported to the World Health Organization, showing that diphtheria is not completely eradicated and that reservoirs exist. These are, for example, groups of people with insufficient access to medical care and also animals seem to play a role as reservoirs of the infection. Isolation of C. diphtheriae strains were reported from domestic cats and horses and animal reservoirs are even more common, when Corynebacterium ulcerans is taken into consideration, which has been detected as a commensal in various domestic and wild animals.


Diphtheria Toxin Splenic Abscess Diphtheria Toxoid Gentian Violet Mass Immunization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Allen CE, Schmitt MP (2009) HtaA is an iron-regulated hemin binding protein involved in the utilization of heme iron in Corynebacterium diphtheriae. J Bacteriol 191:2638–2648PubMedCrossRefGoogle Scholar
  2. Baba M, Gilliatt RW, Harding AE, Reiners K (1984) Demyelination following diphtheria toxin in the presence of axonal atrophy. J Neurol Sci 64:199–211PubMedCrossRefGoogle Scholar
  3. Baird GJ, Fontaine MC (2007) Corynebacterium pseudotuberculosis and its role in ovine caseous lymphadenitis. J Comp Pathol 137:179–210PubMedCrossRefGoogle Scholar
  4. Barksdale L (1970) Corynebacterium diphtheriae and its relatives. Bacteriol Rev 34:378–422PubMedGoogle Scholar
  5. Barksdale L, Linder R, Sulea IT, Pollice M (1981) Phospholipase D activity of Corynebacterium pseudotuberculosis (Corynebacterium ovis) and Corynebacterium ulcerans, a distinctive marker within the genus Corynebacterium. J Clin Microbiol 13:335–343PubMedGoogle Scholar
  6. Belmares J, Detterline S, Pak JB, Parada JP (2007) Corynebacterium endocarditis species-specific risk factors and outcomes. BMC Infect Dis 7:4PubMedCrossRefGoogle Scholar
  7. Begg N (1994) Manual of the management and control of diphtheria in the European region. Vol ICP/EPI 038 (B). World Health Organization, CopenhagenGoogle Scholar
  8. Bezjak V, Farsey SJ (1970a) Corynebacterium diphtheriae carriership in Ugandan children. J Trop Pediatr 16:12–16PubMedCrossRefGoogle Scholar
  9. Bezjak V, Farsey SJ (1970b) Corynebacterium diphtheriae in skin lesions in Ugandan children. Bull World Health Organ 43:643–650PubMedGoogle Scholar
  10. Bibb LA, Schmitt MP (2010) The ABC transporter HrtAB confers resistance to hemin toxicity and is regulated in a hemin-dependent manner by the ChrAS two-component system in Corynebacterium diphtheriae. J Bacteriol 192:4606–4617PubMedCrossRefGoogle Scholar
  11. Bonmarin I, Guiso N, Le Fleche-Mateos A, Patey O, Patrick ADG, Levy-Bruhl D (2009) Diphtheria: a zoonotic disease in France? Vaccine 27:4196–4200PubMedCrossRefGoogle Scholar
  12. Bostock AD, Gilbert FR, Lewis D, Smith DC (1984) Corynebacterium ulcerans infection associated with untreated milk. J Infect 9:286–288PubMedCrossRefGoogle Scholar
  13. Buck GA, Cross RE, Wong TP, Loera J, Groman N (1985) DNA relationships among some tox-bearing corynebacteriophages. Infect Immun 49(3):679–684PubMedGoogle Scholar
  14. Cerdeno-Tarraga AM, Efstratiou A, Dover LG, Holden MTG, Pallen M, Bentley SD, Besra GS, Churcher C, James KD, De Zoysa A, Chillingworth T, Cronin A, Dowd L, Feltwell T, Hamlin N, Holroyd S, Jagels K, Moule S, Quail MA, Rabbinowitch E, Rutherford KM, Thomson NR, Unwin L, Whitehead S, Barrell BG, Parkhill J (2003) The complete genome sequence and analysis of Corynebacterium diphtheriae NCTC13129. Nucleic Acids Res 31:6516–6523PubMedCrossRefGoogle Scholar
  15. Cianciotto NP, Groman NB (1996) Extended host range of a beta-related corynebacteriophage. FEMS Microbiol Lett 140:221–225PubMedGoogle Scholar
  16. Connell TG, Rele M, Daley AJ, Curtis N (2005) Skin ulcers in a returned traveler. Lancet 365:726PubMedGoogle Scholar
  17. Corboz L, Thoma R, Braun U, Zbinden R (1996) Isolation of Corynebacterium diphtheriae subsp. belfanti from a cow with chronic active dermatitis. Schweiz Arch Tierheilkd 138:596–599 (article in German)PubMedGoogle Scholar
  18. Davidson S, Rotem Y, Bogkowski B, Rubinstein E (1976) Corynebacterium diphtheriae endocarditis. Am J Med Sci 271:351–353PubMedCrossRefGoogle Scholar
  19. De Zoysa A, Hawkey PM, Engler K, George R, Mann G, Reilly W, Taylor D, Efstratiou A (2005) Characterization of toxigenic Corynebacterium ulcerans strains isolated from humans and domestic cats in the United Kingdom. J Clin Microbiol 43:4377–4381PubMedCrossRefGoogle Scholar
  20. Dessau RB, Brandt-Christensen M, Jensen OJ, Tonnesen P (1995) Pulmonary nodules due to Corynebacterium ulcerans. Eur Respir J 8:651–653PubMedGoogle Scholar
  21. Dias AAOS, Silva FC Jr, Santos LS, Ribeiro-Carvalho MM, Sabbadini PS, Santos CS, Filardy AA, Miyoshi A, Azevedo VA, Hirata R Jr, Villas-Boas MHS, Mattos-Guaraldi AL (2011) Strain-dependent arthritogenic potential of the zoonotic pathogen Corynebacterium ulcerans. Vet Microbiol. doi:10.1016/j.metmic.2011.06.007Google Scholar
  22. Dittmann S, Wharton M, Vitek C, Ciotti M, Galazka A, Guichard S, Hardy I, Kartoglu U, Koyama S, Kreysler J, Martin B, Mercer D, Ronne T, Roure C, Steinglass R, Strebel P, Sutter R, Trostle M (2000) Successful control of epidemic diphtheria in the states of the former Union of Soviet Socialist Republics: lessons learned. J Infect Dis 181(suppl 1):S10–S22PubMedCrossRefGoogle Scholar
  23. Dixon B (2010) Sick as a dog. Lancet 10:73Google Scholar
  24. Dolman C (1973) Landmarks and pioneers in the control of diphtheria. Can J Pub Health 64:317–336Google Scholar
  25. Dorella FA, Pacheco LG, Oliveira SC, Miyoshi A, Azevedo V (2006) Corynebacterium pseudotuberculosis: microbiology, biochemical properties, pathogenesis and molecular studies of virulence. Vet Res 37:201–218PubMedCrossRefGoogle Scholar
  26. Edwards B, Hunt AC, Hoskisson PA (2011) Recent cases of non-toxigenic Corynebacterium diphtheriae in Scotland: justification of continued surveillance. J Med Microbiol 60:561–562PubMedCrossRefGoogle Scholar
  27. Efstratiou A, Engler KH, Dawes CS, Sesardic D (1998) Comparison of phenotypic and genotypic methods for detection of diphtheria toxin among isolates of pathogenic corynebacteria. J Clin Microbiol 36:3173–3177PubMedGoogle Scholar
  28. English PC (1985) Diphtheria and theories of infectious disease: centennial appreciation of the critical role of diphtheria in the history of medicine. Pediatrics 76:1–9PubMedGoogle Scholar
  29. Eskola J, Lumio J, Vuopio-Varkila J (1998) Resurgent diphtheria – are we safe? Br Med Bull 54:635–645PubMedCrossRefGoogle Scholar
  30. Falnes PO, Sandvig K (2000) Penetration of protein toxins into cells. Curr Opin Cell Biol 12:407–413PubMedCrossRefGoogle Scholar
  31. Galazka AM, Robertson SE, Oblapenko GP (1995) Resurgence of diphtheria. Eur J Epidemiol 11:95–105PubMedCrossRefGoogle Scholar
  32. Galazka A (2000) The changing epidemiology of diphtheria in the vaccine era. J Infect Dis 181(suppl 1):S2–S9PubMedCrossRefGoogle Scholar
  33. Gilbert L (1997) Infections with Corynebacterium diphtheriae – changing epidemiology and clinical manifestations. Report of the third international meeting of the European Laboratory Working Group on Diphtheria (ELWGD), Institute Pasteur (Paris, 7–8 June 1996). Commun Dis Intell 21:161–164PubMedGoogle Scholar
  34. Gomes DLR, Martins CAS, Faria LMD, Santos LS, Santos CS, Sabbadini PS, Souza MC, Alves GB, Rosa ACP, Nagao PE, Pereira GA, Hirata R Jr, Mattos-Guaraldi AL (2009) Corynebacterium diphtheriae as an emerging pathogen in nephrostomy catheter-related infection: evaluation of traits associated with bacterial virulence. J Med Microbiol 58:1419–1427PubMedCrossRefGoogle Scholar
  35. Groman NB (1984) Conversion by corynephages and its role in the natural history of diphtheria. J Hyg 93:405–417CrossRefGoogle Scholar
  36. Grundbacher FJ (1992) Behring’s discovery of diphtheria and tetanus antitoxins. Immunol Today 13:188–190PubMedCrossRefGoogle Scholar
  37. Hadfield TL, McEvoy P, Polotsky Y, Tzinserling VA, Yakovlev AA (2000) The pathology of diphtheria. J Infect Dis 181(suppl 1):S116–S120PubMedCrossRefGoogle Scholar
  38. Hall AJ, Cassiday PK, Bernard KA, Bolt F, Steigerwalt AG, Bixler D, Pawloski LC, Whitney AM, Iwaki M, Baldwin A, Dowson CG, Komiya T, Takahashi M, Henrikson HP, Tondella ML (2010) Novel Corynebacterium diphtheriae in domestic cats. Emerg Infect Dis 16:688–691PubMedCrossRefGoogle Scholar
  39. Hamour AA, Efstratiou A, Neill R, Dunbar EM (1995) Epidemiology and molecular characterization of toxigenic Corynebacterium diphtheriae var mitis from a case of cutaneous diphtheria in Manchester. J Infect 31:153–157PubMedCrossRefGoogle Scholar
  40. Hardy IRB, Dittmann S, Sutter RW (1996) Current situation and control strategies for resurgence of diphtheria in newly independent states of the former Soviet Union. Lancet 347:1739–1744PubMedCrossRefGoogle Scholar
  41. Hart RJ (1984) Corynebacterium ulcerans in humans and cattle in North Devon. J Hyg (Lond) 92:161–164CrossRefGoogle Scholar
  42. Hatanaka A, Tsunoda A, Okamoto M, Ooe K, Nakamura A, Miyakoshi M, Komiya T, Takahashi M (2003) Corynebacterium ulcerans in Japan. Emerg Infect Dis 9:752–753PubMedCrossRefGoogle Scholar
  43. Henricson B, Segarra M, Garvin J, Burns J, Jenkins S, Kim C, Popovic T, Golaz A, Akey A (2000) Toxigenic Corynebacterium diphtheriae associated with an equine wound infection. J Vet Diagn Invest 12:253–257PubMedCrossRefGoogle Scholar
  44. Hirata R Jr, Pereira GA, Filardy AA, Gomes DLR, Damasco PV, Rosa ACP, Nagao PE, Pimenta FP, Mattos-Guaraldi AL (2008) Potential pathogenic role of aggregative-adhering Corynebacterium diphtheriae of different clonal groups in endocarditis. Braz J Med Biol Res 41:986–991CrossRefGoogle Scholar
  45. Höfler W (1991) Cutaneous diphtheria. Int J Dermatol 30:845–847PubMedCrossRefGoogle Scholar
  46. Holmes RK (2000) Biology and molecular epidemiology of diphtheria toxin and the tox gene. J Infect Dis 181(suppl 1):S156–S167PubMedCrossRefGoogle Scholar
  47. Homna Y, Yoshii Y, Watanabe Y, Aoki N, Komiya T, Iwaki M, Arai H, Arakawa Y, Takahashi M, Kimura H (2009) A case of afebrile pneumonia caused by non-toxigenic Corynebacterium diphtheriae. Jpn J Infect Dis 62:327–329Google Scholar
  48. Isaac-Renton JL, Boyko WJ, Chan R, Crichton E (1981) Corynebacterium diphtheriae septicemia. Am J Clin Pathol 75:631–634PubMedGoogle Scholar
  49. Iwaki M, Komiya T, Yamamoto A, Ishiwa A, Nagata N, Arakawa Y, Takahashi M (2010) Genome organization and pathogenicity of Corynebacterium diphtheriae C7(−) and PW8 strains. Infect Immun 78:3791–3800PubMedCrossRefGoogle Scholar
  50. John TJ (2008) Resurgence of diphtheria in India in the 21st century. Indian J Med Res 128:669–670Google Scholar
  51. Klebs E (1883) Ueber Diphtherie. Verh Cong Inn Med 2:139–154Google Scholar
  52. Kline MW, Kaplan SL (1998) Infections, immunizations, and principles of antimicrobial therapy. In: Garson A, Bricker JT, Fisher DJ, Neish SR (eds) The science and practice of pediatric cardiology. Williams and Wilkins, Baltimore, pp 2856–2857Google Scholar
  53. Kneen R, Giao PN, Solomon T, Van TTM, Hoa NTT, Long TB, Wain J, Day NPJ, Hien TT, Parry CM, White NJ (1998) Penicillin vs. erythromycin in the treatment of diphtheria. Clin Infect Dis 27:845–850PubMedCrossRefGoogle Scholar
  54. Kolodkina V, Denisevich T, Titov L (2011) Identification of Corynebacterium diphtheriae gene involved in adherence to epithelial cells. Infect Genet Evol 11:518–521PubMedCrossRefGoogle Scholar
  55. Kwantes W (1984) Diphtheria in Europe. J Hyg (Camb) 93:433–437CrossRefGoogle Scholar
  56. Lehmann KB, Neumann R (1896) Atlas und Grundriss der Bakteriologie und Lehrbuch der speziellen bakteriologischen Diagnostik. Lehmann, MunichGoogle Scholar
  57. Leggett BA, De Zoysa A, Abbott YE, Leonard N, Markey B, Efstratiou A (2010) Toxigenic Corynebacterium diphtheriae isolated from a wound in a horse. Vet Rec 166:656–657PubMedCrossRefGoogle Scholar
  58. Levy FM (1973) The 50th anniversary of diphtheria and tetanus immunization. Prev Med 4:226–237CrossRefGoogle Scholar
  59. Liebow AA, MacLean PD, Bumstead JM (1946) Tropical ulcers and cutaneous diphtheria. Arch Intern Med 78:255–295CrossRefGoogle Scholar
  60. Livingood CS, Perry D, Forrester JS (1946) Cutaneous diphtheria: report of 140 cases. J Invest Dermatol 7:341–364PubMedCrossRefGoogle Scholar
  61. Loeffler F (1884) Untersuchungen über die Bedeutung der Mikroorganismen für die Entstehung der Diphtherie beim Menschen, bei der Taube und beim Kalbe. Mitt Klein Gesundheitsamte, Berlin, vol 2, pp 421–499Google Scholar
  62. Lord JM, Smith DC, Roberts LM (1999) Toxin entry: how bacterial proteins get into mammalian cells. Cell Microbiol 1:85–91PubMedCrossRefGoogle Scholar
  63. Lowe CF, Bernard KA, Romney MG (2011) Cutaneous diphtheria in the urban poor population of Vancouver, British Columbia: a 10-year review. J Clin Microbiol 49:2664–2666PubMedCrossRefGoogle Scholar
  64. MacGregor RR (1995) Corynebacterium diphtheriae. In: Mandell GL, Douglas JE, Dolin R (eds) Principles and practice of infectious diseases, 4th edn. Churchill Livingston, New York, pp 1866–1869Google Scholar
  65. Marston CK, Jamieson F, Cahoon F, Lesiak G, Golaz A, Reeves M, Popovic T (2001) Persistence of a distinct Corynebacterium diphtheriae clonal group within two communities in the United States and Canada where diphtheria is endemic. J Clin Microbiol 39:1586–1590PubMedCrossRefGoogle Scholar
  66. Mattos-Guaraldi AL, Sampaio JL, Santos CS, Pimenta FP, Pereira GA, Pacheco LG, Miyoshi A, Azevedo V, Moreira LO, Gutierrez FL, Costa JL, Costa-Filho R, Damasco PV, Camello TC, Hirata R Jr (2008) First detection of Corynebacterium ulcerans producing a diphtheria-like toxin in a case of human with pulmonary infection in the Rio de Janeiro metropolitan area, Brazil. Mem Inst Oswaldo Cruz 103:396–400PubMedCrossRefGoogle Scholar
  67. McKean S, Davies J, Moore R (2005) Identification of macrophage-induced genes of Corynebacterium pseudotuberculosis by differential fluorescence induction. Microbes Infect 7:1352–1363PubMedCrossRefGoogle Scholar
  68. Menon T, Senthilkumar S, Pachaiyappan P (2010) Native valve endocarditis caused by a non-toxigenic strain of Corynebacterium diphtheriae. Indian J Pathol Microbiol 53:899–900PubMedCrossRefGoogle Scholar
  69. Mishra B, Dignan RJ, Hughes CF, Hendel N (2005) Corynebacterium diphtheriae endocarditis – surgery for some but not all! Asian Cardiovasc Thorac Ann 13:119–126PubMedGoogle Scholar
  70. Mokrousov I (2009) Corynebacterium diphtheriae: genome diversity, population structure and genotyping perspectives. Infect Genet Evol 9:1–15PubMedCrossRefGoogle Scholar
  71. Murphy JR (1996) Corynebacterium diphtheriae. In: Baron S (ed) Medical microbiology, 4th edn. University of Texas Medical Branch at Galveston, Galveston, pp 99–100, Chapter 32Google Scholar
  72. Murray K, Noble M (1985) In vitro studies on the comparative sensitivities of cells of the central nervous system to diphtheria toxin. J Neurol Sci 70(3):283–293PubMedCrossRefGoogle Scholar
  73. Muttaiyah S, Best EJ, Freeman JT, Taylor SL, Morris AJ, Roberts SA (2011) Corynebacterium diphtheriae endocarditis: a case series and review of the treatment approach. Int J Infect Dis. doi:10.1016/j.ijid.2011.04.003Google Scholar
  74. Naglich JG, Metherall JE, Russell DW, Eidels L (1992) Expression cloning of a diphtheria toxin receptor: identity with a heparin-binding EGF-like growth factor precursor. Cell 69:1051–1061PubMedCrossRefGoogle Scholar
  75. Neal SE, Efstratiou A, on the behalf of DIPNET and International Diphtheria Reference Laboratories (2009) International external quality assurance for laboratory diagnosis of diphtheria. J Clin Microbiol 47:4037–4042Google Scholar
  76. Nikolaeva IN, Astaf’eva NV, Barer GM, Parkhomenko IG, Iushchuck ND, Petina GK, Vorob’ev AS (1995) Diphtheria of the oral mucosa. Stomatologiia 74:26–28PubMedGoogle Scholar
  77. Nureki S, Miyazaki E, Matsuno O, Takenaka R, Ando M, Kumamoto T, Nakano T, Ohkusu K, Ezaki T (2007) Corynebacterium ulcerans infection of the lung mimicking the histology of Churg-Strauss syndrome. Chest 131:1237–1239PubMedCrossRefGoogle Scholar
  78. Ott L, Höller M, Gerlach RG, Hensel M, Rheinlaender J, Schäffer TE, Burkovski A (2010) Corynebacterium diphtheriae invasion-associated protein (DIP1281) is involved in cell surface organization, adhesion and internalization in epithelial cells. BMC Microbiol 10:2PubMedCrossRefGoogle Scholar
  79. Pappenheimer AM Jr (1977) Diphtheria toxin. Annu Rev Biochem 46:69–94PubMedCrossRefGoogle Scholar
  80. Park WH, Williams AW (1896) The production of diphtheria toxin. J Exp Med 1:164–185PubMedCrossRefGoogle Scholar
  81. Pereira GA, Pimenta FP, dos Santos FRW, Damasco PV, Hirata R Jr, Mattos-Guaraldi AL (2008) Antimicrobial resistance among Brazilian Corynebacterium diphtheriae strains. Mem Inst Oswaldo Cruz 103:507–510PubMedCrossRefGoogle Scholar
  82. Perles Z, Nir A, Cohen E, Bashary A, Engelhard D (2000) Atrioventricular block in a toxic child: do not forget diphtheria. Pediatr Cardiol 21:282–283PubMedCrossRefGoogle Scholar
  83. Popovic T, Mazurova IK, Efstratiou A, Vuopio-Varkila J, Reeves MW, De Zoysa A, Glushkevich T, Grimont P (2000) Molecular epidemiology of diphtheria. J Infect Dis 181(suppl 1):S168–S177PubMedCrossRefGoogle Scholar
  84. Puliti M, von Hunolstein C, Marangi M, Bistoni F, Tissi L (2006) Experimental model of infection with non-toxigenic strains of Corynebacterium diphtheriae and development of septic arthritis. J Med Microbiol 55:229–235PubMedCrossRefGoogle Scholar
  85. Riegel P, Ruimy R, de Briel D, Prevost G, Jehl F, Christen R, Monteil H (1995) Taxonomy of Corynebacterium diphtheriae and related taxa, with recognition of Corynebacterium ulcerans sp. nov. nom. rev. FEMS Microbiol Lett 126:271–276PubMedCrossRefGoogle Scholar
  86. Rogers EA, Das A, Ton-That H (2011) Adhesion by pathogenic corynebacteria. Adv Exp Med Biol 715:91–103PubMedCrossRefGoogle Scholar
  87. Romney MG, Roscoe DL, Bernard K, Lai S, Efstratiou A, Clarke AM (2006) Emergence of an invasive clone of nontoxigenic Corynebacterium diphtheriae in the urban poor population of Vancouver, Canada. J Clin Microbiol 44:1625–1629PubMedCrossRefGoogle Scholar
  88. Roush SW, Murphy TV, The Vaccine-Preventable Disease Table Working Group (2007) Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA 298:2155–2163Google Scholar
  89. Roux E, Yersin A (1888) Contribution à l’étude de la diphtérie. Ann Inst Pasteur 2:629–661Google Scholar
  90. Schnell D, Beyler C, Lanternier F, Lucron H, Lebeaux D, Bille E, Bonnet D, lortholary O, Nassif X, Zahar JR, Bajolle F (2010) Nontoxigenic Corynebacterium diphtheriae as a rare cause of native endocarditis in childhood. Pediatr Infect Dis J 29:886–888PubMedCrossRefGoogle Scholar
  91. Schuhegger R, Schoerner C, Dlugaiczyk J, Lichtenfeld I, Trouillier A, Zeller-Peronnet V, Busch U, Berger A, Kugler R, Hörmansdorfer S, Sing A (2009) Pigs as source for toxigenic Corynebacterium ulcerans. Emerg Infect Dis 15:1314–1315PubMedCrossRefGoogle Scholar
  92. Schuhegger R, Lindermayer M, Kugler R, Heesemann J, Busch U, Sing A (2008) Detection of toxigenic Corynebacterium diphtheriae and Corynebacterium ulcerans strains by a novel real-time PCR. J Clin Microbiol 46:2822–2823PubMedCrossRefGoogle Scholar
  93. Shashikala P, Reddy PV, Prashanth K, Kanungo R, Devi S, Anitha P, Rajarajeshweri N, Cherian TM (2011) Persistence of nontoxigenic Corynebacterium diphtheriae biotype gravis in Pondicherry, Southern India. J Clin Microbiol 49:763–764PubMedCrossRefGoogle Scholar
  94. Sing A, Hogardt M, Bierschenk S, Heesemann J (2003) Detection of differences in the nucleotide and amino acid sequences of diphtheria toxin from Corynebacterium diphtheriae and Corynebacterium ulcerans causing extrapharyngeal infections. J Clin Microbiol 41:4848–4851PubMedCrossRefGoogle Scholar
  95. Sing A, Bierschenk S, Heesemann J (2005) Classical diphtheria caused by Corynebacterium ulcerans in Germany: amino acid sequence differences between diphtheria toxins from Corynebacterium diphtheriae and C. ulcerans. Clin Infect Dis 40:325–326PubMedCrossRefGoogle Scholar
  96. Sing A, Berger A, Schneider-Brachert W, Holzmann T, Reischl U (2011) Rapid detection and molecular identification of toxigenic Corynebacterium diphtheriae and Corynebacterium ulcerans strains by LightCycler PCR. J Clin Microbiol 49(7):2485–2489, PMID 21593261PubMedCrossRefGoogle Scholar
  97. Soares SC, Dorella FA, Pacheco LGC, Hirata R Jr, Mattos-Guaraldi AL, Azevedo V, Miyoshi A (2011) Plasticity of Corynebacterium diphtheriae pathogenicity islands revealed by PCR. Genet Mol Res 10:1290–1294PubMedCrossRefGoogle Scholar
  98. Sykes JE, Mapes S, Lindsay LL, Samitz E, Byrne BA (2010) Corynebacterium ulcerans bronchopneumonia in a dog. J Vet Intern Med 24:973–976PubMedCrossRefGoogle Scholar
  99. Tiwari TSP, Golaz A, Yu DT, Ehresmann KR, Jones TF, Hill HE, Cassiday PK, Pawloski LC, Moran JS, Popovic T, Wharton M (2008) Investigations of 2 cases of diphtheria-like illness due to toxigenic Corynebacterium ulcerans. Clin Infect Dis 46:395–401PubMedCrossRefGoogle Scholar
  100. Vitek CR (2006) Diphtheria. Curr Top Microbiol Immunol 34:71–94CrossRefGoogle Scholar
  101. von Bering EA (1890) Über das Zustandekommen der Diphtherie – Immunität und der Tetanus – Immunität bei Thieren. Dtsch Med Wochenschr 16:113–114Google Scholar
  102. Von Hunolstein C, Rota MC, Alfarone G, Ricci ML, Salmaso S, Italian Serology Working Group (2000) Diphtheria antibody levels in the Italian population. Eur J Clin Microbiol Infect Dis 19:433–437PubMedCrossRefGoogle Scholar
  103. Wagner J, Ignatius R, Voss S, Höpfner V, Ehlers S, Funke G, Weber U, Hahn H (2001) Infection of the skin caused by Corynebacterium ulcerans and mimicking classical cutaneous diphtheria. Clin Infect Dis 33:1598–1600PubMedCrossRefGoogle Scholar
  104. Wagner KS, White JM, Crowcroft NS, De Martin S, Mann G, Efstratiou A (2010) Diphtheria in the United Kingdom, 1986–2008: the increasing role of Corynebacterium ulcerans. Epidemiol Infect 138:1519–1530PubMedCrossRefGoogle Scholar
  105. Wagner KS, White JM, Neal S, Crowcroft NS, Kupreviciene N, Paberza R, Lucenko I, Joks U, Akbas E, Alexandrou-athanassoulis H, Detcheva A, Vuopio J, von Hunolstein C, Murphy PG, Andrews N, Efstratiou A (2011) Screening for Corynebacterium diphtheriae and Corynebacterium ulcerans in patients with upper respiratory tract infections 2007–2008: a multicentre European study. Clin Microbiol Infect 17:519–525PubMedCrossRefGoogle Scholar
  106. Zasada AA, Baczewska-Rej M, Wardak S (2010) The increase in non-toxigenic Corynebacterium diphtheriae infections in Poland – molecular epidemiology and antimicrobial susceptibility of strains isolated from past outbreaks and those currently circulating in Poland. Int J Infect Dis 14:e907–e912PubMedCrossRefGoogle Scholar
  107. Zuber PLF, Gruner E, Altwegg M, von Graevenitz A (1992) Invasive infection with non-toxigenic Corynebacterium diphtheriae among drug users. Lancet 339:1359PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Friedrich-Alexander-Universität Erlangen-NürnbergErlangenGermany

Personalised recommendations