eMedicine Specialties > Infectious Diseases > Bacterial Infections

Corynebacterium Infections: Follow-up

Author: Lynda A Frassetto, MD, Associate Clinical Professor, Department of Internal Medicine, University of California at San Francisco School of Medicine
Contributor Information and Disclosures

Updated: Jun 30, 2008

Follow-up

Inpatient & Outpatient Medications

See Medication.

Deterrence/Prevention

  • Vaccination
    • As mentioned above, childhood immunization is the prevention method of choice. Diphtheria/tetanus/pertussis (DTP) vaccine, given at ages 2, 4, and 6 months; at age 15-18 months; and at least 5 years later (age 4-6 y) is the immunization regimen recommended by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians.
    • Unvaccinated people older than 7 years or people whose immunization status is unknown should receive 3 doses of the adult formulation of the tetanus-diphtheria toxoid (Td). The first 2 doses are given 4-8 weeks apart, and the third dose is given 6-12 months later. The first booster dose of Td should be given at least 5 years after the last immunization and every 10 years thereafter.
    • Adverse reactions include local induration, pain, redness, and, occasionally, low-grade fevers. Serum sickness hypersensitivity reactions are reported in some adults.
    • Vaccination coverage levels are monitored by the CDC National Immunization Survey, which estimates vaccination coverage for the 50 states. Compared with the baseline year of 1992, national coverage with 4 or more doses of DTP increased significantly, from 55% to 78%.
    • In comparison, some industrialized countries have much lower immunization levels. In a recent seroepidemiologic study from Spain, only 26% of the sample population of 3944 men and women aged 5-59 years were fully protected and more than 85% of those aged 20-39 years had little or no protection against diphtheria.28 In other Western countries, serologic protection was found in 50-80% of subjects, with some countries showing a greater protection rate in older subjects (eg, Sweden) and some countries showing a greater protection rate in younger subjects (eg, Germany, France, Turkey, Slovakia).
    • Risks for travelers, therefore, are higher in parts of the world where immunization levels are low and the disease is prevalent. The Health Protection Agency Centre for Infections in the United Kingdom recommends boosters every 10 years for travelers planning to visit areas of endemic disease.29 The CDC has an up-to-date Web site on diphtheria prevention for the public at www.cdc.gov/travel/diseases/dtp.htm.
    • In 2008, the Advisory Committee on Immunization Practices (ACIP) issued guidelines on the prevention of pertussis, tetanus, and diphtheria in pregnant and postpartum women and their infants. Details can be found at http://www.medscape.com/viewarticle/574587.

Complications

Prognosis

Patient Education

  • Vaccination is the key to preventing C diphtheriae infections. Public health services and individual physicians are important resources for providing appropriate treatments. Vaccination is especially important for high-risk groups (eg, children, elderly individuals, immigrants from areas of continued endemic infections).
  • Infections with other diphtheroids are becoming an increasingly important problem in immunocompromised individuals; updated education of physicians caring for these patients is needed.
  • For excellent patient education resources, visit eMedicine's Children's Health Center and Public Health Center. Also, see eMedicine's patient education articles Immunization Schedule, Children and Immunization Schedule, Adults.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize pseudomembrane of diphtheria
  • Failure to administer antitoxin and antimicrobials promptly while awaiting culture-proven diagnosis
  • Failure to anticipate respiratory arrest due to obstruction
  • Failure to refer contacts for treatment and testing
  • Failure to contact appropriate health organizations for epidemiologic tracking and treatment of contacts

Special Concerns

  • Pregnancy: Vaccination of susceptible pregnant women is advised by the American College of Obstetrics and Gynecology. Infants born to mothers with high antibody titers are not protected and require the usual vaccinations. In 2008, the Advisory Committee on Immunization Practices (ACIP) issued guidelines on the prevention of pertussis, tetanus, and diphtheria in pregnant and postpartum women and their infants. Details can be found at http://www.medscape.com/viewarticle/574587.
 


More on Corynebacterium Infections

Overview: Corynebacterium Infections
Differential Diagnoses & Workup: Corynebacterium Infections
Treatment & Medication: Corynebacterium Infections
Follow-up: Corynebacterium Infections
Multimedia: Corynebacterium Infections
References
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Further Reading

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Keywords

Corynebacterium infection, corynebacterial infection, corynebacterial disease, diphtheria, diphtheroids, Corynebacterium diphtheriae, C diphtheriae, Corynebacterium ulcerans, C ulcerans, Corynebacterium pseudotuberculosis, C pseudotuberculosis, Corynebacterium ovis, C ovis, Corynebacterium pyogenes, C pyogenes, Corynebacterium haemolyticum, C haemolyticum, Corynebacterium aquaticum, C aquaticum, Corynebacterium pseudodiphtheriticum, C pseudodiphtheriticum, Corynebacterium hofmannii, C hofmannii, Corynebacterium urealyticum, C urealyticum, Corynebacterium jeikeium, C jeikeium, Corynebacterium renale, C renale, Corynebacterium cystidis, C cystidis, Corynebacterium pilosum, C pilosum, Corynebacterium bovis, C bovis, Corynebacterium striatum, C striatum, Corynebacterium xerosis, C xerosis, Corynebacterium seminale, C seminale, Corynebacterium macginleyi, C macginleyi

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Contributor Information and Disclosures

Author

Lynda A Frassetto, MD, Associate Clinical Professor, Department of Internal Medicine, University of California at San Francisco School of Medicine
Lynda A Frassetto, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology
Disclosure: Nothing to disclose.

Medical Editor

John M Leedom, MD, Professor of Medicine, Keck School of Medicine, University of Southern California; Chief, Division of Infectious Diseases, Department of Internal Medicine, Los Angeles County, University of Southern California Medical Center
John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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