Corynebacterium Infections Follow-up: Inpatient & Outpatient Medications, Deterrence/Prevention, Complications

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Follow-up

Inpatient & Outpatient Medications

See Medication.

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. A reduced antigen booster (combined with tetanus and pertussis) is available that is highly immunogenic with low reactogenicity.^[47]

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.^[48]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.^[49]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. In 2012, the American College of Obstetrics and Gynecology announced their findings that the toxoid in Tdap vaccine was not associated with adverse fetal outcomes and published their revised guidelines.^[50]

Complications

See History and Lab Studies.

Prognosis

See History and Lab Studies.

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 patient education resources, see the Children's Health Center and Public Health Center, as well as Immunization Schedule, Children and Immunization Schedule, Adults.

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Media Gallery

The corynebacterial tox gene is regulated by the corynebacterial iron-binding repressor, labeled DtxR. Binding of ferrous iron to the DtxR molecule forms a complex that binds to the tox gene operator and inhibits transcription. Depletion of iron from the system removes the repression and allows the toxin to be produced.
The characteristic thick membrane of diphtheria infection in the posterior pharynx.
Cervical edema and cervical lymphadenopathy from diphtheria infection produce a bullneck appearance in this child. (Source: Public Domain www.immunize.org/images/ca.d/ipcd1861/img0002.htm)

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