Corynebacterium Infections Treatment & Management: Medical Care, Surgical Care, Consultations

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Treatment

Medical Care

For the initial office visit or emergency department treatment, see Diphtheria in the Medscape Reference Emergency Medicine section.

C diphtheriae

Since the early 1900s, diphtheria antitoxin (DAT), produced in horses, has been the mainstay of therapy. The antiserum works only to neutralize the toxin before it enters the cell. The antiserum is thought to be more effective in less severely ill patients and in those who are treated earlier in the disease course. Therefore, more severely ill patients and those with longer symptom duration are given higher doses than those with less severe disease of shorter duration. Whether this is an effective way of dosing the antiserum has never been tested.

Many people show signs of hypersensitivity reactions to the horse antiserum, and a test dose is usually given, with epinephrine available in case the patient has a severe reaction. However, because the mortality rate associated with antiserum has declined markedly, desensitization with increasing doses of antiserum is recommended.

Antibiotics treatment is the second arm of treatment. The goal is both to kill the organism and to terminate toxin production. Many antibiotics are effective, including penicillin, erythromycin, clindamycin, rifampin, and tetracycline; erythromycin or penicillin is the treatment of choice and is usually given for 14 days.

Supportive care is also important, including rest, airway management, observation for development of secondary lung infections, and management of cardiac and neurologic disease complications.

Diphtheroids

Antibiotics are the treatment of choice for nondiphtherial corynebacteria infections. Many species and groups are sensitive to various antibiotics, including penicillins, macrolide antibiotics, rifampin, and fluoroquinolones. However, antibiotic susceptibility can vary, and susceptibility testing is recommended. A review by Riegel et al on identification and antimicrobial sensitivity in 415 corynebacterial isolates from clinical specimens of patients hospitalized in Strasbourg, France, demonstrated that many species or groups were susceptible to ampicillin, cefotaxime, and rifampicin.^[41]Many species or groups were resistant to erythromycin, and 2 groups (ie, JK, C urealyticum) were resistant to nearly every drug tested.

Another review, by Spanik et al, examined risk factors for disease with corynebacteria.^[42]Of 123 episodes of breakthrough bacteremia during antibiotic prophylaxis in patients with cancer, 10% were from corynebacteria causing indwelling catheter infections. In this review, catheter removal and modification of antimicrobial therapy, depending on susceptibility testing, were independent risk factors for an improved outcome.

Surgical Care

The mainstay of treatment for these infections is nonsurgical. However, a case report discussed necrotizing lymphadenitis that was unresponsive to repeated antibiotic therapy, requiring surgical drainage and adequate debridement of the infected area.^[43]

Consultations

The World Health Organization expanded its network of laboratories after the outbreaks of diphtheria in the Russian republics; the Diphtheria Surveillance Network integrates epidemiologic and microbiologic aspects of potentially toxigenic corynebacteria.^[38]

The US Centers for Disease Control and Prevention (CDC) is the source for antitoxin (ie, DAT) in the United States. If treating suspected cases of diphtheria, contact the diphtheria duty officer at 800-CDC-INFO (800-232-4636).

Report all suspected cases of diphtheria to local and state health departments. Local infectious disease specialists who work with the CDC are available 24 hours a day through the local public health department for help with symptoms and disease management.

Cardiologists, pulmonary specialists, and neurologists may help in the care of patients who have specific disease complications.

Medication

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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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