Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species (Part 5)

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Management Patients in whom diphtheria is suspected should be hospitalized in respiratory isolation rooms, with close monitoring of cardiac and respiratory function. A cardiac workup is recommended to assess the possibility of myocarditis. In patients with extensive pseudomembranes, consultation with an anesthesiologist or an ear, nose, and throat specialist is recommended because of the possibility that tracheostomy or intubation will be required. In some settings, pseudomembranes can be removed surgically. Treatment with glucocorticoids has not been shown to reduce the risk of myocarditis or polyneuropathy. Prognosis Fatal pseudomembranous diphtheria typically occurs in patients with nonprotective antibody titers and in unimmunized patients. ...

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Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species (Part 5) Management Patients in whom diphtheria is suspected should be hospitalized in respiratory isolation rooms, with close monitoring of cardiac and respiratory function. A cardiac workup is recommended to assess the possibility of myocarditis. In patients with extensive pseudomembranes, consultation with an anesthesiologist or an ear, nose, and throat specialist is recommended because of the possibility that tracheostomy or intubation will be required. In some settings, pseudomembranes can be removed surgically. Treatment with glucocorticoids has not been shown to reduce the risk of myocarditis or polyneuropathy. Prognosis Fatal pseudomembranous diphtheria typically occurs in patients with nonprotective antibody titers and in unimmunized patients. The pseudomembrane may increase in size from the time it is first noted. Risk factors for death include
bullneck diphtheria; myocarditis with ventricular tachycardia; atrial fibrillation; complete heart block; an age of >60 years or
years old. As of 2006, it is recommended that (1) adults 19–64 years old receive a single dose of Tdap if their last dose of Td (tetanus and reduced-dose diphtheria toxoids, adsorbed) was >10 years earlier and (2) intervals of
Nondiphtherial Corynebacteria and Related Species Nondiphtherial corynebacteria, which are also referred to as diphtheroids or coryneforms, are a widely diverse collection of bacteria that are taxonomically lumped together on the basis of their 16S rDNA signature nucleotides. The diversity of this group is exemplified by the wide range in guanine-plus-cytosine content (45–70%). Although frequently considered colonizers or contaminants, the nondiphtherial corynebacteria have been associated with invasive disease, particularly in immunocompromised patients. Specifically, for example, these organisms have been implicated in bacteremia, particularly in association with catheterization, endocarditis, prosthetic valve infection, meningitis, neurosurgical shunt infection, brain abscess, peritonitis (often in the setting of chronic ambulatory peritoneal dialysis), osteomyelitis, septic arthritis, urinary tract infection, empyema, and pneumonia. Patients infected with nondiphtherial corynebacteria usually have significant medical comorbidity or immunosuppression. Several of these organisms, including C. jeikeium and C. urealyticum, are associated with resistance to multiple antibiotics. The related organism Rhodococcus equi is associated with necrotizing pneumonia and granulomatous infection, particularly in immunocompromised individuals. Other related species that can cause infections in humans are Actinomyces (formerly Corynebacterium) pyogenes and Arcanobacterium (formerly Corynebacterium) haemolyticum.