Diphtheria today

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          A recent development at work is identifying all (possible) Corynebacterium in a culture. By recent, I mean within the last 12 months. For the most part, these gram positive rods tend to be harmless. In fact, they are commensal. Most of the times, we could chalk it up as normal flora unless it's in a respiratory culture.


Your basic club-looking gpb you could find on a Wiki page.

          The occasions where they could cause issues, the most notable is C. diphtheriae. Some of you might remember the hard membranes that caused suffocation. But, I'm sure many of you have received vaccinations against that particular bacteria. Often, it's in combination with tetanus and pertussis.

          What's worse is its toxins: https://en.wikipedia.org/wiki/Diphtheria_toxin.

          In short, it causes complications and destroy many of the cells in your body. Imagine your cells melting in a slow, agonizing, acidic bath.

          So, what do you have to fear if you are already vaccinated against C. diphtheriae? Well, the joke is on you because life happens. There exist other Corynebacterium species that can produce the said toxin. In this case, C. ulcernan and C. pseudotuberculosis. They are similar enough that it shouldn't be a surprise they could deliver the same problems.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC264307/

          There have been documentations in the 80s of certain toxigenic variants. Meaning, it wasn't a common occurrence. Over time, I suppose it has become more and more prevalent. Or, is it because we didn't have the technology we have today to identify risks?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406963/

          In that paper from 2012, researchers saw C. ulcernan as an emerging pathogen. Here's the best part, with possible zoonotic potential. So, the next time you hear about "diphtheria" in a diagnosis, it might not be from the traditional bacteria.

          Like I said before, life finds a way. Nature has things evolved to find new approaches to kill you the same way.

So what does the lab do?

          The lab picks out suspicious small, white/gray colonies (more so than most other bacteria) on a culture. Then, the MALDI-TOF can identify the species with high accuracy. The clinicians can decide whether they are significant or require more testing.

          I tried to search for some culture pictures, but they all seem unhelpful. The most useful snapshots are the ones that show you what this genus looks like when mixed in with other flora.

https://pubmed.ncbi.nlm.nih.gov/32727830/

          That study is from last year. It's a recent development that they are looking into more rapid identification. In particular, whether the said Corynebacterium has toxigenic potential.

          While it's extra work for lab personnel, it's not overcomplicated. And it could help physicians evaluate risks for the patient. It's not uncommon to find the bacteria on the patient's body before they actually infect them.

          In my career, I have only seen one case of diphtheria through lab work. The case involved C. diphtheriae, so this is all new to me. In this field, you do see how practices change as the organisms evolve. I remember my boss recalls the days when Pseudomonas weren't as antibiotic resistant. Nowadays, it can be one of the most resistant germs you find in a culture, causing all sorts of problems.

          Anyways, the point is that other germs can cause "diphtheria".

Posted with STEMGeeks



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15 comments
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Bang, I did it again... I just rehived your post!
Week 64 of my contest just started...you can now check the winners of the previous week!
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Tell the clinicians to go easy on antibiotics administrations. Americans need to stop dumping unused antibiotics into toilet bowls or the ocean!!!

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This has nothing to do with antibiotic use. Just a bacteria picking up a dangerous weapon from its cousin.

Try not to use buzz words.

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Tell the clinicians to go easy on antibiotics administrations.

Doesn't say in the post that says it was antibiotic induced. The virulence factor seems to support that these cousins have their own unique identities that also produce the toxin.

And assuming Americans are the only ones doing the dumping is far off the mark. It's not related to the post but are you sure those pork sold on the markets weren't fed antibiotics and shit those antibiotics to a sewer?

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Good point! I'm happily a vegetarian and growing my own organic food.

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Let's just get something straight here, you don't have full grasp of the post.

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Oh no :)

I was never vaccinated against diptheria. Polio, smallpox, yes. Whooping cough, diptheria, no. They weren't required for school entry. Back then, everybody caught whooping cough,measles and mumps. My mother had six kids. Sometimes she'd have several of us sick at the same time. Poor Mom ;)

Fortunately, none of us suffered serious side effects.

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In short, it causes complications and destroys many of the cells in your body. Imagine your cells melting in a slow, agonizing, acidic bath.

I did not know about it but now got to know. There is a lot that we need to take care to stay healthy.

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That's the layman's way of explaining it.

The more precise mechanism has more to do with the toxins inhibiting protein synthesis. This effectively causes necrosis and a dose large enough will destroy your organs.

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