CLINICAL AND MOLECULAR STUDY OF CORYNEBACTERIUM-DIPHTHERIAE SYSTEMIC INFECTIONS IN FRANCE

Diphtheria is a disease with a long history that almost completely dis appeared from developed countries. In addition, until 1987, systemic i nfections involving Corynebacterium diphtheriae were rare, However, in 1990, an epidemic occurred in Russia, These two circumstances have pr ovided the stimulus to gain insight into the situation in France, In f act, between 1987 and 1993, a total of 59 C. diphtheriae strains were isolated, Epidemiological data were collected for patients from whom 4 0 strains were isolated from normally sterile sites, including 34 from blood cultures, and half of the bacteremic patients developed endocar ditis, Osteoarticular involvement was noted in 11 of these 40 patients , including 5 bacteremic patients, The fatality rate following bactere mia was 36%, despite specific antibiotic treatment (beta-lactams and a minoglycosides). The mean age of the participants was 38 years, with h alf of the patients subsisting under low socioeconomic conditions and suffering from homelessness or alcoholism, Apparently, the skin turned out to be the major route of transmission in this reemerging disease, Eighty-eight percent of the isolates belonged to the C. diphtheriae b iotype mitis. These were found predominantly in the Paris area, and mo st were of the same ribotype. Those isolates originating from the over seas territories (Guyana and New Caledonia) belonged to C. diphtheriae biotype gravis, No strains were positive for the tox gene by PCR, Thi s study attests to the persistent circulation in France of C. diphther iae in the form of systemic infections, The matter is especially signi ficant since these strains are nontoxigenic and are of a unique riboty pe, The strains are, however, sensitive to most antibiotics, although 20% are rifampin resistant.