THE RETURN OF CORYNEBACTERIUM-DIPHTHERIAE - THE RISE OF NONTOXIGENIC STRAINS

With the decline in incidence of diphtheria in Europe and the USA, man y laboratories no longer routinely culture throat swabs for Corynebact erium diphtheriae. However, there is an outbreak of infection with tox igenic strains in Russia and most adults do not have protective levels of antibody. Non-toxigenic strains are known to cause local disease a nd lysogenic conversion probably occurs in vivo as well as in vitro. N on-toxigenic C. diphtheriae var. gravis, formerly quite rare, has been isolated with increasing frequency in the UK over the last five years . During prospective screening at one Sexually Transmitted Disease Cli nic, six (1%) of 578 homosexual men were found to harbour the organism in the throat, four of them with clinical pharyngitis. Only one of 16 96 heterosexual men and women were found to be carriers. Seven cases o f endocarditis due to this organism were reported in a single year in Sydney, Australia and non-toxigenic C. diphtheriae var. mitis has caus ed four cases of endocarditis in Switzerland. Non-toxigenic strains ar e responsible for pharyngitis and occasional invasive disease and shou ld be treated. Routine screening of throat swabs should not be abandon ed.