Diphtheria and infections due to Corynebacterium diphtheriae in 1997.

Introduction. - Diphteria is a reemerging disease. Two epidemics recently o ccurred in Algeria and Independant States Community, not so far from Europe . Imported cases were diagnosed in contiguous European countries. This revi ew focuses on the data obtained from these epidemics, with particular empha sis on new clinical forms of Corynebacterium diphtheriae infections. Currents knowledge and key points. - Sore throat with membranes is no longe r the only clinical feature of diphtheria. However, patients' management is identical, with combination of antibiotics, injection of specific antisera , and immunization of patients' close contacts and relatives. French and Am erican sero-epidemiological studies showed that antibody levels does not pr ovide protection, particularly in the elderly. Adult populations would ther efore be at risk every 10 years. Recent advances in molecular biology led t o the development of gene amplification with polymerase chain reaction, tha t may be used for the detection of the toxin gene. They also promoted epide miological surveys of circulating strains via ribotyping. Although this tec hnic evidenced predominant strains in the various countries, genotypes enco untered during an epidemics may differ Besides diphtheria which has apparen tly been eradicated in France, systemic infections with non-toxigenic strai ns of C diphtheriae, such as endocarditis, septicemia and arthritis, are ev enly diagnosed. Future prospects and projects. - A French national reference center for C d iphtheriae has been recently created This center collects most of the strai ns isolated in France, clinical data and assesses the toxigenicity of bacte ria, allowing strict epidemiological survey. (C) 1999 Elsevier, Paris.