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  • Title: Incidence of cutaneous diphtheria in Bangladesh.
    Author: Rahman KM, Khan HM, Haq JA.
    Journal: Bangladesh Med Res Counc Bull; 1983 Dec; 9(2):49-53. PubMed ID: 6426456.
    Abstract:
    Corynebacterium diphtheriae (C. diphtheriae) was isolated from 23 (7%) skin ulcers out of 327 cases studied. Eight (33%) of the 23 positive cases belonged to the age group of 6 to 10 years. Of the 19 strains of C. diphtheriae typed, 18 (95%) were gravis and of which 14 (77%) were toxigenic. More than 90% of the C. diphtheriae positive ulcer cases had serum anti-toxin level at or above the protective level as against 49% of control. No diphtheria bacilli were isolated from throat of any of the skin positive cases. All the ulcers from which C. diphtheriae were isolated also harboured other definite wound pathogens. It is believed that the presence of toxigenic C. diphtheriae in skin wound might play an important role in the spread of faucial diphtheriae. It is evident from serum anti-toxin level that infected persons develop natural immunity. The incidence of cutaneous and faucial diphtheria among 327 patients with skin ulcers from Dhaka, Bangladesh, was established, the organisms typed, and the patients' antitoxin levels determined. Corynebacterium diphtheriae was confirmed in 23 (7%). 33% of the positive swabs were taken from the 6-10 year age group. Only 1 positive throat culture was found, in a patient with a negative skin culture. 18 organisms out of 19 typed were gravis strain and 14 of these produced toxin. 91% of the patients with positive skin cultures had serum antitoxin levels above 0.01 IU/ml, compared to 49% of the negative cases (p.001). All wounds harbored from 1-3 other pathogenic organisms, of which staphylococcus, beta hemolytic streptococcus and E. coli were identified. It is likely that skin wounds infected with C. diphtheriae may aid in the spread of faucial diphtheria.
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