Fatal Respiratory Disease Due to Corynebacterium diphtheriae: Case Report and Review of Guidelines for Management, Investigation, and Control

Authors:
  • PSPeter M. Strebel
    Peter M. Strebel
  • RCRobert T. Chen
    Robert T. Chen
  • AKAnita Kimbler
    Anita Kimbler
  • TCTimothy J. Cleary
    Timothy J. Cleary
  • SCStephen L. Cochi
    Stephen L. Cochi
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Abstract
Dramatic reductions in the incidence of diphtheria and high levels of childhood vaccination in recent decades have led the United States to establish the goal of diphtheria elimination among persons ⩽25 years of age by the year 2000. In 1990, an unimmunized 25-month-old child died of respiratory diphtheria in Dade County, Florida, before treatment with diphtheria antitoxin could be instituted. Twenty-three asymptomatic household contacts and other close contacts of the child were identified, cultured for Corynebacterium diphtheriae, given antimicrobial prophylaxis, and vaccinated with diphtheria toxoid when indicated. Three contacts (13%) had pharyngeal cultures positive for toxigenic C. diphtheriae of the same type as that causing infection in the deceased child, but no additional cases developed. Although the source of infection was not determined, three other close contacts had recently been to Haiti, where diphtheria is endemic. A serological survey of 396 children