IV. INVESTIGATION OF C . UII’NTHERIAE
117
contacts of an outbreak and their relationship to the cases because only
carriers harbouring the same phage type as the case (usually gravis toxf
strains) could be regarded as dangerous. Today, the occurrence during a
routine survey of a C. dz$htheriae gravis toxf phage type in a carrier is a
curiosity in Romania, representing a rare event, indicating the need for a
more analytical epidemiological investigation. The majority of strains
isolated at present in communities and/or in an open environment, originate
from healthy carriers and are represented by non-toxigenic C. dz$hthmiae
gravis or intermedius types. No prophylactic or therapeutic measures are
necessary for these carriers. I n the U.S.A. during recent years, outbreaks
accounting for 70-200 cases have been described in Austin, Texas, Phoenix,
Arizona, and San Antonio, Texas (Doegge and Walker, 1962; Zalma et al.,
1970; Marcuse et al., 1973; Brooks et al., 1974). These outbreaks persisted
over periods of months and years, suggesting high levels of endemic
carriage and failures in containment in spite of the intensive mass immunisation programmes. This represents a striking example showing that
diphtheria cannot be exterminated by immunisation programmes alone.
I n the best immunised community a lack of immunity is always to be found,
stressing the need for thorough and continuous surveillance. This is
readily possible by using all modern microbiological typing methods.
The occurrence of cutaneous diphtheria among American Indians in
south-west U.S.A. (Belsey et al., 1969) and Canada (Wilson and Toshach,
1957) raises new questions concerning the relationships between these
forms, and faucial diphtheria. During the Second World War cutaneous
diphtheria appeared in soldiers and large epidemics were reported in
troops serving in tropical or subtropical countries. Close personal contact
and poor personal hygiene favoured spread of the disease. Lesions occurred
most frequently on the lower extremities, scrotum and hands. Few patients
died, unless they also suffered from faucial diphtheria, but many (20-25%)
experienced neurological complications. These findings underline the need
for methods tracing the origin of outbreaks, the paths of spread, connection
of cases and determination of the duration of carriage.
VIII. OTHER CORYNEBACTERIA W I T H HUMAN HABITAT
A. Corynebacterium ulcernns
1. Dejinition
Corynebacterium ulcerans is another pathogenic member of the genus
Corynebacterium. It produces two different toxins, a species specific toxin
present in all strains and a typical diphtherial toxin, immunologically
117
contacts of an outbreak and their relationship to the cases because only
carriers harbouring the same phage type as the case (usually gravis toxf
strains) could be regarded as dangerous. Today, the occurrence during a
routine survey of a C. dz$htheriae gravis toxf phage type in a carrier is a
curiosity in Romania, representing a rare event, indicating the need for a
more analytical epidemiological investigation. The majority of strains
isolated at present in communities and/or in an open environment, originate
from healthy carriers and are represented by non-toxigenic C. dz$hthmiae
gravis or intermedius types. No prophylactic or therapeutic measures are
necessary for these carriers. I n the U.S.A. during recent years, outbreaks
accounting for 70-200 cases have been described in Austin, Texas, Phoenix,
Arizona, and San Antonio, Texas (Doegge and Walker, 1962; Zalma et al.,
1970; Marcuse et al., 1973; Brooks et al., 1974). These outbreaks persisted
over periods of months and years, suggesting high levels of endemic
carriage and failures in containment in spite of the intensive mass immunisation programmes. This represents a striking example showing that
diphtheria cannot be exterminated by immunisation programmes alone.
I n the best immunised community a lack of immunity is always to be found,
stressing the need for thorough and continuous surveillance. This is
readily possible by using all modern microbiological typing methods.
The occurrence of cutaneous diphtheria among American Indians in
south-west U.S.A. (Belsey et al., 1969) and Canada (Wilson and Toshach,
1957) raises new questions concerning the relationships between these
forms, and faucial diphtheria. During the Second World War cutaneous
diphtheria appeared in soldiers and large epidemics were reported in
troops serving in tropical or subtropical countries. Close personal contact
and poor personal hygiene favoured spread of the disease. Lesions occurred
most frequently on the lower extremities, scrotum and hands. Few patients
died, unless they also suffered from faucial diphtheria, but many (20-25%)
experienced neurological complications. These findings underline the need
for methods tracing the origin of outbreaks, the paths of spread, connection
of cases and determination of the duration of carriage.
VIII. OTHER CORYNEBACTERIA W I T H HUMAN HABITAT
A. Corynebacterium ulcernns
1. Dejinition
Corynebacterium ulcerans is another pathogenic member of the genus
Corynebacterium. It produces two different toxins, a species specific toxin
present in all strains and a typical diphtherial toxin, immunologically