Diphtheria laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Laboratory Findings
A presumptive diagnosis of diphtheria is usually based on clinical features. A definitive diagnosis is made by growing the specific Corynebacterium species on special cultures from the respiratory tract secretions or cutaneous lesions.[1][2][3]
Culture and Staining
The diagnosis of diphtheria is made by culture and special staining for the different Corynebacterium species from respiratory tract secretions or cutaneous lesions:[1][2][3][4]
- Gram stain: Gram positive rods in a "Chinese character" distribution
- Tellurite stain: Gray-black colonies
- Tindale: Black colonies with halos around it and an associated garlic odor
- Loffler medium: Metachromatic staining
Biochemical Tests
Most species of Corynebacterium are catalase positive, urea negative, nitrate positive, pyrazinamidase negative and cystinase positive.[1]
Elek's test
It's worth noting that a low concentration of iron is required in the medium for toxin production; as at high iron concentrations, iron molecules bind to a repressor which shuts down toxin production[5]. This is most appreciated when performing Elek's test for toxogenecity, in order to know if the organism is able to produce the diphtheria toxin or not.
PCR
PCR assays can also be performed on isolates, swabs, or membrane specimens to rapidly confirm the presence of the tox gene responsible for production of diphtheria toxin, but the test is available only in research or reference laboratories.
References
- ↑ 1.0 1.1 1.2 Efstratiou A, Engler KH, Mazurova IK, Glushkevich T, Vuopio-Varkila J, Popovic T (2000). "Current approaches to the laboratory diagnosis of diphtheria". J. Infect. Dis. 181 Suppl 1: S138–45. doi:10.1086/315552. PMID 10657205.
- ↑ 2.0 2.1 Colman G, Weaver E, Efstratiou A (1992). "Screening tests for pathogenic corynebacteria". J. Clin. Pathol. 45 (1): 46–8. PMC 495813. PMID 1740514.
- ↑ 3.0 3.1 Widelock D (1951). "Laboratory Diagnosis of Diphtheria". Am J Public Health Nations Health. 41 (1): 120. PMC 1525936. PMID 18017268.
- ↑ Mandell, Gerald L. (1985). Principles and Practice of Infectious Disease. USA: John Wiley & Sons. p. 1171. ISBN 0471876437.
- ↑ Microbiology: A Human Perspective. Fourth edition. McGraw Hill