Diphtheria classification

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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

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Diphtheria can be classified according to the type of Corynebacterium that causes a specific case. It can also be divided according to the resulting clinical presentation into respiratory, systemic, or cutaneous diphtheria.

## Classification

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Diphtheria infection can be classified according to either the causative agent or the clinical manifestations of the infection.

### Causative Agent

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Diphtheria can be caused by several Corynebacterium species including:[1][2]

* Corynebacterium diphtheria, which can be further divided into 4 types based on morphologic and biochemical properties:[3]
* Var. gravis
* Var. mitis
* Var. belfanti
* Var. intermedius
* Corynebacterium ulcerans
* Corynebacterium hemolyticum
* Corynebacterium pseudotuberculosis

### Clinical Manifestations

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Diphtheria infection can present in any of the following ways:[4]

* Respiratory diphtheria, which can be further divided into nasal, pharyngeal, and laryngeal diphtheria[5]
* Systemic diphtheria, which results from the dissemination of diphtheria toxin into the heart[6][7], kidneys and nervous system[5]
* Cutaneous diphtheria, which is caused by toxigenic and non-toxigenic strains of Corynebacterium diphtheria[8]

## References

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1. ↑ Wong TP, Groman N (1984). "Production of diphtheria toxin by selected isolates of Corynebacterium ulcerans and Corynebacterium pseudotuberculosis". Infect. Immun. 43 (3): 1114–6. PMC 264307. PMID 6321350.
2. ↑ Moore LS, Leslie A, Meltzer M, Sandison A, Efstratiou A, Sriskandan S (2015). "Corynebacterium ulcerans cutaneous diphtheria". Lancet Infect Dis. 15 (9): 1100–7. doi:10.1016/S1473-3099(15)00225-X. PMID 26189434.
3. ↑ 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.
4. ↑ Center for Disease Control and Prevention http://www.cdc.gov/diphtheria/clinicians.html Accessed on Oct. 7, 2016.
5. ↑ 5.0 5.1 Dobie RA, Tobey DN (1979). "Clinical features of diphtheria in the respiratory tract". JAMA. 242 (20): 2197–201. PMID 490806.
6. ↑ Lumio JT, Groundstroem KW, Melnick OB, Huhtala H, Rakhmanova AG (2004). "Electrocardiographic abnormalities in patients with diphtheria: a prospective study". Am. J. Med. 116 (2): 78–83. PMID 14715320.
7. ↑ BOYER NH, WEINSTEIN L (1948). "Diphtheritic myocarditis". N. Engl. J. Med. 239 (24): 913–9. doi:10.1056/NEJM194812092392403. PMID 18103551.
8. ↑ Rappold LC, Vogelgsang L, Klein S, Bode K, Enk AH, Haenssle HA (2016). "Primary cutaneous diphtheria: management, diagnostic workup, and treatment as exemplified by a rare case report". J Dtsch Dermatol Ges. 14 (7): 734–6. doi:10.1111/ddg.12722. PMID 27373251.

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