Analysis index

Antibody evidence: 2 ml serum

Pathogen demonstration: Swabs from the borders of the infected areas.

Carefully lift the pseudo membrane and take samples either from the bottom of the membrane or from the base of the lesion. Nasopharyngeal swabs, swabs from ulcerations, wound swabs (borders), eye swabs and blood cultures are important. Taking of material prior to each antibacterial therapy. Always put the swab into the transport medium. It is very important to clearly mark the request form with the information that testing for corynebacterium diphtheria is required.

< 0,1 IE/ml: Not protected, initial immunisation required
0,1 IE/ml – 1,0 IE/ml: Protected, booster vaccination required
1,0 IE/ml – 1,4 IE/ml: Long-term protection, booster vaccination after approx.  5 years
1,5 IE/ml – 1,9 IE/ml: Long-term protection, booster vaccination after approx.  7 years
> 2,0 IE/ml: Long-term protection, booster vaccination after approx.  10 years

 
For a long-term protection, the antitoxin level should not be less than 1,0 IE/ml.

Suspicion of diphtheria, skin diphtheria, vaccination status

The laboratory will inform the responsible health authority, stating the patients’ name in case of any pathogen detection of a toxin-producing strain in accordance with §7 IfSG. Suspicion of disease, disease outbreak and death are to be reported by the treating physician as per §6 IfSG.

If there is a clinical suspicion, please inform us by telephone prior to sending sample material!

Treatment with antitoxic serum and corresponding antibiotics has to be commenced at once and independent of the laboratory findings. The antitoxin can be obtained from the emergency medication depots (as per “Rote Liste”), set up by the “Landesapothekerkammern” (Federal pharmacy chambers). It is also recommended to take pharyngeal- and nasal swabs from contact persons. Cultures take approx. 3 – 5 days. There is the danger of persons from Eastern Europe or warm countries bringing pathogens into the country. Droplet infection. Infection is mainly inapparent. Only 1 % – 2 % of carriers fall ill. Incubation period is 2 – 6 days. Diphtheria should be considered, when sore throat, initially slight pharyngeal reddening, later either one- or double-sided swelling of pharynx and tonsils with or without pseudomembranous (initially blotchy, later confluent), firmly adherent coatings, severe feeling of illness, sweet foul breath, fever. Complications: Problems swallowing, hoarseness, “bull neck”;

Further toxin presentations are corynebacterium ulcerans and corynebacterium pseudotuberculosis;

Consultant laboratory for diphtheria: Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Veterinärstraße 2, 85764 Oberschleißheim; please also refer to www.rki.de