Diphtheria caused byCorynebacterium diphtheriaeis potentially one of the most important bacterial diseases. Despite the success of mass immunization, which commenced in the 1940s, much remains to be learned about this disease, particularly in relation to its changing epidemiology. Within the developed world, the pattern of infection is mainly of small outbreaks and occasional sporadic cases, the majority of which are imported. The disease is endemic and occasionally epidemic in some regions of the world such as Eastern Europe, Africa, Bangladesh, Pakistan, Vietnam, the tropics and areas within South America. Epidemic and endemic disease pose a potential threat of introduction of toxigenicC. diphtheriaeto countries free of the disease, particularly if immunization rates are not maintained. Increasing international travel, migration from Eastern Europe and the emergence of non-toxigenicC. diphtheriaecausing systemic disease have emphasized the need for laboratories to screen forC. diphtheriae.Reliable microbiological diagnosis is essential to support the clinical diagnosis of the disease.
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