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Diphtheria among Alcoholic Urban Adults: A Decade of Experience in Seattle

James P. Harnisch, MD; Evelyn Tronca, MS; Charles M. Nolan, MD; Marvin Turck, MD; and King K. Holmes, MD, PhD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by National Institutes of Health grants AMO-05250 and AI-12192 and by a grant from the CIBA Foundation.

Current Author Addresses: Dr. Harnisch: 1600 116th Avenue Northeast, Suite 306, Bellevue, WA 98004.

Ms. Tronca: 12415 NE 6th Place, Bellevue, WA 98005.

Dr. Nolan: 1200 Public Safety Building, Seattle, WA 98104.

Dr. Turck: Journal of Infectious Diseases, HL-20, 1910 Fairview Avenue East, Seattle, WA 98102.

Dr. Holmes: Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(1):71-82. doi:10.7326/0003-4819-111-1-71
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Three outbreaks of Corynebacterium diphtheriae infection occurred in Seattle's Skid Road from 1972 through 1982. The first involved a single toxigenic, intermedius biotype clone, whereas the second and third outbreaks involved non-toxigenic mitis and gravis strains. Of 1100 total infections, 947 (86%) were cutaneous. The incidence was highest in winter and spring. In Skid Road, the estimated attack rate during 17 months in 1974 to 1975 was 5% for whites and 27% for native Americans. Streptococcus pyogenes was isolated from 73% of diphtheritic and 41% of nondiphtheritic skin lesions (P < 0.001). Skin infection and environmental contamination by C. diphtheriae were correlated. Complications occurred in 21% of symptomatic nasopharyngeal and 3% of cutaneous toxigenic intermedius infections (P < 0.001), and were significantly correlated with ages 60 years or more. Preferential use of erythromycin for diphtheria and pyodermas preceded plasmid-mediated resistance to erythromycin in C. diphtheriae. Diphtheria outbreaks in urban alcoholic persons are associated with poor hygiene, crowding, season, contaminated fomites, underlying skin disease, hyperendemic streptococcal pyoderma, and introduction of new strains from exogenous reservoirs.







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