June 4, 1997

Respiratory Diphtheria Caused by Corynebacterium ulcerans—Terre Haute, Indiana, 1996

JAMA. 1997;277(21):1665-1666. doi:10.1001/jama.1997.03540450021011

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DIPHTHERIA is a potentially severe illness; among unvaccinated persons, the case-fatality rate may be 5%-10%, even with appropriate treatment. During 1990-1995, approximately 4000 deaths resulted from the ongoing diphtheria epidemic in the former Soviet Union.1 In the United States, respiratory diphtheria is rare: during 1980-1995, only 41 cases were reported. Serologic studies in the 1970s and 1980s indicated that 20%-60% of U.S. adults aged ≥20 years lacked immunity to diphtheria.2,3 This report describes a recent case of respiratory diphtheria caused by a toxin-producing strain of Corynebacterium ulcerans. The case occurred in a resident of Indiana, and an investigation by public health authorities indicated that acquisition of the organism occurred locally in the state.

On October 24, 1996, a 54-year-old woman residing in Terre Haute, Indiana, had onset of fever, sore throat, and difficulty swallowing. On October 26, she was examined in an outpatient clinic and reported