Clinical diphtheria is essentially an intoxication. The diphtheria bacillus is able, while growing superficially on the mucous membranes of the upper respiratory tract, to elaborate toxin, but only rarely does it invade the deeper tissues or blood stream. Zinsser and Bayne-Jones1 expressed the opinion that although this organism had been isolated from the liver and spleen post mortem, the occurrence of septicemia due to the diphtheria bacillus during life had never been proved.
Andrewes and his associates,2 however, in their report on diphtheria to the Medical Research Council, discussed the results obtained by a group of workers in Hamburg who studied the disease from 1909 to 1913 and concluded that there were 2 authentic cases of bacteremia due to pure Corynebacterium diphtheriae on record. Roedelius3 succeeded in isolating diphtheria bacilli from the blood in pure culture from 2 patients in this series of cases. The positive cultures
CHI-WU W, TS'UN T. BACTEREMIA DUE TO THE GRAVIS TYPE OF CORYNEBACTERIUM DIPHTHERIAE. Am J Dis Child. 1936;52(4):899-903. doi:10.1001/archpedi.1936.04140040129013