Epidemic Diphtheria and Skin Infections in Trinidad

Abstract

Patients with nephritis and schoolchildren in South Trinidad were surveyed for the presence of Corynebacterium diphtheriae in throats and skin lesions. The incidence of positive cultures was higher in skin lesions than in throat cultures. None of the children experienced symptoms of systemic intoxication. Subsequent to the increase in cutaneous infections, however, the incidence of symptomatic nasopharyngeal diphtheria also increased in Trinidad, suggesting that the skin lesions constituted an important reservoir of infection. One group of schoolchildren was reexamined after six months, and levels of antitoxin in serum were correlated with the presence of C. diphtheriae in skin lesions and throat cultures. The high levels of antitoxin observed apparently resulted from natural immunization in the absence of clinical signs of diphtheria. No effect of C. diphtheriae was noted on the colonization of skin lesions by streptococci or on the incidence of acute glomerulonephritis in the population. Approximately 25% of the children in rural Trinidad have recurrent impetiginous skin lesions. In 1965, these lesions were implicated as an important etiologic factor in a major epidemic of acute glomerulonephritis (AGN) [1]. After this epidemic, a laboratory was established in San Fernando for long-range surveillance of streptococcal infections in patients with AGN, in their family contacts, and in control groups including "nor