[Current evaluation of diphtheria]

Between 1973-1983 there were 103 scattered cases of diphtheria in the FRG. The mortality rate was 22%. The question remains open, whether there are juts sporadic cases or the beginning of a new epidemic. During the past 200 years diphtheria occurred in waves with a peak every 30 years. Diagnostically we should be on the alert, and start special treatment already with the clinical diagnosis. For a start hyperimmunoglobulin should neutralize still circulating equine toxins which are no longer caught once they are within cells e.g. heart muscle. Only after this, antibiotics should be considered as an addition to kill toxin-producing bacteria. Antibiotics alone do not prevent the sometimes lethal action of toxins. For the bacteriologic proof of the diagnosis not only the coryne bacteria have to show but the toxin production as well. The transformation of non-toxin-producing into toxin-producing coryne-bacteria following an infection with bacteriophages has been observed recently in children during an epidemic.