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Corynebacterium Diphtheriae and Its Relatives' BACTERIOLOGICAL REVIEWS, Dec. 1970, P. 378-422 Vol. 34, No. 4 Copyright @ 1970 American Society for Microbiology Printed in U.S.A. Corynebacterium diphtheriae and Its Relatives' LANE BARKSDALE2 New York University School ofMedicine and Medical Center, New York, New York 10016 INTRODUCTION ............................................................ 379 CORYNEBACTERIUM, MYCOBACTERIUM, AND NOCARDIA: THE CMN GROUP............................................................... 380 CORYNEBACTERIUM DIPHTHERIAE ........................................ 385 Morphology, Ultrastructure, and Molecular Anatomy of Diphtheria Bacilli ........... 385 Cell envelope.............................................................. 385 Murein (peptidoglycan, muropeptide) and arabinogalactan ....................... 385 Lipids and protein of the outer envelope ........................................ 386 Cord factor of C. diphtheriae.................................................. 386 K (surface protein) antigens................................................. 386 Receptors for corynebacteriophages .......................................... 389 From the Nucleus to the Cytoplasmic Membrane (Cellular Inclusions) ..... ........... 389 Fatty material, lipoidal bodies, and fat granules ................................ 389 Polyphosphate granules = metachromatic granules = volutin bodies .............. 389 Localization of tellurium ............. ...................................... 391 Starch................................................................... 391 Intracytoplasmic membrane= intracytoplasmic membrane system (125) = mesosome(s) (80, 268) ................................................................ 392 POPULATIONS OF CORYNEBACTERIA ..................................... 393 Colonial Morphology ........................................................ 393 Serological types of C. diphtheriae............................................ 394 K antigens, adjuvant action, and the Schick test................................ 395 Phage typing corynebacteria ..................... 395 Nutrition and Metabolism..................... 395 Nutrition................................................................. 395 Carbohydrate utilization .................................................... 395 Metabolism and long-chain polyphosphates .................................... 397 Iron and C. diphtheriae..................................................... 398 Ferrous ion, ferric ion, and the growth and ultrastructure of C. diphtheriae......... 398 Heme iron (Feh), nonheme iron (Fenh), and the iron phenotypes .................. 399 Enzymes, Pigments, and Products of Special Interest .............................. 401 Bacteriocins ....................................... 401 Catalase ....................................... 401 "Cystinase," H2S production ................................................ 401 Cytochromes....................................... 401 Deoxyribonuclease....................................... 403 Glycoside hydrolases (3.2) ............. .......................... 403 Hemolysin........................................ 403 Nitrate reductase....................................... 403 Porphyrin................................................................. 404 DNA-Containing Corynebacteriophages ....................................... 404 Corynebacteriophages and the gene tox....................................... 404 Stability of integration of the tox prophages................................... 407 Product of the gene tox....................................... 407 Expression of Tox........................................ 409 Synthesis of toxin in one cycle of viral growth ................................. 409 Synthesis of toxin by the lysogenic, toxinogenic C. diphtheriae strain PW8 ........ 410 APPENDIX .................................................................... 413 Proposed Changes in the Official Description of Corynebacterium diphtheriae (Flugge, 1886) Lehman and Neumann, 1896 ........................I..................... 414 'Although the documentation supporting the point of view presented here amounts to a review of relevant literature, no effort has been made to include in this paper an exhaustive listing of papers related to C. diphtheriae. 2Drawings by James E. Ziegler. 378 VOL. 34, 1970 C. DIPHTHERIAE AND ITS RELATIVES 379 Possible Candidates for the Genus Corynebacterium ............ .................. 414 Species to Be Dropped from the Genus Corynebacterium ......... ................. 415 C. pyogenes ............................................ 415 Propionibacterium: C. acnes, C. parvum ....................................... 415 LITERATURE CITED........................................................ 415 To Andre Lwoff, artist and young and studied (27). For the first time in the 68 man, in his fiftieth year in science years since their discovery, diphtheria bacilli and to Hidebumi-san, Mak-san, and differing by only one prophage (gene) could be A. M. P., Jr. compared. It was at once obvious that in- vasiveness (virulence) and toxinogenicity were INTRODUCTION separable properties (23, 116, 215). For example, From November to March in the northern rabbits infected with C7,( -) tox developed hemisphere (25, 165, 319) and from April to pseudomembranous lesions but later recovered August in the southern hemisphere, wherever from their infections, whereas rabbits infected there are large numbers of human beings, infec- with C7(Q3)"T'+ developed necrotic lesions and tions with Corynebacterium diphtheriae are likely died (23). This separation of invasiveness from to occur. Several cases have been reported in toxinogenicity was consistent with.the reported the southeastern U.S. as recently as 1969 (31). cases of diphtheritic infections in man caused by [In the summer of 1970 there were at least two nontoxinogenic diphtheria bacilli as well as outbreaks of diphtheria in the United States: those reports of diphtheria in individuals having one in San Antonio, Tex., and one in Washing- circulating antitoxin (23, 31, 72, 134). The ton, D.C.] Although diphtheria must have plagued relationship between the easily distinguishable man since ancient times, it was not until 1826 properties invasiveness (virulence) and toxino- when Pierre Brettoneau described the clinical genicity to the etiology of toxaemic and non- entity, diphtheria, involving the appearance of a toxaemic diphtheritic infections is clearly il- pseudomembrane in the throat, that meaningful lustrated in Fig. 1. recording of this disease began. Afterthe etiological Although it was the disease diphtheria that agent(s), C. diphtheriae, had been discovered by led to the discovery of C. diphtheriae, this article Klebs in 1883 (161) and related to the disease will be concerned principally with the bacterium by Loeffler in 1884 (185), a rational means was C. diphtheriae as the type species of the genus available for distinguishing diphtheria from Corynebacterium. other maladies of the throat. In 1888, Roux and Yersin (265) made the exciting discovery cure A that toxic filtrates could be easily obtained free of diphtheria bacilli and that these filtrates were C. diphther ce C7,(-)tH + tc C diphther0Cie C75s(f7t lethal for animals. Since the symptoms produced toxin in animals Invaiive Inva3isve by (neurologic changes, cardiac Nlontoxinogenic Toxinogenic -failure, etc.) accounted for the more dramatic Sensitive to phase it Immune to phcge p signs seen in human diphtheritic infections, the Lvysogenic for phse f 'A 6 c touwwtc action of toxin was held to account for the patho- c oonboximic diphtheria .Mat cnusC diphtheria genesis of diphtheria, and diphtheria bacilli FIG. 1. Changes brought to C7,(-)to- after lyso- which did not produce toxin were all but ignored genization by a bacteriophage carrying the tox gene. Presumably the indicator strain C7, is nonlysogenic, and their relationship with C. diphtheriae was hence the designation (-), and is nontoxinogenic, tox-. little considered. In fact, for many years it was When nontoxinogenic, nonlysogenic C7. is lysed by a erroneously assumed that toxin was required phage carrying the tox+ marker, such as kt'oZ+, toxin is for pseudomembrane formation (62). produced during the course ofphage multiplication and When Freeman discovered in 1951 that certain lysis of the cell. When lysogenized by t~tox+, the genome bacteriophages could endow nontoxinogenic C. of C7, (4l)tox+ includes phage genes which endow it with diphtheriae with the capacity to produce toxin immunity to homologous phage (lysogenic immunity = (81), interest in the biology of diphtheria and synthesis of specific repressor) and the ability to that of its etiologic agents was rekindled. Soon synthesize diphtherial toxin. The subscript s refers to the K one of the gene smooth (surface) antigen of the strain. Once the temperate phages carrying the antigens ofLautrop (see text) are systematized, s would tox, to31+I was characterized and pairs of toxino- be replaced with a more specific designation, e.g. genic and nontoxinogenic strains of C. diph- C7K15(-))to . For other cases of changes in bacteria theriae, such as C7( _-) tox, C78(Of)tOx-, C4S8 brought about by the presence ofprophage, see Fig. 15 ()tox- and C48(,/) tox were isolated, cloned, and 16. 380 BARKSDALE BACTERIOL. REV. CORYNEBACTERIUM, MYCOBACTERIUM, theria bacilli. In Fig. 2E is shown a pair of cells of AND NOCARDIA: THE CMN GROUP C. diphtheriae which are from a culture in the logarithmic phase of growth.
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