A bacteriologic study of the diphtheroid organisms with special reference to Hodgkin's disease

work done in this group reveals the fact that there are bacteria which resemble the true diphtheria organism morphologically and culturally, but which differ in one important respect, namely, that of virulence as tested on guinea-pigs.The true Klebs-Loeffler has been shown to fer- ment dextrose, maltose and dextrin with acid production and to possess definite toxic properties on injection, resulting in the death of the animal in 3-4 days with a characteristic inflammation and congestion of the suprarenal glands.To those bacteria which lack this virulence but which otherwise conform to the character of true diphtheria bac- teria, should be assigned the species designation ''pseudodiphtheria."The generic name given to the group by Lehmann and ^eumann is Corynebacterium and should be retained for the organisms of this group.Certain characters ought to be accepted as properly belonging to the species before we can adequately define what we mean by a diph- theroid.These may be enumerated as follows : Morphological resemblance to diphtheria organism, gram-positive, nonmotile, absence of spores, presence or absence of metachromatic granules, no gas-produc- tion in carbohydrate mediums.The fermentation of sugars may or may not occur.This property gives us a basis for classification which will be taken up later.A careful study of the different species which have been described shows that the characters enumerated ought rightly to be accepted as a basis for differentiating the diphtheroids from other bacteria which have been improperly classed with them.With this end in view the different species are taken up individually and examined from the standpoint of validity and priority.The suitability of the name is considered from the viewpoint of sufficient description, and in the light of more comprehensive studies which have given us sugges- tions for proper nomenclature.When the species name implies etiology which is unknown, doubtful or unconfirmed, that part of it is modified to suit the case.Historical Review of Diphtheroids and Emendations B. pseudodiphtheriticum (Loeffler) MigulaThe description is given as follows : Gram-positive, no polar bodies, non- motile.Grows luxuriantly on blood serum with a glistening layer.In broth clouding is produced.LoeiBer described a pseudodiphtheria organism in his first paper on the etiology of diphtheria.He said the organism resembled diphtheria but was avirulent for guinea-pigs ; that it was smaller than the true diphtheria and showed a marked absence of club-shaped forms.In 1888, V. Hofmann published an account of avirulent diphtheria-like organisms iso- lated from the oral cavity in 26 of 45 normal persons.He called these organ- isms pseudodiphtheria bacilli and described them as follows : Clouding produced in broth, no acid production, grow at room temperature, no spores.The rightful name for this species is Corynebacterium pseudodiphtheriticum (Hofmann-Wellenhof).It is questionable, however, if we can retain this name for all diphtheroids which are morphologically and culturally like the one described by v. Hofmann.Recent studies show that there are diflferent species of saprophytic diphtheroids which conform to the type characters, yet are not found in the nose or throat.At the close of this communication we shall describe a few such strains which have been isolated from widely varying sources.B. PSEUDODIPHTHERITICUS ALCALIFACIENS B. PSEUDODIPHTHERITICUS ACIDUM FACIENS These names were applied by 'Kurth to diphtheroid organisms which he found to be avirulent, and were capable of producing, respectively, a weakly alkaline and an acid reaction in sugar broth.The alcalifaciens species conforms to the following description : No granules, short forms on serum with white growth, abundant growth in bouillon with clouding, no acid produced in sugar broth.This description, although meager, suggests that Kurth was undoubtedly dealing with the type Hofmanni.B. alcalifaciens should lapse into synonymy with this species.As for the B. pseud, acidum faciens a new species is hardly justified in view of the fact that avirulent diphtheroids differ in their fermenta- tive properties in various sugars.Moreover the description is incomplete.Apart from the interest which attaches to the first attempt at classifrcation from the fermentation standpoint, these two species have no particular value. B. XEROSIS (neISSER AND KUSCHBERT) MIGULAClub-shaped, plump, and longer septate forms.On blood serum terminal swellings never noted.Gram-positive, polar bodies sometimes visible, no growth below 25 C, no clouding in bouillon, but granular sediment is formed.Distinguished from pseudodiphtheria by its ability to grow only above 25 C.One point needs slight modification in this description of B. xerosis, namely, that of temperature requirement.On certain mediums, such as ascitic dextrose agar we have noted growth of 12 strains of diphtheroids which were isolated fiom the eye.These organisms complied with the description given for B. xerosis as regards morphology and fermentative properties in different car- bohydrate broths.Some of the strains developed very slowly at temperatures ranging from 18-25 C, showing delicate growth on slant mediums after 4 days.Eisenberg states that B. xerosis grows only at body temperature.B. septatum gelpke Nonmotile, gram-positive, club-shaped forms on serum.Young cultures show polar staining, no spores.Grows on serum with a delicate yellowish dry appearance.In bouillon no clouding occurs but a granular flaky deposit is visible.Does not grow at temperatures below 28 C. Is to be distinguished from other organisms of the group by this property.Associated with conjunc- tival inflammation -"schwelltjngskatarrh."A comparison of the 2 organisms just described makes it appear questionable that we are dealing with a distinct species in B. septatum.This organism which appears to be identical with B. xerosis is, like the latter, not necessarily associated with a conjunctivitis for B. xerosis has been isolated frequently from normal eyes.Zinsser is of the opinion that the B. xerosis is a harmless parasite which may occur more often in the slightly inflamed than in the nor- mal conjunctiva.The term septatum is not especially characteristic for diph- B. RENALIS BOVIS (eNDERLEN) MIGULA Rods with thickened ends, nonmotile, gram-positive.In broth, a granular precipitate is formed, the mediums remaining clear.Obligate aerobe.Does not grow at room temperature.A more adequate description is given by Ernst.He isolated the strain from cases of pyelonephritis in cattle.The organism grows poorly as compared with the diphtheria bacterium.Babes-Ernst granules appear much later.It is club-shaped, lancetlike or cylindrical.No growth takes place at room temperature.Nq acid produced in dextrose and glycerin, no spores, facultative aerobe, nonmotile, gram-positive.Pathogenicity appears doubtful.Ernst was unable to demonstrate virulence for guinea-pigs or rab- Frederick EbersonThis same species is met with in an earlier work on dysentery by Kruse and Pasquale.They isolated from the heart blood and mesenteric fluid in oases of Egyptian dysentery an organism which they call "B.clavatus."It is not described in any way as to warrant its recognition as a species.The char- acters enumerated by Fliigge make it invalid as a type of corynebacteria. SPORE-FORMING DIPHTHEROID OF DE SIMONIIsolated from nasal secretion in case of ozena.Said to form spores only when grown in milk or on potato.Facultative anaerobe.Grows luxuriantly in dextrose, lactose and maltose broth with slight acid formation.The author was undoubtedly misled by the appearance of an impure culture.The illustration given in his article shows a complete transformation from a typical diphtheroid of slender and unevelnly staining aspect to a blunt spore- bearing rod in older cultures.This is highly improbable, yet were it absolutely authentic, one should not be inclined to class this species with the diphtheria group for reasons outlined previously.B. DIPHTHEROIDES Described by Klein.Isolated from purulent secretion of udder of cow.Organism fails to grow below 25 C. Growth on agar slow and sparse, aerobic.On serum grows best at Zl C., producing white colonies.It is oval or spherical in form with a deeply staining center.Club-shaped forms present, grampositive.Produces abscess in guinea-pigs after subcutaneous or intraperito- neal inoculation.The organism dies within a week when grown on artificial mediums.This diphtheroid, according to the few cultural characters given, is in all likelihood identical with C. pyogenes (Glage).The description is too meager to warrant retaining it as a distinct species.The fact that the organism died so readily on artificial mediums indicates that it resembled the hemoglobino- philic type of which Glage's is an example. B. VARIABILIS LYMPHAE VACCINALISThis is the first of several descriptions of a species associated with the vac- cine pustules of calves.Nakanishi, in 1900, reported on an organism which he isolated from a vaccine pustule.It is club-shaped, coccoid, segmented or branched.Stains poorly with Gram, facultative anaerobe, nonmotile.Central granule noted when stained with warm fuschin.Growth on serum is abundant.Pale yellow or orange-yellow pigment produced.Poor growth on gelatin.Spore-formation is questionable.The name of this species is not a binomial and therefore may be discarded.A somewhat later and more adequate descrip- tion by Levy and Fickler is invalid, however, for the same reason.Their organisms were found to be identical with that of Nakanishi and possessed pyogenic properties for guinea-pigs, mice and rabbits.The name given to the species by these authors is Corynebact.lymphae vaccinalis.It is definitely gram-positive.In 1904 this species is met with as Coryneb.pyogenes, so described by Lewandowsky who published a paper almost simultaneously with Galli-Valerio.The last named author found his species to be identical with Nakanishi's and that of Levy and Fickler.Galli-Valerio proposes the name Coryneb.vaccinae (Galli-Valerio).Lewandowsky's designation is a binomial and valid.Galli-Valerio gave no reasons for rejecting a prior description and was apparently unaware of Lewandowsky's work which appeared at the same of acidity when grown in maltose and saccharose broths.As a rule C. xerosis ferments these last named sugars (Morse).It is suggested that the name Coryneb.segmentosum nom.nov.be substituted for the invalid B. coryzae seg- mentosus Cautley.B. diphtheroides citreus corresponds to Coryn.striatum (Chester).It produces yellow pigment.The name given by Graham Smith is not a binomial and disregards priority.It should lapse into synonymy with Coryn.striatum (Chester)