PT  - JOURNAL ARTICLE
AU  - S. Coleman
TI  - The Association between Tuberculosis and Diphtheria
AID  - 10.1101/219584
DP  - 2017 Jan 01
TA  - bioRxiv
PG  - 219584
4099  - http://biorxiv.org/content/early/2017/11/16/219584.short
4100  - http://biorxiv.org/content/early/2017/11/16/219584.full
AB  - This research investigates the now-forgotten relationship between diphtheria and tuberculosis. Historical medical reports from the 19th century are reviewed followed by a statistical regression analysis of the relationship between the two diseases in the early 20th century. Historical medical records show a consistent association between diphtheria and tuberculosis that can increase the likelihood and severity of either disease in a co-infection. The statistical analysis uses historical weekly public health data on reported cases in five American cities over a period of several years, finding a modest but statistically significant relationship between the two diseases. No current medical theory explains the association between diphtheria and tuberculosis. Alternative explanations are explored with a focus on how the diseases assimilate iron. In a co-infection, the effectiveness of tuberculosis at assimilating extracellular iron can lead to increased production of diphtheria toxin, worsening that disease, which may in turn exacerbate tuberculosis. Iron-dependent repressor genes connect both diseases.