Investigations of 2 Cases of Diphtheria-Like Illness Due to Toxigenic Corynebacterium ulcerans

Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 03/2008; 46(3):395-401. DOI: 10.1086/525262
Source: PubMed


We present 2 case reports in the United States and investigations of diphtheria-like illness caused by toxigenic Corynebacterium ulcerans. A fatal case occurred in a 75-year-old male Washington resident who was treated with clindamycin but did not receive equine diphtheria antitoxin. A second, nonfatal case occurred in a 66-year-old female Tennessee resident who received erythromycin and diphtheria antitoxin.
Both case patients and close human and animal contacts were investigated by their respective state health departments.
C. ulcerans isolated from the patient who died was resistant to erythromycin and clindamycin. For both isolates, conventional polymerase chain reaction results were positive for A and B subunits of diphtheria toxin gene tox, and modified Elek tests confirmed toxin production. The source of infection remained undetermined for both cases. Neither patient was up-to-date with diphtheria toxoid vaccination.
These case reports highlight the importance of early treatment with diphtheria antitoxin, the selection of effective antimicrobial agents, and prevention through up-to-date vaccination.

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Available from: Tejpratap Tiwari, Nov 24, 2015
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    • "Human C. ulcerans infections are caused by ingestion of untreated milk (Bostock et al., 1984) or close contact with animals (Hatanaka et al., 2003; Komiya et al., 2010; Tiwari et al., 2008). Our patient had six pet cats; although these animals were examined, C. ulcerans strains were not detected. "
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    • "This observation has been explained by the fact that C. ulcerans may harbor lysogenic β-corynephages coding for the diphtheria toxin, which is responsible for the systemic symptoms caused by C. diphtheriae [4]. Respiratory diphtheria-like illnesses caused by toxigenic C. ulcerans strains are increasingly reported from various industrialized countries [5] and became more common than C. diphtheriae infections in the United Kingdom [6]. Human infections with toxigenic C. ulcerans can be fatal in unvaccinated patients and usually occur in adults, who consumed raw milk [7,8] or had close contact with domestic animals [6]. "
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