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BMC Infectious Diseases Jun 2023Diphtheria is a severe respiratory or cutaneous infectious disease, caused by exotoxin producing Corynebacterium diphtheriae, C. ulcerans and C. pseudotuberculosis....
BACKGROUND
Diphtheria is a severe respiratory or cutaneous infectious disease, caused by exotoxin producing Corynebacterium diphtheriae, C. ulcerans and C. pseudotuberculosis. Diphtheria is once again prevalent due to breakdown of immunisation programmes, social disruption and unrest.
AIM
This study describes the notified diphtheria cases in the Netherlands between 2000-2021 and isolates that were sent to the National Institute for Public Health and the Environment (RIVM).
METHODS
File investigation was performed including all notified cases and isolates of C. diphtheriae, C. ulcerans and C. pseudotuberculosis that were tested for toxin production using a toxin-PCR and Elek test. An exploratory review was performed to understand transmission in populations with a high vaccination uptake.
RESULTS
Eighteen diphtheria notifications were made with confirmed toxigenic C. diphtheriae (n = 9) or ulcerans (n = 9) between 2000 and 2021. Seventeen (94.4%) presented with a cutaneous infection. All cases with a suspected source abroad (n = 8) concerned infection with C. diphtheriae. In contrast, 9/10 cases infected in the Netherlands were caused by C. ulcerans, a zoonosis. Secondary transmission was not reported. Isolates of C. ulcerans sent to the RIVM produced more often the diphtheria exotoxin (11/31; 35%) than C. diphtheriae (7/89; 7.9%).
CONCLUSION
Both human-to-human transmission of C. diphtheriae and animal-to-human transmission of C. ulcerans rarely occurs in the Netherlands. Cases mainly present with a cutaneous infection. Travel-related cases remain a risk for transmission to populations with low vaccination coverage, highlighting the importance of immunization and diphtheria control measures.
Topics: Animals; Humans; Diphtheria; Netherlands; Travel; Travel-Related Illness; Corynebacterium; Corynebacterium diphtheriae; Exotoxins
PubMed: 37344769
DOI: 10.1186/s12879-023-08388-5 -
The Journal of Infectious Diseases Feb 2000Diphtheria reappeared in Lithuania in 1986 and rose to epidemic levels by 1992. Between 1991 and 1996, 110 cases of diphtheria were registered, with an incidence of...
Diphtheria reappeared in Lithuania in 1986 and rose to epidemic levels by 1992. Between 1991 and 1996, 110 cases of diphtheria were registered, with an incidence of 0.03-1.15/100,000 population. Most cases (84%) and all 17 deaths occurred among persons >/=15 years, most of whom had never been vaccinated. Persons 40-49 years old had the highest average annual age-specific morbidity (1.70/100,000) and mortality (0.53/100,000) rates. Low levels of immunity among individuals 40-49 years old and migration to epidemic areas in Russia and Belarus contributed to the epidemic's occurrence. Between 1991 and 1995, toxigenic Corynebacterium diphtheriae strains were isolated from 84 of all registered patients (76%), and nontoxigenic strains were isolated from 13 (12%). By 1996, two mass vaccination campaigns, which provided one dose of vaccine to individuals 25-30 years old and three doses of vaccine to persons 31-60 years old, helped reduce the number of cases. The first campaign achieved 69% coverage; the second achieved 48% coverage.
Topics: Adult; Child; Child, Preschool; Corynebacterium diphtheriae; Diphtheria; Diphtheria Toxoid; Diphtheria-Tetanus Vaccine; Diphtheria-Tetanus-Pertussis Vaccine; Disease Notification; Disease Outbreaks; Humans; Immunization Programs; Immunization Schedule; Incidence; Infant; Lithuania; Middle Aged; National Health Programs; Tetanus Toxoid; Vaccines, Combined
PubMed: 10657191
DOI: 10.1086/315539 -
The Medical Journal of Australia Feb 2024
Topics: Humans; Diphtheria; Corynebacterium diphtheriae; Australia; Travel
PubMed: 38111182
DOI: 10.5694/mja2.52190 -
Infection Aug 2016Corynebacterium diphtheriae, the classical causative agent of diphtheria, is considered to be nearly restricted to humans. Here we report the first finding of a... (Review)
Review
OBJECTIVES
Corynebacterium diphtheriae, the classical causative agent of diphtheria, is considered to be nearly restricted to humans. Here we report the first finding of a non-toxigenic C. diphtheriae biovar belfanti strain in a free-roaming wild animal.
METHODS
The strain obtained from the subcutis and mammary gland of a dead red fox (Vulpes vulpes) was characterized by biochemical and molecular methods including MALDI-TOF and Multi Locus Sequence Typing. Since C. diphtheriae infections of animals, usually with close contact to humans, are reported only very rarely, an intense review comprising also scientific literature from the beginning of the 20th century was performed.
RESULTS
Besides the present case, only 11 previously reported C. diphtheriae animal infections could be verified using current scientific criteria.
CONCLUSIONS
Our report is the first on the isolation of C. diphtheriae from a wildlife animal without any previous human contact. In contrast, the very few unambiguous publications on C. diphtheriae in animals referred to livestock or pet animals with close human contact. C. diphtheriae carriage in animals has to be considered as an exceptionally rare event.
Topics: Animals; Corynebacterium diphtheriae; Diphtheria; Female; Foxes; Germany; Mammary Glands, Animal
PubMed: 26424684
DOI: 10.1007/s15010-015-0846-y -
Clinical Infectious Diseases : An... Nov 2021Respiratory diphtheria is a toxin-mediated disease caused by Corynebacterium diphtheriae. Diphtheria-like illness, clinically indistinguishable from diphtheria, is...
BACKGROUND
Respiratory diphtheria is a toxin-mediated disease caused by Corynebacterium diphtheriae. Diphtheria-like illness, clinically indistinguishable from diphtheria, is caused by Corynebacterium ulcerans, a zoonotic bacterium that can also produce diphtheria toxin. In the United States, respiratory diphtheria is nationally notifiable: specimens from suspected cases are submitted to the Centers for Disease Control and Prevention (CDC) for species and toxin confirmation, and diphtheria antitoxin (DAT) is obtained from CDC for treatment. We summarize the epidemiology of respiratory diphtheria and diphtheria-like illness and describe DAT use during 1996-2018 in the United States.
METHODS
We described respiratory diphtheria cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and C. ulcerans-related diphtheria-like illness identified through specimen submissions to CDC during 1996-2018. We reviewed DAT requests from 1997 to 2018.
RESULTS
From 1996 to 2018, 14 respiratory diphtheria cases were reported to NNDSS. Among these 14 cases, 1 was toxigenic and 3 were nontoxigenic C. diphtheriae by culture and Elek, 6 were culture-negative but polymerase chain reaction (PCR)-positive for diphtheria toxin gene, 1 was culture-positive without further testing, and the remaining 3 were either not tested or tested negative. Five cases of respiratory diphtheria-like illness caused by toxigenic C. ulcerans were identified. DAT was requested by healthcare providers for 151 suspected diphtheria cases between 1997 and 2018, with an average of 11 requests per year from 1997 to 2007, and 3 per year from 2008 to 2018.
CONCLUSIONS
Respiratory diphtheria remains rare in the United States, and requests for DAT have declined. Incidental identification of C. ulcerans-related diphtheria-like illness suggests surveillance of this condition might be warranted.
Topics: Corynebacterium; Corynebacterium diphtheriae; Diphtheria; Diphtheria Antitoxin; Diphtheria Toxin; Humans; United States
PubMed: 32818967
DOI: 10.1093/cid/ciaa1218 -
Tropical Biomedicine Jun 2021Nasopharyngeal diphtheria is an acute infectious upper respiratory tract disease caused by toxigenic strains of Corynebacterium diphtheriae. We report a case of a young...
Nasopharyngeal diphtheria is an acute infectious upper respiratory tract disease caused by toxigenic strains of Corynebacterium diphtheriae. We report a case of a young adult who presented to us with a short history of fever, sore throat, hoarseness of voice and neck swelling. He claimed to have received all his childhood vaccinations and had no known medical illnesses. During laryngoscopy, a white slough (or membrane) was seen at the base of his tongue. The epiglottis was also bulky and the arytenoids were swollen bilaterally. The membrane was sent to the microbiology laboratory for culture. A diagnosis of nasopharyngeal diphtheria was made clinically and the patient was treated with an antitoxin together with erythromycin, while awaiting the culture result. Nevertheless, the patient's condition deteriorated swiftly and although the laboratory eventually confirmed an infection by toxin-producing C. diphtheriae, the patient had already succumbed to the infection.
Topics: Corynebacterium diphtheriae; Diphtheria; Erythromycin; Fatal Outcome; Fever; Hoarseness; Humans; Male; Pharyngitis; Young Adult
PubMed: 34172699
DOI: 10.47665/tb.38.2.045 -
Zhurnal Mikrobiologii, Epidemiologii I... 1998
Review
Topics: Bacteriophages; Corynebacterium diphtheriae; DNA, Bacterial; Diphtheria; Extrachromosomal Inheritance; Genotype; Humans; Molecular Epidemiology
PubMed: 9783414
DOI: No ID Found -
Infection Dec 2019We report a rare case of post-traumatic cutaneous diphtheria in a patient referred from a hospital in rural India. The diagnosis of cutaneous diphtheria was confirmed by...
We report a rare case of post-traumatic cutaneous diphtheria in a patient referred from a hospital in rural India. The diagnosis of cutaneous diphtheria was confirmed by the isolation of Corynebacterium diphtheriae cultured from the ulcer of the leg, along with Staphylococcus aureus, Streptococcus pyogenes, and Arcanobacterium haemolyticum. The patient was kept on isolation and treated with erythromycin for 14 days without antitoxin. He was discharged when his subsequent cultures turned out to be negative. Chemoprophylaxis was also given to his family members. Such a case highlights the revisiting of vaccination strategies and the role of cutaneous carriers in transmission of this deadly disease.
Topics: Adult; Anti-Bacterial Agents; Corynebacterium diphtheriae; Diphtheria; Erythromycin; Humans; India; Male; Skin Diseases; Treatment Outcome
PubMed: 30953325
DOI: 10.1007/s15010-019-01300-x -
Journal of Travel Medicine Jan 2018
Topics: Communicable Diseases, Emerging; Corynebacterium diphtheriae; Developing Countries; Diphtheria; Disease Outbreaks; Humans; Population Surveillance; Travel; Yemen
PubMed: 30289480
DOI: 10.1093/jtm/tay094 -
Infection Apr 2023Raising awareness of respiratory diphtheria and for the importance of early antitoxin administration.
PURPOSE
Raising awareness of respiratory diphtheria and for the importance of early antitoxin administration.
METHODS
Report of a case of fulminant, imported respiratory diphtheria in an otherwise healthy 24-year-old Afghan refugee in Austria in May 2022.
RESULT
This was the first case of respiratory diphtheria in Austria since 1993. Diphtheria antitoxin was administered at an already progressed disease stage. This delay contributed to a fulminant disease course with multiorgan failure and death.
CONCLUSION
In high-income countries with low case numbers, awareness of respiratory diphtheria and for the importance of early antitoxin administration must be raised.
Topics: Humans; Young Adult; Adult; Diphtheria; Corynebacterium diphtheriae; Refugees; Austria; Diphtheria Antitoxin
PubMed: 36178603
DOI: 10.1007/s15010-022-01926-4