1
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Grönthal TSC, Lehto AK, Aarnio SS, Eskola EK, Aimo-Koivisto EM, Karlsson T, Koskinen HI, Barkoff AM, He Q, Lienemann T, Rimhanen-Finne R, Mykkänen A. Pastern dermatitis outbreak associated with toxigenic and non-toxigenic Corynebacterium diphtheriae and non-toxigenic Corynebacterium ulcerans at a horse stable in Finland, 2021. Zoonoses Public Health 2024; 71:127-135. [PMID: 37926867 DOI: 10.1111/zph.13090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
AIMS Corynebacterium diphtheriae and Corynebacterium ulcerans, when producing toxin, are the cause of diphtheria, a potentially life-threatening illness in humans. Horses (Equus ferus caballus) are known to be susceptible to infection that may manifest clinically on rare occasions. In late 2021 and early 2022, specimens from five horses suffering from pastern dermatitis were cultured at the Laboratory of Clinical Microbiology at the Faculty of Veterinary Medicine, University of Helsinki, Finland. C. diphtheriae and/or C. ulcerans were recovered from all of these. This study aimed to (1) analyse the bacterial isolates and (2) describe the outbreak and identify possible sources of the infection and infection routes in the stable. METHODS AND RESULTS Susceptibility testing, PCR for the tox gene, and Elek test for toxin production in PCR-positive isolates were performed. Whole genome sequencing was also conducted to achieve high-resolution strain typing. An epidemiological survey was done by means of a semi-structured interview of horses' caretaker, and contact tracing was done among people at the stable. Two tox gene-positive, toxin-producing C. diphtheriae belonged to sequence type (ST) 822. Other C. diphtheriae (n = 2, ST828) and C. ulcerans (n = 2, ST325 and ST838) isolates did not carry the tox gene. The epidemiological investigation explored numerous possible routes of transmission, but the definite source of infection was not identified. All established human contacts tested negative for diphtheriae. All horses recovered after antimicrobial treatment. CONCLUSIONS Our study shows that C. diphtheriae and C. ulcerans may readily spread among horses at the same stable and complicate pastern dermatitis infections. These potentially zoonotic bacteria can cause outbreaks even in a country with a very low prevalence. Caretakers should be encouraged to wear gloves and practice good hand hygiene when treating infected skin lesions in horses.
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Affiliation(s)
- Thomas Sven Christer Grönthal
- Animal Health Diagnostics Unit, Finnish Food Authority, Helsinki, Finland
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Anna Karoliina Lehto
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Sanna Sofia Aarnio
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Eva Katarina Eskola
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Elina Marjaana Aimo-Koivisto
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Teemu Karlsson
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Heli Irmeli Koskinen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Alex-Mikael Barkoff
- Institute of Biomedicine, Research Center for Infections and Immunity, University of Turku, Turku, Finland
| | - Qiushui He
- Institute of Biomedicine, Research Center for Infections and Immunity, University of Turku, Turku, Finland
| | - Taru Lienemann
- Animal Health Diagnostics Unit, Finnish Food Authority, Helsinki, Finland
| | - Ruska Rimhanen-Finne
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Anna Mykkänen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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2
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Fuchs F, Markert D, Wagner IV, Liebau MC, Berger A, Dangel A, Sing A, Fabri M, Plum G. Toxigenic Corynebacterium diphtheriae-Associated Genital Ulceration. Emerg Infect Dis 2021; 26:2180-2181. [PMID: 32818407 PMCID: PMC7454060 DOI: 10.3201/eid2609.180830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In October 2016, an adolescent boy sought care for acute genital ulceration in Cologne, Germany. We presumed a sexually transmitted infection, but initial diagnostic procedures yielded negative results. He was hospitalized because swab samples from the lesion grew toxigenic Corynebacterium diphtheriae, leading to the diagnosis of possibly sexually transmitted cutaneous diphtheria.
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3
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Viana MVC, Profeta R, da Silva AL, Hurtado R, Cerqueira JC, Ribeiro BFS, Almeida MO, Morais-Rodrigues F, Soares SDC, Oliveira M, Tavares L, Figueiredo H, Wattam AR, Barh D, Ghosh P, Silva A, Azevedo V. Taxonomic classification of strain PO100/5 shows a broader geographic distribution and genetic markers of the recently described Corynebacterium silvaticum. PLoS One 2020; 15:e0244210. [PMID: 33347470 PMCID: PMC7751848 DOI: 10.1371/journal.pone.0244210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022] Open
Abstract
The bacterial strain PO100/5 was isolated from a skin abscess taken from a pig (Sus scrofa domesticus) in the Alentejo region of southern Portugal. It was identified as Corynebacterium pseudotuberculosis using biochemical tests, multiplex PCR and Pulsed Field Gel Electrophoresis. After genome sequencing and rpoB phylogeny, the strain was classified as C. ulcerans. To better understand the taxonomy of this strain and improve identification methods, we compared strain PO100/5 to other publicly available genomes from C. diphtheriae group. Taxonomic analysis reclassified it and three others strains as the recently described C. silvaticum, which have been isolated from wild boar and roe deer in Germany and Austria. The results showed that PO100/5 is the first sequenced genome of a C. silvaticum strain from livestock and a different geographical region, has the unique sequence type ST709, and could be could produce the diphtheriae toxin, along with strain 05–13. Genomic analysis of PO100/5 showed four prophages, and eight conserved genomic islands in comparison to C. ulcerans. Pangenome analysis of 38 C. silvaticum and 76 C. ulcerans genomes suggested that C. silvaticum is a genetically homogeneous species, with 73.6% of its genes conserved and a pangenome near to be closed (α > 0.952). There are 172 genes that are unique to C. silvaticum in comparison to C. ulcerans. Most of these conserved genes are related to nutrient uptake and metabolism, prophages or immunity against them, and could be genetic markers for species identification. Strains PO100/5 (livestock) and KL0182T (wild boar) were predicted to be potential human pathogens. This information may be useful for identification and surveillance of this pathogen.
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Affiliation(s)
- Marcus Vinicius Canário Viana
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Genetics, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Rodrigo Profeta
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra Lima da Silva
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel Hurtado
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Janaína Canário Cerqueira
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Ferreira Sampaio Ribeiro
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelle Oliveira Almeida
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francielly Morais-Rodrigues
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Siomar de Castro Soares
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Manuela Oliveira
- Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisboa, Portugal
| | - Luís Tavares
- Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisboa, Portugal
| | - Henrique Figueiredo
- National Reference Laboratory of Aquatic Animal Disease, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alice Rebecca Wattam
- Biocomplexity Institute, University of Virginia, Charlottesville, Virginia, United States of America
| | - Debmalya Barh
- Institute of Integrative Omics and Applied Biotechnology, Purba Medinipur, West Bengal, India
| | - Preetam Ghosh
- Department of Computer Science, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Artur Silva
- Department of Genetics, Institute of Biological Sciences, Federal University of Pará, Belém, Pará, Brazil
| | - Vasco Azevedo
- Department of Genetics, Ecology and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
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4
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Sharma NC, Efstratiou A, Mokrousov I, Mutreja A, Das B, Ramamurthy T. Diphtheria. Nat Rev Dis Primers 2019; 5:81. [PMID: 31804499 DOI: 10.1038/s41572-019-0131-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2019] [Indexed: 01/09/2023]
Abstract
Diphtheria is a potentially fatal infection mostly caused by toxigenic Corynebacterium diphtheriae strains and occasionally by toxigenic C. ulcerans and C. pseudotuberculosis strains. Diphtheria is generally an acute respiratory infection, characterized by the formation of a pseudomembrane in the throat, but cutaneous infections are possible. Systemic effects, such as myocarditis and neuropathy, which are associated with increased fatality risk, are due to diphtheria toxin, an exotoxin produced by the pathogen that inhibits protein synthesis and causes cell death. Clinical diagnosis is confirmed by the isolation and identification of the causative Corynebacterium spp., usually by bacterial culture followed by enzymatic and toxin detection tests. Diphtheria can be treated with the timely administration of diphtheria antitoxin and antimicrobial therapy. Although effective vaccines are available, this disease has the potential to re-emerge in countries where the recommended vaccination programmes are not sustained, and increasing proportions of adults are becoming susceptible to diphtheria. Thousands of diphtheria cases are still reported annually from several countries in Asia and Africa, along with many outbreaks. Changes in the epidemiology of diphtheria have been reported worldwide. The prevalence of toxigenic Corynebacterium spp. highlights the need for proper clinical and epidemiological investigations to quickly identify and treat affected individuals, along with public health measures to prevent and contain the spread of this disease.
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Affiliation(s)
- Naresh Chand Sharma
- Laboratory Department, Maharishi Valmiki Infectious Diseases Hospital, Delhi, India
| | - Androulla Efstratiou
- WHO Collaborating Centre for Diphtheria and Streptococcal Infections, Reference Microbiology Division, Public Health England, London, UK
| | - Igor Mokrousov
- Laboratory of Molecular Epidemiology and Evolutionary Genetics, St. Petersburg Pasteur Institute, St. Petersburg, Russia
| | - Ankur Mutreja
- Global Health-Infectious Diseases, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Bhabatosh Das
- Infection and Immunology Division, Translational Health Science and Technology Institute, Faridabad, India
| | - Thandavarayan Ramamurthy
- Infection and Immunology Division, Translational Health Science and Technology Institute, Faridabad, India.
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5
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Edwards D, Kent D, Lester C, Brown CS, Murphy ME, Brown NM, Sule O, Itani A, Chand M, Trindall A, Pearson C, Roddick I, Fry NK, Hoffmann J, Iyanger N, Kemp L, White J, Javid B, Ramsay ID, Zenner D, Ahmed A, Amirthalingam G, Salimee S, Litt D, Reacher M. Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 30280689 PMCID: PMC6169202 DOI: 10.2807/1560-7917.es.2018.23.39.1700681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In early 2017, a United Kingdom (UK)-born person in their 20s presented with a skin ulcer on the foot 3 weeks after returning from Ghana. The patient had last received a diphtheria-containing vaccine in 2013, completing the recommended course. MALDI-TOF of a cutaneous swab identified Corynebacterium diphtheriae. Real-time PCR ascertained the species and presence of the diphtheria toxin gene. An Elek test confirmed toxigenicity. The isolate was macrolide sensitive and penicillin resistant. The local Public Health England (PHE) Health Protection Team obtained the patient's clinical history and traced contacts to inform appropriate public health action. One close contact (in their early 80s with uncertain immunisation status who had not recently travelled) had a positive throat swab for toxigenic C. diphtheriae and reported a history of mild coryzal symptoms. Multilocus sequence typing revealed that strains from the index case and contact had Sequence Type 463. Diphtheria is extremely rare in the UK due to high vaccine coverage and this is the first documented transmission in 30 years. Clinicians and laboratory staff should remain highly suspicious of lesions in overseas travellers, even when patients are fully vaccinated. Older individuals who might not have completed a full immunisation course may have higher diphtheria susceptibility.
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Affiliation(s)
- David Edwards
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Dianne Kent
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Caroline Lester
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | | | - Michael E Murphy
- Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Nicholas M Brown
- PHE Public Health Laboratory Cambridge, Public Health England, Cambridge, United Kingdom
| | - Olajumoke Sule
- PHE Public Health Laboratory Cambridge, Public Health England, Cambridge, United Kingdom
| | | | - Meera Chand
- NIHR Health Protection Research Unit in Respiratory Infections, Public Health England, London, United Kingdom
| | - Amy Trindall
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
| | - Callum Pearson
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
| | - Iain Roddick
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
| | - Norman K Fry
- National Infection Service, Public Health England, London, United Kingdom
| | - Jorg Hoffmann
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Nalini Iyanger
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Joanne White
- National Infection Service, Public Health England, London, United Kingdom
| | - Babak Javid
- Department of Medicine, University of Cambridge School of Clinical Medicine, University of Cambridge Hospitals Trust, Cambridge, United Kingdom
| | - Isobel D Ramsay
- Department of Medicine, University of Cambridge School of Clinical Medicine, University of Cambridge Hospitals Trust, Cambridge, United Kingdom
| | - Dominik Zenner
- National Infection Service, Public Health England, London, United Kingdom
| | - Aliko Ahmed
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
| | - Sultan Salimee
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - David Litt
- National Infection Service, Public Health England, London, United Kingdom
| | - Mark Reacher
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
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6
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Seth-Smith HMB, Egli A. Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings. Front Public Health 2019; 7:235. [PMID: 31497588 PMCID: PMC6713046 DOI: 10.3389/fpubh.2019.00235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
Corynebacterium diphtheriae (C. diphtheriae) is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by Corynebacterium ulcerans and Corynebacterium pseudotuberculosis. Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic C. diphtheriae diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of C. diphtheriae and share our own experience with the coordination of a Swiss-German outbreak.
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Affiliation(s)
- Helena M B Seth-Smith
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
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7
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Berger A, Dangel A, Peters M, Mühldorfer K, Braune S, Eisenberg T, Szentiks CA, Rau J, Konrad R, Hörmansdorfer S, Ackermann N, Sing A. Tox-positive Corynebacterium ulcerans in hedgehogs, Germany . Emerg Microbes Infect 2019; 8:211-217. [PMID: 30866774 PMCID: PMC6455118 DOI: 10.1080/22221751.2018.1562312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Toxigenic Corynebacterium ulcerans may cause both respiratory and cutaneous diphtheria in humans. As a zoonotic emerging pathogen it has been isolated from a wide variety of animals living in captivity, such as livestock, pet, zoo and research animals and additionally in a large number of different wild animals. Here we report the isolation of tox-positive C. ulcerans in four hedgehogs with cutaneous diphtheria and pneumonia, respectively.
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Affiliation(s)
- Anja Berger
- a National Consiliary Laboratory for Diphtheria , Oberschleißheim , Germany.,b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Alexandra Dangel
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Martin Peters
- c Chemisches und Veterinäruntersuchungsamt Westfalen , Arnsberg , Germany
| | | | - Silke Braune
- e Lower Saxony State Office for Consumer Protection and Food Safety , Food and Veterinary Institute , Hannover , Germany
| | | | | | - Jörg Rau
- g Chemisches und Veterinäruntersuchungsamt Stuttgart , Fellbach , Germany
| | - Regina Konrad
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Stefan Hörmansdorfer
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Nikolaus Ackermann
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Andreas Sing
- a National Consiliary Laboratory for Diphtheria , Oberschleißheim , Germany.,b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
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8
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Hacker E, Antunes CA, Mattos-Guaraldi AL, Burkovski A, Tauch A. Corynebacterium ulcerans, an emerging human pathogen. Future Microbiol 2016; 11:1191-208. [PMID: 27545005 DOI: 10.2217/fmb-2016-0085] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
While formerly known infections of Corynebacterium ulcerans are rare and mainly associated with contact to infected cattle, C. ulcerans has become an emerging pathogen today. In Western Europe, cases of respiratory diphtheria caused by C. ulcerans have been reported more often than infections by Corynebacterium diphtheria, while systemic infections are also increasingly reported. Little is known about factors that contribute to host colonization and virulence of this zoonotic pathogen. Research in this field has received new impetus by the publication of several C. ulcerans genome sequences in the past years. This review gives a comprehensive overview of the basic knowledge of C. ulcerans, as well as the recent advances made in the analysis of putative virulence factors.
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Affiliation(s)
- Elena Hacker
- Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Camila A Antunes
- Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Laboratory of Diphtheria and Clinically Important Corynebacteria (LDCIC), Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana L Mattos-Guaraldi
- Laboratory of Diphtheria and Clinically Important Corynebacteria (LDCIC), Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Andreas Burkovski
- Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Tauch
- Centrum für Biotechnologie, Universität Bielefeld, Bielefeld, Germany
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9
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Corynebacterium ulcerans cutaneous diphtheria. THE LANCET. INFECTIOUS DISEASES 2015; 15:1100-1107. [PMID: 26189434 DOI: 10.1016/s1473-3099(15)00225-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/12/2015] [Accepted: 03/10/2015] [Indexed: 11/21/2022]
Abstract
We describe the case of a patient with cutaneous diphtheria caused by toxigenic Corynebacterium ulcerans who developed a right hand flexor sheath infection and symptoms of sepsis such as fever, tachycardia, and elevated C-reactive protein, after contact with domestic cats and dogs, and a fox. We summarise the epidemiology, clinical presentation, microbiology, diagnosis, therapy, and public health aspects of this disease, with emphasis on improving recognition. In many European countries, C ulcerans has become the organism commonly associated with cutaneous diphtheria, usually seen as an imported tropical disease or resulting from contact with domestic and agricultural animals. Diagnosis relies on bacterial culture and confirmation of toxin production, with management requiring appropriate antimicrobial therapy and prompt administration of antitoxin, if necessary. Early diagnosis is essential for implementation of control measures and clear guidelines are needed to assist clinicians in managing clinical diphtheria. This case was a catalyst to the redrafting of the 2014 national UK interim guidelines for the public health management of diphtheria, released as final guidelines in March, 2015.
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10
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Eisenberg T, Kutzer P, Peters M, Sing A, Contzen M, Rau J. Nontoxigenic tox-bearing Corynebacterium ulcerans infection among game animals, Germany. Emerg Infect Dis 2015; 20:448-52. [PMID: 24572455 PMCID: PMC3944853 DOI: 10.3201/eid2003.130423] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Corynebacterium ulcerans may cause diphtheria in humans and caseous lymphadenitis in animals. We isolated nontoxigenic tox-bearing C. ulcerans from 13 game animals in Germany. Our results indicate a role for game animals as reservoirs for zoonotic C. ulcerans.
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11
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Boschert V, Berger A, Konrad R, Huber I, Hörmansdorfer S, Zöls S, Eddicks M, Ritzmann M, Sing A. Corynebacterium species nasal carriage in pigs and their farmers in Bavaria, Germany: implications for public health. Vet Rec 2014; 175:248. [PMID: 25037890 DOI: 10.1136/vr.102634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Reports on cases of human diphtheria caused by toxigenic Corynebacterium ulcerans that were linked to occupational swine contact as well as isolation of C ulcerans from wild boars have suggested that pigs might serve as reservoir for human infections. Therefore, a prevalence study on Corynebacterium species nasal carriage in pigs and their farmers was performed between August 1 and December 31, 2009, in 41 swine farms from Bavaria, Germany. All 411 asymptomatic pigs and 29 of 30 healthy farmers were colonised with Corynebacterium strains of up to 11 different species. No potentially toxigenic Corynebacterium strain was isolated either from the pigs or from their farmers, respectively. The patterns of the species composition in the pigs and the farmers were very similar, suggesting a potential transmission of strains between animals and humans.
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Affiliation(s)
- V Boschert
- Bavarian Health and Food Safety Authority, Oberschleißheim 85764, Germany Clinic for Swine, Ludwig-Maximilians-University Munich, Oberschleißheim 85764, Germany
| | - A Berger
- National Consiliary Laboratory for Diphtheria, Oberschleißheim 85764, Germany Bavarian Health and Food Safety Authority, Oberschleißheim 85764, Germany
| | - R Konrad
- National Consiliary Laboratory for Diphtheria, Oberschleißheim 85764, Germany Bavarian Health and Food Safety Authority, Oberschleißheim 85764, Germany
| | - I Huber
- Bavarian Health and Food Safety Authority, Oberschleißheim 85764, Germany
| | - S Hörmansdorfer
- Bavarian Health and Food Safety Authority, Oberschleißheim 85764, Germany
| | - S Zöls
- Clinic for Swine, Ludwig-Maximilians-University Munich, Oberschleißheim 85764, Germany
| | - M Eddicks
- Clinic for Swine, Ludwig-Maximilians-University Munich, Oberschleißheim 85764, Germany
| | - M Ritzmann
- Clinic for Swine, Ludwig-Maximilians-University Munich, Oberschleißheim 85764, Germany
| | - A Sing
- National Consiliary Laboratory for Diphtheria, Oberschleißheim 85764, Germany Bavarian Health and Food Safety Authority, Oberschleißheim 85764, Germany
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