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Hillan A, Gibbs T, Weaire-Buchanan G, Brown T, Pang S, McEvoy SP, Parker E. Zoonotic transmission of diphtheria toxin-producing Corynebacterium ulcerans. Zoonoses Public Health 2024; 71:157-169. [PMID: 37957801 DOI: 10.1111/zph.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Diphtheria caused by toxin-producing Corynebacterium ulcerans is a re-emerging human disease that can cause local and systemic sequelae. In Australia, toxigenic diphtheria is a rare notifiable communicable disease, due to high-vaccination coverage. The public health management of cutaneous cases of toxigenic C. ulcerans varies between jurisdictions, as opposed to the more uniform public health response to toxigenic Corynebacterium diphtheriae presenting as respiratory or laryngeal diphtheria. AIM To report a case of zoonotically acquired C. ulcerans, review evidence on the zoonotic reservoir and reported transmission events, and examine public health guidelines for the management of human and animal contacts. METHODS AND RESULTS In this case report, we detail our case investigation, treatment and public health management, including contact tracing and an approach to animal testing. We successfully identified companion canines as probable sources for the human case, with WGS confirming the link. The zoonotic disease link of C. ulcerans to domestic and agricultural animals is established in the literature; however, the management of animal contacts in human cases is inconsistent with jurisdictional or national guidelines. CONCLUSIONS While a rare disease, a consistent approach to public health management is warranted to systematically elucidate the disease source and improve understanding of transmission.
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Affiliation(s)
- Adeline Hillan
- Metropolitan Communicable Disease Control, North Metropolitan Health Service, Perth, Western Australia, Australia
| | - Tristan Gibbs
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Graham Weaire-Buchanan
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Tracy Brown
- Metropolitan Communicable Disease Control, North Metropolitan Health Service, Perth, Western Australia, Australia
| | - Stanley Pang
- Department of Microbiology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Suzanne P McEvoy
- Metropolitan Communicable Disease Control, North Metropolitan Health Service, Perth, Western Australia, Australia
| | - Erica Parker
- Metropolitan Communicable Disease Control, North Metropolitan Health Service, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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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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Crestani C, Arcari G, Landier A, Passet V, Garnier D, Brémont S, Armatys N, Carmi-Leroy A, Toubiana J, Badell E, Brisse S. Corynebacterium ramonii sp. nov., a novel toxigenic member of the Corynebacterium diphtheriae species complex. Res Microbiol 2023; 174:104113. [PMID: 37572824 DOI: 10.1016/j.resmic.2023.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
The Corynebacterium diphtheriae species complex comprises seven bacterial species, including Corynebacterium ulcerans, a zoonotic pathogen from multiple animal species. In this work, we characterise phenotypically and genotypically isolates belonging to two C. ulcerans lineages. Results from phylogenetic analyses, in silico DNA-DNA hybridization (DDH) and MALDI-TOF spectra differentiate lineage 2 from C. ulcerans lineage 1, which, together with their distinct transmission dynamics (probable human-to-human vs animal-to-human), indicates that lineage 2 is a separate Corynebacterium species, which we propose to name Corynebacterium ramonii. This species is of particular medical interest considering that its human-to-human transmission is likely, and that some C. ramonii isolates carry the diphtheria toxin gene.
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Affiliation(s)
- Chiara Crestani
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.
| | - Gabriele Arcari
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Annie Landier
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Virginie Passet
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Dorian Garnier
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Sylvie Brémont
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France; Institut Pasteur, French National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Nathalie Armatys
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Annick Carmi-Leroy
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France; Institut Pasteur, French National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Julie Toubiana
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France; Institut Pasteur, French National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France; Necker-Enfants Malades University Hospital, Paris, France
| | - Edgar Badell
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France; Institut Pasteur, French National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France; Institut Pasteur, French National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France.
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Museux K, Arcari G, Rodrigo G, Hennart M, Badell E, Toubiana J, Brisse S. Corynebacteria of the diphtheriae Species Complex in Companion Animals: Clinical and Microbiological Characterization of 64 Cases from France. Microbiol Spectr 2023; 11:e0000623. [PMID: 37022195 PMCID: PMC10269909 DOI: 10.1128/spectrum.00006-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/07/2023] [Indexed: 04/07/2023] Open
Abstract
Corynebacteria of the diphtheriae species complex (CdSC) can cause diphtheria in humans and have been reported from companion animals. We aimed to describe animal infection cases caused by CdSC isolates. A total of 18,308 animals (dogs, cats, horses, and small mammals) with rhinitis, dermatitis, nonhealing wounds, and otitis were sampled in metropolitan France (August 2019 to August 2021). Data on symptoms, age, breed, and the administrative region of origin were collected. Cultured bacteria were analyzed for tox gene presence, production of the diphtheria toxin, and antimicrobial susceptibility and were genotyped by multilocus sequence typing. Corynebacterium ulcerans was identified in 51 cases, 24 of which were toxigenic. Rhinitis was the most frequent presentation (18/51). Eleven cases (6 cats, 4 dogs, and 1 rat) were monoinfections. Large-breed dogs, especially German shepherds (9 of 28 dogs; P < 0.00001), were overrepresented. C. ulcerans isolates were susceptible to all tested antibiotics. tox-positive C. diphtheriae was identified in 2 horses. Last, 11 infections cases (9 dogs and 2 cats; mostly chronic otitis and 2 sores) had tox-negative C. rouxii, a recently defined species. C. rouxii and C. diphtheriae isolates were susceptible to most antibiotics tested, and almost all of these infections were polymicrobial. Monoinfections with C. ulcerans point toward a primary pathogenic potential to animals. C. ulcerans represents an important zoonotic risk, and C. rouxii may represent a novel zoonotic agent. This case series provides novel clinical and microbiological data on CdSC infections and underlines the need for management of animals and their human contacts. IMPORTANCE We report on the occurrence and clinical and microbiological characteristics of infections caused by members of the CdSC in companion animals. This is the first study based on the systematic analysis of a very large animal cohort (18,308 samples), which provides data on the frequency of CdSC isolates in various types of clinical samples from animals. Awareness of this zoonotic bacterial group remains low among veterinarians and veterinary laboratories, among which it is often considered commensal in animals. We suggest that in the case of CdSC detection in animals, the veterinary laboratories should be encouraged to send the samples to a reference laboratory for analysis of the presence of the tox gene. This work is relevant to the development of guidelines in the case of CdSC infections in animals and underlines their public health relevance given the zoonotic transmission risk.
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Affiliation(s)
| | - Gabriele Arcari
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | | | - Melanie Hennart
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Collège doctoral, Sorbonne Université, Paris, France
| | - Edgar Badell
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the diphtheriae complex, Paris, France
| | - Julie Toubiana
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the diphtheriae complex, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker-Enfants Malades, APHP, Université de Paris, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the diphtheriae complex, Paris, France
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Colombo S, Cornegliani L, Vercelli A, Fondati A. Ear tip ulcerative dermatitis treated with oclacitinib in 25 dogs: a retrospective case series. Vet Dermatol 2021; 32:363-e100. [PMID: 34250688 DOI: 10.1111/vde.12992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ear tip ulcerative dermatitis (ETUD) is an uncommon clinical reaction pattern in canine dermatology. The lesions are suggestive of vascular damage which may be caused by inflammatory or noninflammatory diseases, and often are idiopathic. Therapeutic options for ETUD include topical glucocorticoids or tacrolimus, pentoxifylline, vitamin E, doxycycline, tetracycline and niacinamide, sulfonamides, glucocorticoids, ciclosporin and surgical correction. HYPOTHESIS/OBJECTIVES The aims of this retrospective case series were to describe the clinical features and report response to treatment with oclacitinib in dogs with idiopathic, chronic ETUD. ANIMALS Twenty-five privately owned dogs with unilateral or bilateral ETUD. METHODS AND MATERIALS Cases of ETUD which were poorly responsive to conventional therapy and subsequently treated with oclacitinib, are summarised. All cases were tested for leishmaniosis by serological examination [indirect fluorescent antibody test (IFAT) or enzyme-linked immunosorbent assay (ELISA)]. Histopathological examination was performed in two cases. RESULTS Serological results were negative for leishmaniosis in all dogs. Histopathological changes consistent with proliferative thrombovascular necrosis of the pinnae were documented in two cases. Oclacitinib, used at the standard dose range recommended for the treatment of canine atopic dermatitis, effectively resolved ETUD in 22 of 25 dogs within one to three months. Several of the dogs required prolonged use of twice daily dosing. CONCLUSIONS AND CLINICAL RELEVANCE Oclacitinib should be included among the therapeutic options for ETUD, once infectious diseases have been ruled out.
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Affiliation(s)
- Silvia Colombo
- Servizi Dermatologici Veterinari, via Felice Musazzi 24, Legnano, MI, I-20025, Italy
| | - Luisa Cornegliani
- Clinica Veterinaria Città di Torino, c.so Traiano 99/d, Torino, I-10135, Italy
| | - Antonella Vercelli
- Clinica Veterinaria Città di Torino, c.so Traiano 99/d, Torino, I-10135, Italy
| | - Alessandra Fondati
- Clinica Veterinaria Colombo, Viale Cristoforo Colombo 153, Lido di Camaiore, LU, I-55041, Italy
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Schlez K, Eisenberg T, Rau J, Dubielzig S, Kornmayer M, Wolf G, Berger A, Dangel A, Hoffmann C, Ewers C, Sing A. Corynebacterium rouxii, a recently described member of the C. diphtheriae group isolated from three dogs with ulcerative skin lesions. Antonie van Leeuwenhoek 2021; 114:1361-1371. [PMID: 34170418 PMCID: PMC8379122 DOI: 10.1007/s10482-021-01605-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
Corynebacterium (C.) diphtheriae is one of the two etiological pathogens for human diphtheria with significant morbidity and mortality. Recently, members of its biovar Belfanti have been described as two novel species, C. belfantii and C. rouxii. The most important virulence factor and also the premise to cause diphtheria is the isolate’s capacity to encode and express the diphtheria toxin (DT). In contrast to C. ulcerans, which represents a potentially zoonotic pathogen, C. diphtheriae (incl. the novel deduced species) has almost exclusively been found to comprise a human pathogen. We here report three rare cases of C. rouxii isolation from dogs suffering from disseminated poly-bacterial exsudative to purulent dermatitis and a traumatic labial defect, respectively. The isolates were identified as C. diphtheriae based on commercial biochemistry and matrix-assisted laser desorption/ionisation–time of flight mass spectrometry (MALDI-TOF MS) analysis. However, recently described specific spectral peaks were highly similar to spectra of C. rouxii, which was confirmed by whole genome sequencing. Further investigations of the dog isolates for the presence of DT by tox gene qPCR revealed negative results. The findings from this study point out that skin infections in companion animals can be colonized by uncommon and so believed human specific pathogens, thereby resembling the clinical signs of cutaneous diphtheria.
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Affiliation(s)
- Karen Schlez
- Hessian State Laboratory, Department of Veterinary Medicine, Hessisches Landeslabor, Schubertstr. 60, 35392, Giessen, Germany.
| | - Tobias Eisenberg
- Hessian State Laboratory, Department of Veterinary Medicine, Hessisches Landeslabor, Schubertstr. 60, 35392, Giessen, Germany.
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 87-89, 35392, Giessen, Germany.
| | - Jörg Rau
- Chemical and Veterinary Analysis Agency Stuttgart, Schaflandstr. 3/2, 70736, Fellbach, Germany
| | - Sabine Dubielzig
- Veterinary Practice for Pets, Wehrenpfad 3, 34560, Fritzlar, Germany
| | - Matthias Kornmayer
- Department for Clinical Veterinary Medicine, Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany
| | - Georg Wolf
- Department of Veterinary Sciences, Institute of Infectious Diseases and Zoonoses, Faculty of Veterinary Medicine, Ludwig-Maximilian-University, Veterinärstr. 13, 80539, Munich, Germany
| | - Anja Berger
- National Consiliary Laboratory on Diphtheria, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstr. 2, 85764, Oberschleißheim, Germany
| | - Alexandra Dangel
- National Consiliary Laboratory on Diphtheria, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstr. 2, 85764, Oberschleißheim, Germany
| | - Christiane Hoffmann
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 87-89, 35392, Giessen, Germany
| | - Christa Ewers
- Institute of Hygiene and Infectious Diseases of Animals, Justus Liebig University Giessen, Frankfurter Str. 87-89, 35392, Giessen, Germany
| | - Andreas Sing
- National Consiliary Laboratory on Diphtheria, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Veterinärstr. 2, 85764, Oberschleißheim, Germany
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Abbott Y, Efstratiou A, Brennan G, Hallanan S, Leggett B, Leonard FC, Markey BK, Tuite C, Fry NK. Toxigenic Corynebacterium ulcerans associated with upper respiratory infections in cats and dogs. J Small Anim Pract 2020; 61:554-560. [PMID: 32734615 DOI: 10.1111/jsap.13185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To describe infection in companion animals with the zoonotic pathogen Corynebacterium ulcerans and to determine its prevalence in clinically-affected and healthy animals. MATERIALS AND METHODS The clinical presentation and treatment of three cases of C. ulcerans infection is described. Two studies to determine C. ulcerans prevalence rates were undertaken: (a) a prospective study of nasal samples from healthy animals, 479 dogs and 72 cats; (b) a retrospective analysis of records of nasal samples collected over a 10-year period from 189 dogs and 64 cats affected by respiratory signs. RESULTS Toxigenic C. ulcerans was isolated from four cats with nasal discharge while concurrent C. ulcerans and mecC methicillin-resistant S. aureus infection was detected in a dog suffering from chronic nasal discharge. Clinical features were not distinctive and all cases recovered following antimicrobial treatment. Multilocus sequence typing supported a common source for isolates from the shelter cats. Carriage rates of C. ulcerans in healthy animals were 0.42% (2/479) in dogs and 0.00% (0/72) in cats whereas in animals with signs of upper respiratory tract infection prevalence rates were 0.53% (1/189) in dogs and 6.25% (4/64) in cats. CLINICAL SIGNIFICANCE Clinicians should be aware that dogs and cats can be infected with (or carriers of) toxigenic C. ulcerans Considering the potential zoonotic risk, assistance from medical and public health colleagues should be sought in confirmed cases.
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Affiliation(s)
- Y Abbott
- Veterinary Pathobiology Section, School of Veterinary Medicine, University College Dublin, Belfield, Stillorgan Road, Dublin, D04 W6F6, Ireland
| | - A Efstratiou
- WHO Global Reference Centre for Diphtheria and Streptococcal Infections, Public Health England, National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - G Brennan
- National MRSA Reference Laboratory, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - S Hallanan
- Riverforest Veterinary Centre, Riverforest Court, Captain's Hill, Leixlip, Co. Kildare, W23 A5N4, Ireland
| | - B Leggett
- Veterinary Pathobiology Section, School of Veterinary Medicine, University College Dublin, Belfield, Stillorgan Road, Dublin, D04 W6F6, Ireland
| | - F C Leonard
- Veterinary Pathobiology Section, School of Veterinary Medicine, University College Dublin, Belfield, Stillorgan Road, Dublin, D04 W6F6, Ireland
| | - B K Markey
- Veterinary Pathobiology Section, School of Veterinary Medicine, University College Dublin, Belfield, Stillorgan Road, Dublin, D04 W6F6, Ireland
| | - C Tuite
- Fairview Veterinary Hospital, 13 Fairview Strand, Dublin, D03 P27, Ireland
| | - N K Fry
- Vaccine Preventable Bacteria Section, Public Health England, National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, UK.,Immunisation and Countermeasures Division, Public Health England, National Infection Service, 61 Colindale Avenue, London, NW9 5EQ, UK
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