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.
| Original language | English |
|---|---|
| Pages (from-to) | 1100-1107 |
| Number of pages | 8 |
| Journal | The Lancet Infectious Diseases |
| Volume | 15 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 1 Sept 2015 |
Bibliographical note
Funding Information:We identified citations for this Grand Round by searching PubMed with the terms “diphtheria”, “ Corynebacterium ulcerans ”, and “ Corynebacterium diphtheriae ” for articles published in English between Jan 1, 1990 and Sept 1, 2014. Relevant articles resulting from these searches, and important references cited in those articles, were reviewed. Contributors LSPM searched the scientific literature. LSPM and SS wrote the first draft of the manuscript with section contributions from AL and MM (public health and epidemiology), AS (histopathology and diagnostics), and AE (diagnostics and management). All authors reviewed, revised, and approved the final draft of the manuscript. Declaration of interests LSPM has served on a scientific advisory board for bioMérieux. All other authors declare no competing interests. The funding bodies had no direct involvement in the writing of the manuscript or the decision to submit it for publication. The authors declare that they have not been paid to write this manuscript by a pharmaceutical company or other agency. LSPM declares that as the corresponding author, he has had full access to all the information described in this manuscript and had final responsibility for the decision to submit for publication. Acknowledgments LSPM and SS acknowledge the National Institute of Health Research Imperial Biomedical Research Centre for their support for clinical research in relation to this case. The authors thank the clinical and the public health teams who dealt with the incident. This study was funded by the National Institute of Health Research Imperial Biomedical Research Centre in the form of a Fellowship grant to LSPM, and the UK Clinical Research Collaboration who fund the National Centre for Infection Prevention and Management (UKCRC G0800777), with whom LSPM and SS are affiliated.
Publisher Copyright:
© 2015 Elsevier Ltd.
