Septicemia in an immunocompetent adult in the Czech Republic caused by Corynebacterium diphtheriae nontoxigenic strain biotype mitis: emergence of invasive cases in Western Europe

Massmann, Ricardo; Zavadilová, Jana; Drozenová, Jana; Fiksa, David; Smíšková, Dita

doi:10.1016/j.bjid.2019.12.003

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…It remains to be determined whether the negative tox gene is – like in C. belfantii – a constant feature in this species, which might directly influence its role as a human diphtheria pathogen. On the other hand, even severe human infections with non-toxigenic strains must not be underestimated with respect to the pathogenic potential (de Santis et al 2020 ; Massmann et al 2020 ). With four more animal isolates from three dogs from this study and one fox (Sing et al 2016 ) and possibly also from two cat isolates from the USA (Hall et al 2010 ) it is tempting to speculate and remains to be determined whether C. rouxii is also a zoonotic pathogen.…”

Section: Discussionmentioning

confidence: 99%

Corynebacterium rouxii, a recently described member of the C. diphtheriae group isolated from three dogs with ulcerative skin lesions

Schlez

Eisenberg

Rau

et al. 2021

Antonie van Leeuwenhoek

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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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Section: Discussionmentioning

confidence: 99%

Corynebacterium rouxii, a recently described member of the C. diphtheriae group isolated from three dogs with ulcerative skin lesions

Schlez

Eisenberg

Rau

et al. 2021

Antonie van Leeuwenhoek

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“…The definitive assay for diphtheria toxin expression is an immunoprecipitation reaction known as the Elek test [8,9]. Corynebacterium diphtheriae, C. ulcerans and C. pseudotuberculosis strains, which do not express diphtheria toxin are considered non-toxigenic, although such strains are capable of causing local and systemic disease, including endocarditis, septic arthritis, osteomyelitis and septicaemia [10][11][12][13][14][15][16][17][18][19][20][21][22]. The mechanisms for this are not fully understood, but are likely to result from the ability of these commensal organisms to opportunistically become invasive and/or cause persistent infections.…”

Section: Introductionmentioning

confidence: 99%

Household transmission of non-toxigenic diphtheria toxin gene-bearing Corynebacterium diphtheriae following a cluster of cutaneous cases in a specialist outpatient setting

Fry,

Pringle,

Newsholme

et al. 2023

Journal of Medical Microbiology

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Introduction. Combination of PCR and Elek testing to identify toxigenic corynebacteria has revealed organisms described as non-toxigenic toxin-gene bearing (NTTB) Corynebacterium diphtheriae or C. ulcerans (i.e. PCR tox positive; Elek negative). These organisms carry part or all of tox, but are unable to express diphtheria toxin (DT) and present a challenge to clinical and public health case management. Gap analysis/Hypothesis. There are few data on the theoretical risk of NTTB reversion to toxigenicity. This unique cluster and subsequent epidemiologically linked isolates allowed the opportunity to determine any change in DT expression status. Aim. To characterize a cluster of infections due to NTTB in a skin clinic and subsequent cases in two household contacts. Methodology. Epidemiological and microbiological investigations were carried out according to existing national guidance at the time. Susceptibility testing used gradient strips. The tox operon analysis and multi-locus sequence typing (MLST) was derived from whole-genome sequencing. Alignment of the tox operon and phylogenetic analyses were performed using clustalW, mega, the public core-genome MLST (cgMLST) scheme and an in-house bioinformatic single nucleotide polymorphism (SNP) typing pipeline. Results. Isolates of NTTB C. diphtheriae were recovered from four cases (cases 1 to 4) with epidermolysis bullosa attending the clinic. Two further isolates were subsequently recovered from case 4, >18 months later, and from two household contacts (cases 5 and 6) after a further 18 months and 3.5 years, respectively. All eight strains were NTTB C. diphtheriae biovar mitis, belonged to the same sequence type (ST-336) with the same deletion in tox. Phylogenetic analysis showed relatively high diversity between the eight strains with 7–199 SNP and 3–109 cgMLST loci differences between them. The number of SNPs between the three isolates from case 4 and two household contacts (cases 5 and 6) was 44–70 with 28–38 cgMLST loci differences. Conclusions. We report a cluster of NTTB C. diphtheriae cases in a skin clinic and evidence of onward household transmission. We conclude the deletion in the tox was responsible for the non-expression of DT. There was no evidence of reversion to DT expression over the 6.5 year period studied. These data informed revision to guidance in the management of NTTB cases and their contacts in the UK.

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Septicemia in an immunocompetent adult in the Czech Republic caused by Corynebacterium diphtheriae nontoxigenic strain biotype mitis: emergence of invasive cases in Western Europe

Cited by 2 publications

References 4 publications

Corynebacterium rouxii, a recently described member of the C. diphtheriae group isolated from three dogs with ulcerative skin lesions

Corynebacterium rouxii, a recently described member of the C. diphtheriae group isolated from three dogs with ulcerative skin lesions

Household transmission of non-toxigenic diphtheria toxin gene-bearing Corynebacterium diphtheriae following a cluster of cutaneous cases in a specialist outpatient setting

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