An increase in non-toxigenic Corynebacterium diphtheriae infections in Poland — molecular epidemiology and antimicrobial susceptibility of strains isolated from past outbreaks and those currently circulating in Poland

Zasada, Aleksandra Anna; Baczewska-Rej, Milena; Wardak, Sebastian

doi:10.1016/j.ijid.2010.05.013

Cited by 49 publications

(33 citation statements)

References 19 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a Brazilian study, 97% of C. diphtheriae strains were found to be resistant to between 4 and 7 antimicrobial drug classes using disk diffusion and Etest methods (14). In contrast, data collected from the Russian Federation outbreak of the early 1990s showed 2.4% monoresistance to trimethoprim and rifampin but no MDR (12) and, more recently, 0% of Polish strains (19) were found to be MDR. Contemporary data for MDR diphtheria isolates recovered in Canada or the United States remains scant.…”

Section: Case Reportmentioning

confidence: 85%

Canada's First Case of a Multidrug-Resistant Corynebacterium diphtheriae Strain, Isolated from a Skin Abscess

et al. 2011

View full text Add to dashboard Cite

A toxigenic Corynebacterium diphtheriae biovar mitis sequence type 136 (ST136) strain was recovered from a toe infection of an unvaccinated patient recently returned from India. The isolate was resistant to clindamycin, erythromycin (ermX positive), tetracycline, and trimethoprim-sulfamethoxazole, intermediate to ceftriaxone and cefotaxime, and had high MICs for telithromycin and chloramphenicol but was sensitive to other drugs. CASE REPORTA 38-year-old male was seen by a family physician in a city located in a western Canadian province for an evaluation of an abscess on his left second toe which started 3 days prior while the patient was visiting family and friends in India. The patient had no history of traumatic injury, denied contact with sick persons, and had an unknown vaccination history. A swab of the left second toe was sent within hours to a private laboratory for bacterial culture and drug sensitivity testing. The patient was prescribed 500 mg of cephalexin three times a day for 10 days, and he recovered uneventfully. Patient consent to describe this case was obtained for the purpose of this study.The direct Gram stain of the specimen revealed Gram-positive cocci and Gram-positive bacilli. After ϳ48 h of incubation under facultatively anaerobic conditions at 35°C on 5% sheep blood agar, the culture grew colonies which were identified as group A streptococci and Staphylococcus aureus. In addition, the culture also grew creamy, opaque, slightly raised nonhemolytic colonies; Gram smear of the isolate revealed Grampositive bacilli with club-shaped ends and occasional V forms. This strain was urease negative and facultatively anaerobic. Colonies were black with dark halos on Tinsdale medium (17). The isolate was referred to the BC Center for Disease Control Laboratory for confirmation and identification as Corynebacterium diphtheriae. This strain fermented glucose and maltose but not lactose, mannitol, glycogen, or xylose. When studied by conventional methods, this strain reduced nitrate to nitrite and was catalase positive. Black colonies typical for C. diphtheriae grew on freshly prepared cystine-tellurite blood agar (17). Albert's staining (18a) was performed after 24 h of growth on Loeffler's medium (PML Microbiologicals, bioMérieux), where typical blue-black metachromatic granules against a green cytoplasm were observed, consistent with C. diphtheriae (6). The strain was forwarded to the Canadian National Microbiology Laboratory (NML) for further characterization and toxigenicity testing (NML identifier 090066).Growth in brain heart infusion broth was not enhanced by the addition of ϳ1% (vol/vol) sterile Tween 80, a feature that, if present, is suggestive of C. diphtheriae biovar intermedius (9). Using conventional carbohydrate broth sugars (2), the strain was corroborated as being positive for catalase, reduction of nitrate, and fermentation of glucose, fructose, galactose, maltose, mannose, and ribose but not glycerol, glycogen, lactose, mannitol, raffinose, sucrose, trehalose, or xylose. Oxidase wa...

show abstract

Section: Case Reportmentioning

confidence: 85%

Canada's First Case of a Multidrug-Resistant Corynebacterium diphtheriae Strain, Isolated from a Skin Abscess

et al. 2011

View full text Add to dashboard Cite

show abstract

“…As a consequence of the decreased prevalence of diphtheria, there has been a recent surge in NTCD infections, especially invasive diseases including IE, in countries such as Brazil [14], France [8,15], India [11], Poland [9], the United Kingdom [6], the United States [4,12], and New Zealand [7].…”

Section: Discussionmentioning

confidence: 99%

“…Although NTCD was isolated from a blood specimen of a patient with IE in 1987, the organism was not biotyped [21]. In countries where anti-diphtheria vaccination is being regularly implemented, the spectrum of diseases caused by C. diphtheriae has been altered [6][7][8][9]12], resulting in increased prevalence of NTCD infections, which can occur in DPT-immunized populations [6,8]. The causative agent in this patient was NTCD biotype gravis, similar to the organism isolated from invasive infections in Poland [9,15], the United States [4,12], and New Zealand [7].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, nontoxigenic strains of C. diphtheriae (NTCD) have been recognized to cause disease in many countries with high diphtheria vaccination coverage [4][5][6][7][8][9]. The spectrum of NTCD diseases ranges from cutaneous lesions and pharyngitis to severe invasive disease with bacteremia, endocarditis, septic arthritis, and splenic abscesses [6][7][8][9][10][11][12]. This report describes the first-ever case of a patient with infective endocarditis (IE) due to NTCD, complicated by a cerebral infarction and septic emboli in the Kingdom of Saudi Arabia (KSA) after the introduction of vaccination.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Late-onset prosthetic valve endocarditis caused by nontoxigenic Corynebacterium diphtheriae

El‐Hazmi

2015

J Infect Dev Ctries

View full text Add to dashboard Cite

In developed countries, Corynebacterium diphtheriae infection is rare due to efficient immunization programs. However, cases of nontoxigenic strains of C. diphtheriae infections, including endocarditis, have been reported recently. Although the incidence remains low, these infections are associated with high morbidity and mortality. This report describes the first and atypical case of bacteremia and endocarditis caused by nontoxigenic C. diphtheriae var. gravis after introduction of immunization in the Kingdom of Saudi Arabia (KSA).

show abstract

“…22 Although the toxin is the main virulence factor, the increase in invasive infections due to nontoxigenic C diphtheriae suggests that other factors, such as those involved in bacterial adhesion, colonization, or the evasion of host defenses, also contribute to virulence. 16,23 Nontoxigenic C diphtheriae are present in asymptomatic carriers and can convert to the toxigenic form if lysogenized by a bacteriophage with the tox gene. 16,20 Although this conversion is possible, the increase in severe infections due to nontoxigenic diphtheria over the last 25 to 30 years has not been accompanied by a rise in the toxigenic form.…”

Section: Figurementioning

confidence: 99%

A Case of Necrotizing Epiglottitis Due to NontoxigenicCorynebacterium diphtheriae

Lake

Ehrhardt

Suchi³

et al. 2015

Pediatrics

View full text Add to dashboard Cite

Diphtheria is a rare cause of infection in highly vaccinated populations and may not be recognized by modern clinicians. Infections by nontoxigenic Corynebacterium diphtheriae are emerging. We report the first case of necrotizing epiglottitis secondary to nontoxigenic C diphtheriae. A fully vaccinated child developed fever, poor oral intake, and sore throat and was found to have necrotizing epiglottitis. Necrotizing epiglottitis predominantly occurs in the immunocompromised host. Laboratory evaluation revealed pancytopenia, and bone marrow biopsy was diagnostic for acute lymphoblastic leukemia. Clinicians should be aware of aggressive infections that identify immunocompromised patients. This case highlights the features of a reemerging pathogen, C diphtheriae.

show abstract

An increase in non-toxigenic Corynebacterium diphtheriae infections in Poland — molecular epidemiology and antimicrobial susceptibility of strains isolated from past outbreaks and those currently circulating in Poland

Cited by 49 publications

References 19 publications

Canada's First Case of a Multidrug-Resistant Corynebacterium diphtheriae Strain, Isolated from a Skin Abscess

Canada's First Case of a Multidrug-Resistant Corynebacterium diphtheriae Strain, Isolated from a Skin Abscess

Late-onset prosthetic valve endocarditis caused by nontoxigenic Corynebacterium diphtheriae

A Case of Necrotizing Epiglottitis Due to NontoxigenicCorynebacterium diphtheriae

Contact Info

Product

Resources

About