Nasopharyngeal Corynebacterium ulcerans diphtheria in the Netherlands

Abstract

A 59 year old woman was admitted to hospital with a three day history of a sore throat and increasing dysphagia. During treatment with oral penicillin for one day, pain and dysphagia progressed and the patient was admitted. On examination, she was afebrile, her soft palate and uvula were swollen, and a membraneous exudate was seen on the soft palate and nasopharynx.

Detection of Differences in the Nucleotide and Amino Acid Sequences of Diphtheria Toxin from Corynebacterium diphtheriae and Corynebacterium ulcerans Causing Extrapharyngeal Infections

“…Several cases of human infection have therefore been linked to the drinking of unpasteurized milk from cows or goats (2). However, as with our two patients, most of the recent cases reported in the literature have not been associated with exposure to cattle or raw milk (3,13,21,22). The observation that C. ulcerans infections can mimic classical diphtheria has been linked to the ability of C. ulcerans to produce DT similarly to C. diphtheriae (and C. pseudotuberculosis).…”

“…This has been explained by the fact that in similarity to Corynebacterium diphtheriae and Corynebacterium pseudotuberculosis, C. ulcerans may harbor lysogenic ␤-corynephages coding for the diphtheria toxin (DT) which is responsible for the systemic symptoms caused by C. diphtheriae. Recently, several reports of severe C. ulcerans infections causing pseudomembrane formation (3,6,14,21) and the isolation of C. ulcerans from domestic cats (20) alerted public health professionals involved in diphtheria control in Europe and the United States and prompted a change in the guidelines on control of toxigenic C. ulcerans in the United Kingdom (J. M. White, N. S. Crowcroft, A. Efstratiou, K. Engler, G. Mann, and R. C. George, Abstr. Publ.…”

Corynebacterium ulcerans in an Immunocompromised Patient with Diphtheria and Her Dog

“…These results have the following implications: (i) C. ulcerans diphtheria probably does not result from a simple transfer of phages coding for the C. diphtheria toxin from C. diphtheria to C. ulcerans; (ii) toxins of C. ulcerans may induce either extrapharyngeal infection or diphtheria, depending more of the immunological status of the patient rather than on the nature of the toxin; and (iii) animals may be an environmental reservoir for sporadic cases of C. ulcerans diphtheria. The incidence of C. ulcerans infections in humans remains low; only a few cases have been reported in Denmark, Germany, Switzerland, The Netherlands, the United States, and Japan (2,5,7,8,14). In the United Kingdom, 24 cases of toxigenic C. ulcerans infections have been reported from 1993 to 1999 (8).…”

Investigations of 2 Cases of Diphtheria-Like Illness Due to Toxigenic Corynebacterium ulcerans

“…As shown in table 2, respiratory diphtheria-like illnesses caused by toxigenic strains of C. ulcerans are increasingly reported from developed countries [3][4][5][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. C. ulcerans accounted for 21 (58%) of 36 human toxin-producing isolates of Corynebacterium species in the United Kingdom from 1997 through 2002 [42], 3 (33%) of 9 isolates in Canada from 1999 through 2003 [43], and 1 (33%) of 3 isolates in Italy from 1990 through 2001 [44].…”