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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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Sting R, Pölzelbauer C, Eisenberg T, Bonke R, Blazey B, Peters M, Riße K, Sing A, Berger A, Dangel A, Rau J. Corynebacterium ulcerans Infections in Eurasian Beavers ( Castor fiber). Pathogens 2023; 12:979. [PMID: 37623939 PMCID: PMC10459376 DOI: 10.3390/pathogens12080979] [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: 06/07/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
The Eurasian beaver (Castor fiber) has been reintroduced successfully in Germany since the 1990s. Since wildlife is an important source of zoonotic infectious diseases, monitoring of invasive and reintroduced species is crucial with respect to the One Health approach. Three Eurasian beavers were found dead in the German federal states of Bavaria, North Rhine-Westphalia and Baden-Wuerttemberg in 2015, 2021 and 2022, respectively. During post-mortem examinations, Corynebacterium (C.) ulcerans could be isolated from the abscesses of two beavers and from the lungs of one of the animals. Identification of the bacterial isolates at the species level was carried out by spectroscopic analysis using MALDI-TOF MS, FT-IR and biochemical profiles and were verified by molecular analysis based on 16-23S internal transcribed spacer (ITS) region sequencing. Molecular characterization of the C. ulcerans isolates using whole-genome sequencing (WGS) revealed a genome size of about 2.5 Mbp and a GC content of 53.4%. Multilocus sequence typing (MLST) analysis classified all three isolates as the sequence type ST-332. A minimum spanning tree (MST) based on cgMLST allelic profiles, including 1211 core genes of the sequenced C. ulcerans isolates, showed that the beaver-derived isolates clearly group on the branch of C. ulcerans with the closest relationship to each other, in close similarity to an isolate from a dog. Antibiotic susceptibility testing revealed resistance to clindamycin and, in one strain, to erythromycin according to EUCAST, while all isolates were susceptible to the other antimicrobials tested.
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Affiliation(s)
- Reinhard Sting
- Chemical and Veterinary Analysis Agency (CVUA) Stuttgart, 70736 Fellbach, Germany; (C.P.); (B.B.); (J.R.)
- Consiliary Laboratory for Corynebacterium pseudotuberculosis (DVG), 70736 Fellbach, Germany
| | - Catharina Pölzelbauer
- Chemical and Veterinary Analysis Agency (CVUA) Stuttgart, 70736 Fellbach, Germany; (C.P.); (B.B.); (J.R.)
| | - Tobias Eisenberg
- Hessian State Laboratory (LHL), 35392 Giessen, Germany; (T.E.); (R.B.); (K.R.)
| | - Rebecca Bonke
- Hessian State Laboratory (LHL), 35392 Giessen, Germany; (T.E.); (R.B.); (K.R.)
| | - Birgit Blazey
- Chemical and Veterinary Analysis Agency (CVUA) Stuttgart, 70736 Fellbach, Germany; (C.P.); (B.B.); (J.R.)
| | - Martin Peters
- Chemical and Veterinary Investigation Office Westfalen, 59821 Arnsberg, Germany;
| | - Karin Riße
- Hessian State Laboratory (LHL), 35392 Giessen, Germany; (T.E.); (R.B.); (K.R.)
| | - Andreas Sing
- Germany National Consiliary Laboratory for Diphtheria, 85764 Oberschleißheim, Germany; (A.S.); (A.B.)
| | - Anja Berger
- Germany National Consiliary Laboratory for Diphtheria, 85764 Oberschleißheim, Germany; (A.S.); (A.B.)
| | - Alexandra Dangel
- Bavarian Health and Food Safety Authority, 85764 Oberschleißheim, Germany;
| | - Jörg Rau
- Chemical and Veterinary Analysis Agency (CVUA) Stuttgart, 70736 Fellbach, Germany; (C.P.); (B.B.); (J.R.)
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3
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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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Zendri F, Isgren CM, Sinovich M, Richards-Rios P, Hopkins KL, Russell K, Groves N, Litt D, Fry NK, Timofte D. Case Report: Toxigenic Corynebacterium ulcerans Diphtheria-Like Infection in a Horse in the United Kingdom. Front Vet Sci 2021; 8:650238. [PMID: 34141732 PMCID: PMC8203807 DOI: 10.3389/fvets.2021.650238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Corynebacterium ulcerans (C. ulcerans) may cause diphtheria in humans and can be carried by a wide range of animal species including dairy cows and, more recently, dogs and cats that have been increasingly involved in zoonotic trasmission. We isolated and characterized, by WGS, a toxigenic C. ulcerans strain from a diseased horse in the United Kingdom showing clinical signs of respiratory diphtheria comparable to those seen in people. Our results indicate a role for horses as reservoirs for zoonotic C. ulcerans.
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Affiliation(s)
- Flavia Zendri
- Department of Veterinary Anatomy, Physiology and Pathology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Cajsa Marie Isgren
- Department of Equine Clinical Science, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Matthew Sinovich
- Department of Equine Clinical Science, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Peter Richards-Rios
- Department of Veterinary Anatomy, Physiology and Pathology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Katie L. Hopkins
- Healthcare Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, United Kingdom
| | - Katherine Russell
- Emerging Infections and Zoonoses section, National Infection Service, Public Health England, London, United Kingdom
| | - Natalie Groves
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - David Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
| | - Norman K. Fry
- Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Dorina Timofte
- Department of Veterinary Anatomy, Physiology and Pathology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
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5
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Otshudiema JO, Acosta AM, Cassiday PK, Hadler SC, Hariri S, Tiwari TSP. Respiratory illness caused by Corynebacterium diphtheriae and C. ulcerans, and use of diphtheria anti-toxin in the United States, 1996-2018. Clin Infect Dis 2020; 73:e2799-e2806. [PMID: 32818967 DOI: 10.1093/cid/ciaa1218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 01/30/2023] Open
Abstract
Respiratory illness caused by Corynebacterium diphtheriae and C. ulcerans, and use of diphtheria anti-toxin in the United States, 1996-2018. BACKGROUND Respiratory diphtheria is a toxin-mediated disease caused by Corynebacterium diphtheriae. Diphtheria-like illness, clinically indistinguishable from diphtheria, is caused by C. ulcerans, a zoonotic bacterium that can also produce diphtheria toxin. In the United States, respiratory diphtheria is nationally notifiable: specimens from suspected cases are submitted to the Centers for Disease Control (CDC) for species and toxin confirmation, and diphtheria antitoxin (DAT) is obtained from CDC for treatment. We summarize the epidemiology of respiratory diphtheria and diphtheria-like illness and describe DAT use during 1996-2018 in the United States. METHODS We described respiratory diphtheria cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and C. ulcerans-related diphtheria-like illness identified through specimen submissions to CDC during 1996-2018. We reviewed DAT requests from 1997-2018. RESULTS From 1996-2018, 14 respiratory diphtheria cases were reported to NNDSS. Among these 14 cases, 1 was toxigenic and 3 were non-toxigenic C. diphtheriae by culture and Elek, 6 were culture-negative but PCR-positive for diphtheria toxin gene, 1 was culture-positive without further testing, and the remaining 3 were either not tested or tested negative. Five cases of respiratory diphtheria-like illness caused by toxigenic C. ulcerans were identified. DAT was requested by healthcare providers for 151 suspected diphtheria cases between 1997-2018, with an average of 11 requests per year from 1997-2007, and 3 per year from 2008-2018. CONCLUSIONS Respiratory diphtheria remains rare in the United States, and requests for DAT have declined. Incidental identification of C. ulcerans-related diphtheria-like illness suggests surveillance of this condition might be warranted.
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Affiliation(s)
- John O Otshudiema
- Epidemic Intelligence Service Program, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Meningitis and Vaccine-Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Anna M Acosta
- Meningitis and Vaccine-Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Pamela K Cassiday
- Meningitis and Vaccine-Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stephen C Hadler
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Susan Hariri
- Meningitis and Vaccine-Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tejpratap S P Tiwari
- Meningitis and Vaccine-Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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6
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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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7
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Otsuji K, Fukuda K, Ogawa M, Saito M. Mutation and Diversity of Diphtheria Toxin in Corynebacterium ulcerans. Emerg Infect Dis 2019; 25:2122-2123. [PMID: 31625851 PMCID: PMC6810190 DOI: 10.3201/eid2511.181455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Corynebacterium ulcerans infection is emerging in humans. We conducted phylogenetic analyses of C. ulcerans and C. diptheriae, which revealed diverse diphtheria toxin in C. ulcerans. Diphtheria toxin diversification could decrease effectiveness of diphtheria toxoid vaccine and diphtheria antitoxin for preventing and treating illnesses caused by this bacterium.
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8
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Berger A, Dangel A, Peters M, Mühldorfer K, Braune S, Eisenberg T, Szentiks CA, Rau J, Konrad R, Hörmansdorfer S, Ackermann N, Sing A. Tox-positive Corynebacterium ulcerans in hedgehogs, Germany . Emerg Microbes Infect 2019; 8:211-217. [PMID: 30866774 PMCID: PMC6455118 DOI: 10.1080/22221751.2018.1562312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Toxigenic Corynebacterium ulcerans may cause both respiratory and cutaneous diphtheria in humans. As a zoonotic emerging pathogen it has been isolated from a wide variety of animals living in captivity, such as livestock, pet, zoo and research animals and additionally in a large number of different wild animals. Here we report the isolation of tox-positive C. ulcerans in four hedgehogs with cutaneous diphtheria and pneumonia, respectively.
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Affiliation(s)
- Anja Berger
- a National Consiliary Laboratory for Diphtheria , Oberschleißheim , Germany.,b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Alexandra Dangel
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Martin Peters
- c Chemisches und Veterinäruntersuchungsamt Westfalen , Arnsberg , Germany
| | | | - Silke Braune
- e Lower Saxony State Office for Consumer Protection and Food Safety , Food and Veterinary Institute , Hannover , Germany
| | | | | | - Jörg Rau
- g Chemisches und Veterinäruntersuchungsamt Stuttgart , Fellbach , Germany
| | - Regina Konrad
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Stefan Hörmansdorfer
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Nikolaus Ackermann
- b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
| | - Andreas Sing
- a National Consiliary Laboratory for Diphtheria , Oberschleißheim , Germany.,b MA DTM&H, National Consiliary Laboratory for Diphtheria , Bavarian Health and Food Safety Authority , Oberschleißheim , Germany
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9
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Othieno R, Mark K, Etherson M, Foster G, Murray S, Kalima P, Fry NK, Cameron C, Strachan J. A case of cutaneous toxigenic Corynebacterium ulcerans likely acquired from a domestic dog. Access Microbiol 2019; 1:e000025. [PMID: 32974539 PMCID: PMC7481734 DOI: 10.1099/acmi.0.000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Corynebacterium ulcerans can produce diphtheria toxin and although still rare, is now the predominant cause of toxigenic diphtheria infection in the UK, making this organism of great clinical and public health importance. Here we describe a cutaneous case, likely secondary to domestic animal contact. Case presentation A 60-year-old female presented with a slow-healing finger-burn wound. A skin swab cultured Corynebacterium ulcerans, which was confirmed to be toxin producing. She resided with her partner and two dogs, one of which had a chronic skin lesion. Her most recent diphtheria vaccine was in 2009. Four close contacts were identified, two of whom were healthcare professionals, and nose and throat swabs were obtained. The patient was treated with clarithromycin (14 day course), diphtheria vaccine and excluded from work until completion of antibiotics and negative clearance swabs. Contacts were given erythromycin (7 day course), vaccinated and healthcare worker contacts excluded from work until swab negative. A veterinary practitioner swabbed the throats and a skin lesion of their dogs. One contact (partner of patient) and all dog swabs were positive. Partial allelic profiles from MLST supported an epidemiological link. The dogs were treated with antibiotics and antimicrobial skin wash. Repeat swabs for the index case, contact and both dogs were negative following treatment. Conclusion This was a rare case of cutaneous diphtheria secondary to Corynebacterium ulcerans with domestic animals the most likely source, although human-to-human contact could not be excluded, with important human and animal public health implications.
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Affiliation(s)
| | - Kate Mark
- National Health Services (NHS) Lothian, Edinburgh, UK
| | | | | | | | - Pota Kalima
- National Health Services (NHS) Lothian, Edinburgh, UK
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10
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Zasada AA, Mosiej E. Contemporary microbiology and identification of Corynebacteria spp. causing infections in human. Lett Appl Microbiol 2018; 66:472-483. [PMID: 29573441 DOI: 10.1111/lam.12883] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Abstract
The Corynebacterium is a genus of bacteria of growing clinical importance. Progress in medicine results in growing population of immunocompromised patients and growing number of infections caused by opportunistic pathogens. A new infections caused by new Corynebacterium species and species previously regarded as commensal micro-organisms have been described. Parallel with changes in Corynebacteria infections, the microbiological laboratory diagnostic possibilities are changing. But identification of this group of bacteria to the species level remains difficult. In the paper, we present various manual, semi-automated and automated assays used in clinical laboratories for Corynebacterium identification, such as API Coryne, RapID CB Plus, BBL Crystal Gram Positive ID System, MICRONAUT-RPO, VITEK 2, BD Phoenix System, Sherlock Microbial ID System, MicroSeq Microbial Identification System, Biolog Microbial Identification Systems, MALDI-TOF MS systems, polymerase chain reaction (PCR)-based and sequencing-based assays. The presented assays are based on various properties, like biochemical tests, specific DNA sequences, composition of cellular fatty acids, protein profiles and have specific limitations. SIGNIFICANCE AND IMPACT OF THE STUDY The number of opportunistic infections caused by Corynebacteria is increasing due to increase in number of immunocompromised patients. New Corynebacterium species and new human infections, caused by this group of bacteria, has been described recently. However, identification of Corynebacteria is still a challenge despite application of sophisticated laboratory methods. In the study we present possibilities and limitations of various commercial systems for identification of Corynebacteria.
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Affiliation(s)
- A A Zasada
- Department of Sera and Vaccines Evaluation, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - E Mosiej
- Department of Sera and Vaccines Evaluation, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
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11
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Carfora V, Scarampella F, Iurescia M, Donati V, Stravino F, Lorenzetti S, Menichini E, Franco A, Caprioli A, Battisti A. Non-toxigenic Corynebacterium ulcerans sequence types 325 and 339 isolated from two dogs with ulcerative lesions in Italy. J Vet Diagn Invest 2018. [PMID: 29528813 DOI: 10.1177/1040638718764786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Corynebacterium ulcerans, an emerging pathogen related to C. diphtheriae and C. pseudotuberculosis, is able to cause disease in both human and animal hosts. C. ulcerans may harbor acquired virulence factors such as dermonecrotic exotoxin phospholipase D (PLD) and the prophage-encoded diphtheria toxin (DT). Infections typically occur in persons reporting close contact with animals. In pets, C. ulcerans has been isolated from both asymptomatic carriers and clinically affected dogs and cats. We describe the isolation and characterization of C. ulcerans strains from 2 pet dogs with ulcerative lesions in Italy. The 2 isolates tested negative for both DT genes, but were PLD-producers and belonged to sequence types (STs) 325 and 339. These 2 cases highlight that C. ulcerans cutaneous infections might be underestimated in pets, given that many veterinary laboratories do not routinely consider and/or identify Corynebacterium species from cutaneous samples. Early detection and molecular typing of C. ulcerans is essential in order to implement effective treatment and to prevent diffusion and possible zoonotic transmission of certain STs.
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Affiliation(s)
- Virginia Carfora
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Fabia Scarampella
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Manuela Iurescia
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Valentina Donati
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Fiorentino Stravino
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Serena Lorenzetti
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Erika Menichini
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Alessia Franco
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Andrea Caprioli
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
| | - Antonio Battisti
- Experimental Zooprophylactic Institute of Latium and Tuscany "M. Aleandri", General Diagnostic Department, Rome, Italy (Carfora, Iurescia, Donati, Stravino, Lorenzetti, Menichini, Franco, Caprioli, Battisti).,Animal Dermatology Practice, Milan, Italy (Scarampella)
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12
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Hacker E, Antunes CA, Mattos-Guaraldi AL, Burkovski A, Tauch A. Corynebacterium ulcerans, an emerging human pathogen. Future Microbiol 2016; 11:1191-208. [PMID: 27545005 DOI: 10.2217/fmb-2016-0085] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
While formerly known infections of Corynebacterium ulcerans are rare and mainly associated with contact to infected cattle, C. ulcerans has become an emerging pathogen today. In Western Europe, cases of respiratory diphtheria caused by C. ulcerans have been reported more often than infections by Corynebacterium diphtheria, while systemic infections are also increasingly reported. Little is known about factors that contribute to host colonization and virulence of this zoonotic pathogen. Research in this field has received new impetus by the publication of several C. ulcerans genome sequences in the past years. This review gives a comprehensive overview of the basic knowledge of C. ulcerans, as well as the recent advances made in the analysis of putative virulence factors.
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Affiliation(s)
- Elena Hacker
- Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Camila A Antunes
- Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Laboratory of Diphtheria and Clinically Important Corynebacteria (LDCIC), Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana L Mattos-Guaraldi
- Laboratory of Diphtheria and Clinically Important Corynebacteria (LDCIC), Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Andreas Burkovski
- Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Tauch
- Centrum für Biotechnologie, Universität Bielefeld, Bielefeld, Germany
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13
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Katsukawa C, Umeda K, Inamori I, Kosono Y, Tanigawa T, Komiya T, Iwaki M, Yamamoto A, Nakatsu S. Toxigenic Corynebacterium ulcerans isolated from a wild bird (ural owl) and its feed (shrew-moles): comparison of molecular types with human isolates. BMC Res Notes 2016; 9:181. [PMID: 27000873 PMCID: PMC4802582 DOI: 10.1186/s13104-016-1979-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 03/07/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Corynebacterium ulcerans is a pathogen causing diphtheria-like illness to humans. In contrast to diphtheria by Corynebacterium diphtheriae circulating mostly among humans, C. ulcerans infection is zoonotic. The present study aimed to clarify how a zoonotic pathogen C. ulcerans circulates among wild birds and animals. RESULTS By screening 380 birds, a single strain of toxigenic C. ulcerans was isolated from a carnivorous bird, ural owl (Strix uralensis). The bacterium was also isolated from two individuals of Japanese shrew-mole (Urotrichus talpoides), a food preference of the owl. Analysis by ribotyping showed that the owl and mole isolates were classified in a group, suggesting that C. ulcerans can be transmissible among wild birds and their prey animals. Moreover, our isolates were found to belong to a group of previously reported C. ulcerans isolates from dogs and a cat, which are known to serve as sources for human infection. CONCLUSION The findings suggest that the shrew-mole may be a potential reservoir of a zoonotic pathogen C. ulcerans.
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Affiliation(s)
- Chihiro Katsukawa
- Department of Infectious Diseases, Osaka Prefectural Institute of Public Health, 1-3-69 Nakamichi, Higashinari-ku, Osaka-Shi, Osaka, 537-0025, Japan
| | - Kaoru Umeda
- Department of Microbiology, Osaka City Institute of Public Health and Environmental Sciences, 8-34 Tojo-cho, Tennoji-ku, Osaka-Shi, Osaka, 543-0026, Japan
| | - Ikuko Inamori
- Nature Conservation Club of Soenji, 1-20-11 Himurodai, Hirakata-Shi, Osaka, 573-0115, Japan
| | - Yuka Kosono
- Bird Bander, 5-17 Suganodai, Nara-Shi, Nara, 631-0043, Japan
| | - Tomokazu Tanigawa
- Wild Living Thing Society of Hirakata, 1-24-10, Tanokuchiyama, Hirakata-Shi, Osaka, 573-0001, Japan
| | - Takako Komiya
- Department of Bacteriology II, National Institute of Infectious Diseases, 4-Gakuen, Musashimurayama-Shi, Tokyo, 208-0011, Japan
| | - Masaaki Iwaki
- Department of Bacteriology II, National Institute of Infectious Diseases, 4-Gakuen, Musashimurayama-Shi, Tokyo, 208-0011, Japan.
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Diseases, 4-Gakuen, Musashimurayama-Shi, Tokyo, 208-0011, Japan.,Division of Biosafety Control and Research, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-Shi, Tokyo, 208-0011, Japan
| | - Susumu Nakatsu
- Nakatsu Animal Hospital, 2-2-15 Shorinji-cho nishi, Sakai-ku, Sakai-Shi, Osaka, 590-0960, Japan
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14
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Terada T, Suga K, Yamamoto A, Ono A, Inoue M, Kawahito M, Mori K. A paediatric case of lymphadenitis by toxigenic Corynebacterium ulcerans. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.005003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tomomasa Terada
- Department of Pediatrics, Tokushima Psrefectural Central Hospital, Tokushima, Japan
| | - Kenichi Suga
- Department of Pediatrics, Tokushima Psrefectural Central Hospital, Tokushima, Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Diseases, Musashimurayama City, Japan
| | - Akemi Ono
- Department of Pediatrics, Tokushima Psrefectural Central Hospital, Tokushima, Japan
| | - Miki Inoue
- Department of Pediatrics, Tokushima Psrefectural Central Hospital, Tokushima, Japan
| | - Masami Kawahito
- Department of Pediatrics, Tokushima Psrefectural Central Hospital, Tokushima, Japan
| | - Kazuhiro Mori
- Department of Pediatrics, Tokushima Psrefectural Central Hospital, Tokushima, Japan
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15
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Konrad R, Hörmansdorfer S, Sing A. Possible human-to-human transmission of toxigenic Corynebacterium ulcerans. Clin Microbiol Infect 2015; 21:768-71. [PMID: 26027917 DOI: 10.1016/j.cmi.2015.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
Toxigenic Corynebacterium ulcerans is an emerging cause of diphtheria. In contrast to the classical diphtheria pathogen C. diphtheriae, human-to-human transmission of this primarily zoonotic pathogen has not been clearly documented. Here we report on a two-person cluster suggesting an initial zoonotic and a subsequent human-to-human transmission event.
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Affiliation(s)
- R Konrad
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany; Consiliary Laboratory on Diphtheria, Oberschleißheim, Germany
| | - S Hörmansdorfer
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - A Sing
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany; Consiliary Laboratory on Diphtheria, Oberschleißheim, Germany.
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