两例由产毒素溃疡棒状杆菌引起的类白喉疾病的调查。

Investigations of 2 cases of diphtheria-like illness due to toxigenic Corynebacterium ulcerans.

作者信息

Tiwari Tejpratap S P, Golaz Anne, Yu Diana T, Ehresmann Kristen R, Jones Timothy F, Hill Hal E, Cassiday Pamela K, Pawloski Lucia C, Moran John S, Popovic Tanja, Wharton Melinda

机构信息

Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

出版信息

Clin Infect Dis. 2008 Feb 1;46(3):395-401. doi: 10.1086/525262.

DOI:10.1086/525262

PMID:18181738

Abstract

BACKGROUND

We present 2 case reports in the United States and investigations of diphtheria-like illness caused by toxigenic Corynebacterium ulcerans. A fatal case occurred in a 75-year-old male Washington resident who was treated with clindamycin but did not receive equine diphtheria antitoxin. A second, nonfatal case occurred in a 66-year-old female Tennessee resident who received erythromycin and diphtheria antitoxin.

METHODS

Both case patients and close human and animal contacts were investigated by their respective state health departments.

RESULTS

C. ulcerans isolated from the patient who died was resistant to erythromycin and clindamycin. For both isolates, conventional polymerase chain reaction results were positive for A and B subunits of diphtheria toxin gene tox, and modified Elek tests confirmed toxin production. The source of infection remained undetermined for both cases. Neither patient was up-to-date with diphtheria toxoid vaccination.

CONCLUSION

These case reports highlight the importance of early treatment with diphtheria antitoxin, the selection of effective antimicrobial agents, and prevention through up-to-date vaccination.

摘要