Alberto C, Osdoit S, Villani A-P, Bellec L, Belmonte O, Schrenzel J, Bagny K, Badell E, Brisse S, Toubiana J
Department of dermatology, Geneva university hospital, Geneva, Switzerland.
Department of dermatology and internal medicine, Felix Guyon university hospital, Saint-Denis, Reunion.
Ann Dermatol Venereol. 2021 Mar;148(1):34-39. doi: 10.1016/j.annder.2020.04.024. Epub 2020 Jul 3.
Diphtheria due to Corynebacteriumdiphtheriae (C. diphtheriae) has become rare in developed countries. In France only 10 cases of toxigenic diphtheria have been reported since 1989, in all cases causing pharyngitis and all emanating from endemic countries with exception of one contact case. We report herein 13 cases with cutaneous diphtheria, in 5 of which diphtheria toxin was produced, and all imported into France between 2015 and 2018.
Thirteen patients aged 4 to 77 years presented painful and rapidly progressive round ulcerations of the legs, that were superficial and in some cases purulent, with an erythematous-purple border covered with greyish membrane. Bacteriological sampling of ulcers revealed the presence of C. diphtheriae. Only 6 patients had been properly immunized over the preceding 5 years.
These cases underline the resurgence of cutaneous diphtheria and the circulation of toxigenic strains in France following importation from Indian Ocean countries. This may constitute an important reservoir for ongoing transmission of the disease. Re-emergence of this pathogen stems from the current migratory flow and decreased adult booster coverage.
Cutaneous diphtheria should be considered in cases of rapidly developing painful skin ulcers with greyish membrane, especially among patients returning from endemic areas, regardless of their vaccination status. The clinician should order specific screening for C. diphtheriae from the bacteriologist, since with routine swabbing Corynebacteriaceae may be reported simply as normal skin flora. Vaccination protects against toxigenic manifestations but not against actual bacterial infection. Early recognition and treatment of cutaneous diphtheria and up-to-date vaccination are mandatory to avoid further transmission and spread of both cutaneous and pharyngeal diphtheria.
由白喉棒状杆菌引起的白喉在发达国家已变得罕见。自1989年以来，法国仅报告了10例产毒白喉病例，所有病例均导致咽炎，除1例接触病例外，所有病例均来自流行国家。我们在此报告13例皮肤白喉病例，其中5例产生白喉毒素，所有病例均于2015年至2018年期间输入法国。
13例年龄在4至77岁之间的患者出现腿部疼痛且迅速进展的圆形溃疡，溃疡表浅，部分有脓性分泌物，边缘呈红斑紫色，覆盖有灰白色膜。溃疡的细菌学采样显示存在白喉棒状杆菌。在过去5年中只有6例患者进行了适当的免疫接种。
这些病例突显了皮肤白喉在法国的再度出现以及从印度洋国家输入后产毒菌株的传播。这可能构成该疾病持续传播的一个重要储存库。这种病原体的再度出现源于当前的移民潮以及成人加强免疫接种覆盖率下降。
对于迅速发展的伴有灰白色膜的疼痛性皮肤溃疡病例，应考虑皮肤白喉，尤其是来自流行地区的患者，无论其疫苗接种状况如何。临床医生应向细菌学家下达对白喉棒状杆菌的特异性筛查医嘱，因为常规拭子检查可能仅将棒状杆菌科报告为正常皮肤菌群。疫苗接种可预防产毒表现，但不能预防实际细菌感染。早期识别和治疗皮肤白喉以及及时接种疫苗对于避免皮肤和咽白喉的进一步传播和扩散至关重要。
