Zink Alicia, Hofer Juliana, Schneider Christian, Kessler Franziska, Klenze Hannes, Klauwer Dietrich, Maleki Klaudia, Müller Andreas, Goretzki Sarah, Wang Shubei, Kobbe Robin, Ramirez Andrea Vanegas, Bode Sebastian, Janda Ales, Fressle Roland, Remppis Jonathan, Henneke Philipp, Rieg Siegbert, Berger Anja, Sing Andreas, Hufnagel Markus, Spielberger Benedikt D
Division for Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany.
Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany.
Infection. 2025 Feb;53(1):329-337. doi: 10.1007/s15010-024-02374-y. Epub 2024 Aug 27.
From September 2022 an increase in Corynebacterium diphtheriae (C. diphtheriae) infections was reported in Europe. Our study focuses on 31 adolescent and young adult refugees with cutaneous C. diphtheriae infections detected in Germany. We examined treatment regimens and outcomes to provide targeted insights into the management of this infection.
We distributed a standardized survey, focused on children and adolescents presenting to paediatric clinics through the German Paediatric Infectious Diseases Society (DGPI) and additional professional contacts in Germany. Data were extracted from routine medical documentation and reported anonymously.
A total of 31 individuals with cutaneous C. diphtheriae infection were reported by 9 centres. Two of these showed diphtheria toxin (DT) related systemic symptoms and four exhibited systemic inflammation requiring complex management. The remaining 25 cases, with exclusively cutaneous manifestations, were afebrile. Treatment with topical antiseptics and systemic antibiotics, mainly aminopenicillin/beta-lactamase inhibitors (BLI) (35%) or clindamycin (25%), achieved eradication in all but two cases treated with aminopenicillin/BLI. Treatment duration varied between 5 and 17 days.
In refugees presenting with chronic skin wounds, C. diphtheriae should be included into the differential diagnosis. Fever seems to be a valuable marker to differentiate severe cases with potentially DT-mediated sequelae from exclusively cutaneous diphtheria (CD). For afebrile CD, topical antiseptics and oral antibiotic therapy with clindamycin for 7 days, followed by clinical surveillance appears to be a safe treatment regimen. Patients with CD who present with fever or pharyngitis should be thoroughly investigated including blood and pharyngeal swab cultures.
自2022年9月起，欧洲报告白喉棒状杆菌（C. diphtheriae）感染有所增加。我们的研究聚焦于在德国检测出皮肤感染白喉棒状杆菌的31名青少年和青年难民。我们研究了治疗方案及结果，以便针对性地了解这种感染的管理方法。
我们通过德国儿科传染病学会（DGPI）以及德国的其他专业联系人，分发了一份针对前往儿科诊所就诊的儿童和青少年的标准化调查问卷。数据从常规医疗记录中提取，并进行匿名报告。
9个中心共报告了31例皮肤感染白喉棒状杆菌的病例。其中2例出现与白喉毒素（DT）相关的全身症状，4例出现需要复杂管理的全身炎症。其余25例仅有皮肤表现的病例无发热症状。局部使用防腐剂和全身使用抗生素进行治疗，主要是氨基青霉素/β-内酰胺酶抑制剂（BLI）（35%）或克林霉素（25%），除2例接受氨基青霉素/BLI治疗的病例外，其余均实现了感染根除。治疗持续时间在5至17天之间。
对于有慢性皮肤伤口的难民，应将白喉棒状杆菌纳入鉴别诊断。发热似乎是区分可能有DT介导后遗症的严重病例与单纯皮肤白喉（CD）的重要指标。对于无发热的CD，局部使用防腐剂并口服克林霉素进行7天抗生素治疗，随后进行临床监测似乎是一种安全的治疗方案。出现发热或咽炎的CD患者应进行全面检查，包括血液和咽拭子培养。
