title: Molecular epidemiology and characteristics of Corynebacterium diphtheriae and Corynebacterium ulcerans strains isolated in Italy during the 1990s.
abstract: Five cases of diphtheria were reported in Italy between January 1990 and June 2001. Three cases were confirmed microbiologically by the isolation of toxigenic Corynebacterium diphtheriae (two cases) and Corynebacterium ulcerans (one case). Over the same period, 11 cases of non-toxigenic C. diphtheriae infection were reported to the Italian Public Health Institute, from which the causative organism was isolated from a skin infection in one case and from the throat in the other ten. Seven of the throat isolates were associated with fever, severe pharyngitis and tonsillitis and were all biotype gravis. Because there are no standardized breakpoints, the antimicrobial sensitivities of C. diphtheriae were determined in accordance with the National Committee for Clinical Laboratory Standards guidelines for Streptococcus spp. other than Streptococcus pneumoniae. MICs for penicillin ranged between 0.125 and 0.250 mg l(-1) and 7 out of 11 strains had a minimal bactericidal concentration (MBC)/MIC ratio >or= 32. All strains were sensitive to clindamycin (MIC <or= 0.25 mg l(-1)), rifampicin (MIC <or= 1 mg l(-1)) and tetracycline (MIC <or= 2 mg l(-1)), and showed moderate susceptibility to cefotaxime (MIC 0.75-1.5 mg l(-1)). Molecular typing (ribotyping) demonstrated the presence of several distinct ribotypes. The ribotype designated 'D11' has been documented amongst strains isolated in the UK, Russia, Germany, Romania and Sweden. Ribotype 'D75' has only been documented in the UK. The C. ulcerans strain had a ribotype pattern identical to that found in recent isolates from the UK.
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: von Hunolstein
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Alfarone
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Franca
authors.initials: F
authors.lastname: Scopetti
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Pataracchia
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Roberto
authors.initials: R
authors.lastname: La Valle
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Fabio
authors.initials: F
authors.lastname: Franchi
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Laila
authors.initials: L
authors.lastname: Pacciani
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Manera
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Giammanco
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Senia
authors.initials: S
authors.lastname: Farinelli
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Engler
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Aruni
authors.initials: A
authors.lastname: De Zoysa
authors.affiliation: Laboratorio di Batteriologia e Micologia Medica, Istituto Superiore di Sanitá, Roma, Italy 2Unitá Ospedaliera Malattie Infettive, Azienda Ospedaliera, Trieste, Italy 3Unitá Organizzativa Microbiologia, Ospedale San Giacomo, Roma, Italy 4Laboratorio di Analisi Chimico-Cliniche e Microbiologiche, Ospedale G. Eastman, Roma, Italy 5Universitá degli Studi di Palermo, Palermo, Italy 6Universitá degli Studi di Perugia, Perugia, Italy 7Respiratory and Systemic Infection Laboratory, PHLS Central Public Health Laboratory, London, UK.
authors.forename: Androulla
authors.initials: A
authors.lastname: Efstratiou
mesh_terms: D015169:Colony Count, Microbial; D003352:Corynebacterium / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D003354:Corynebacterium Infections / Q000453:epidemiology* / Q000382:microbiology; D003353:Corynebacterium diphtheriae / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D004165:Diphtheria / Q000453:epidemiology* / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D016133:Polymerase Chain Reaction; D021521:Ribotyping; D014774:Virulence / Q000235:genetics