title: Investigations of 2 cases of diphtheria-like illness due to toxigenic Corynebacterium ulcerans.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. tit2@cdc.gov
authors.forename: Tejpratap S P
authors.initials: TS
authors.lastname: Tiwari
authors.forename: Anne
authors.initials: A
authors.lastname: Golaz
authors.forename: Diana T
authors.initials: DT
authors.lastname: Yu
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Ehresmann
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Jones
authors.forename: Hal E
authors.initials: HE
authors.lastname: Hill
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Cassiday
authors.forename: Lucia C
authors.initials: LC
authors.lastname: Pawloski
authors.forename: John S
authors.initials: JS
authors.lastname: Moran
authors.forename: Tanja
authors.initials: T
authors.lastname: Popovic
authors.forename: Melinda
authors.initials: M
authors.lastname: Wharton
mesh_terms: D000368:Aged; D003352:Corynebacterium / Q000302:isolation & purification*; D003354:Corynebacterium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003937:Diagnosis, Differential; D004165:Diphtheria / Q000453:epidemiology* / Q000382:microbiology; D004166:Diphtheria Antitoxin / Q000627:therapeutic use; D004168:Diphtheria Toxoid / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D014481:United States / Q000453:epidemiology
chemical_list: D004166:Diphtheria Antitoxin; D004168:Diphtheria Toxoid