title: Corynebacterium ulcerans cutaneous diphtheria.
abstract: We describe the case of a patient with cutaneous diphtheria caused by toxigenic Corynebacterium ulcerans who developed a right hand flexor sheath infection and symptoms of sepsis such as fever, tachycardia, and elevated C-reactive protein, after contact with domestic cats and dogs, and a fox. We summarise the epidemiology, clinical presentation, microbiology, diagnosis, therapy, and public health aspects of this disease, with emphasis on improving recognition. In many European countries, C ulcerans has become the organism commonly associated with cutaneous diphtheria, usually seen as an imported tropical disease or resulting from contact with domestic and agricultural animals. Diagnosis relies on bacterial culture and confirmation of toxin production, with management requiring appropriate antimicrobial therapy and prompt administration of antitoxin, if necessary. Early diagnosis is essential for implementation of control measures and clear guidelines are needed to assist clinicians in managing clinical diphtheria. This case was a catalyst to the redrafting of the 2014 national UK interim guidelines for the public health management of diphtheria, released as final guidelines in March, 2015.
authors.affiliation: National Centre for Infection Prevention and Management, Imperial College London, London, UK; Department of Infectious Diseases, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK. Electronic address: l.moore@imperial.ac.uk.
authors.forename: Luke S P
authors.initials: LSP
authors.lastname: Moore
authors.affiliation: North West London Health Protection Team, London, UK.
authors.forename: Asuka
authors.initials: A
authors.lastname: Leslie
authors.affiliation: North West London Health Protection Team, London, UK.
authors.forename: Margie
authors.initials: M
authors.lastname: Meltzer
authors.affiliation: Department of Histopathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Sandison
authors.affiliation: WHO Global Collaborating Centre for Diphtheria and Streptococcal Infections, Public Health England, London, UK.
authors.forename: Androulla
authors.initials: A
authors.lastname: Efstratiou
authors.affiliation: National Centre for Infection Prevention and Management, Imperial College London, London, UK; Department of Infectious Diseases, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Shiranee
authors.initials: S
authors.lastname: Sriskandan
mesh_terms: D000368:Aged; D003352:Corynebacterium; D004165:Diphtheria / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy*; D005260:Female; D006229:Hand Dermatoses / Q000382:microbiology / Q000628:therapy; D006801:Humans; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy*