Beyond Classical Diphtheria: Nontoxigenic Corynebacterium diphtheriae Isolated from Blood Culture in a Child : A Case Report and Public Health Implication
DOI:
https://doi.org/10.55927/ijsmr.v4i3.8Keywords:
nontoxigenic Corynebacterium diphtheriae, var. gravis, bacteremia, wound swab, cutaneous diphtheriaAbstract
Nontoxigenic Corynebacterium diphtheriae has increasingly been recognized as a clinically relevant pathogen capable of causing invasive and non-invasive infections. However, reports from Southeast Asia, particularly among pediatric populations, remain limited. This study describes two pediatric cases identified during laboratory-based surveillance in North Sumatra, Indonesia. Clinical specimens were examined using culture, microscopic examination, biochemical identification, Elek toxigenicity testing, and polymerase chain reaction (PCR) for diphtheria toxin gene detection at the National Health Biology Laboratory. The first case involved a 5-year-old child whose blood culture yielded C. diphtheriae var. gravis without classical respiratory manifestations. The second case involved a 13-year-old child with a wound infection in which wound swab culture identified the same organism. Both isolates were confirmed as nontoxigenic. These findings highlight the expanding clinical spectrum of nontoxigenic C. diphtheriae and emphasize the importance of laboratory confirmation and surveillance integration for early detection of atypical diphtheria-related infections.
References
World Health Organization. Diphtheria vaccine: WHO position paper. 2017.
Wagner KS, White JM, Lucenko I, et al. Diphtheria in the postepidemic period, Europe, 2000–2009. Emerging Infectious Diseases. 2012
Funke G, et al. Clinical microbiology of coryneform bacteria. Clin Microbiol Rev. 1997.
Zasada AA, Baczewska-Rej M, Wardak S. An increase in non-toxigenic Corynebacterium diphtheriae infections in Poland molecular epidemiology and antimicrobial susceptibility of strains isolated from past outbreaks and those currently circulating in Poland. Int J Infect Dis. 2010
Gubler J, Huber-Schneider C, Gruner E, Altwegg M. An outbreak of nontoxigenic Corynebacterium diphtheriae infection: single bacterial clone causing invasive infection among Swiss drug users. Clin Infect Dis. 1998
Dangel A, Berger A, Konrad R, Bischoff H, Sing A. Geographically diverse clusters of nontoxigenic Corynebacterium diphtheriae infection, Germany, 2016–2017. Emerg Infect Dis. 2018
Tiley SM, Kociuba KR, Heron LG, Munro R. Infective endocarditis due to nontoxigenic Corynebacterium diphtheriae: report of seven cases and review. Clin Infect Dis. 1993
Zasada AA & Rzeczkowska M. Nontoxigenic Corynebacterium diphtheriae Infections, Europe. Emerg Infect Dis. 2019
Dangel A, Berger A, Konrad R, Bischoff H, Sing A, et al. Geographically diverse clusters of nontoxigenic Corynebacterium diphtheriae infection, Germany, 2016–2017. Emerg Infect Dis. 2018
Centers for Disease Control and Prevention. Increase in nontoxigenic Corynebacterium diphtheriae — Washington, 2018–2023. MMWR. 2023.
Lowe CF, Bernard KA, Romney MG. Cutaneous diphtheria in the urban poor population of Vancouver, British Columbia, Canada: a 10-year review. J Clin Microbiol. 2011;.
Reacher M, Ramsay M, White J, De Zoysa A, Efstratiou A, Mann G, Mackay A, George R. Nontoxigenic Corynebacterium diphtheriae: an emerging pathogen in England and Wales? Emerg Infect Dis. 2000
De Zoysa A, Efstratiou A, Hawkey PM. Molecular characterization of diphtheria toxin repressor (dtxR) genes present in nontoxigenic Corynebacterium diphtheriae strains isolated in the United Kingdom. J Clin Microbiol. 2005;
Chorlton SD, Ritchie G, Lawson T, Romney MG, Lowe CF. Whole-genome sequencing of Corynebacterium diphtheriae isolates recovered from an inner-city population demonstrates the predominance of a single molecular strain.
J Clin Microbiol. 2020
Rasmussen M, Mohlin AW, Nilson B.From contamination to infective endocarditis — a population-based retrospective study of Corynebacterium isolated from blood cultures. Eur J Clin Microbiol Infect Dis. 2020
Bonmarin I, Guiso N, Le Flèche-Matéos A, Patey O, Patrick AD, Levy-Bruhl D. Diphtheria: a zoonotic disease in France? Vaccine. 2009
Clarke KEN, MacNeil A, Hadler S, Scott C, Tiwari TSP, Cherian T. Global epidemiology of diphtheria, 2000–2017. Emerg Infect Dis. 2019
Efstratiou A, George RC. Laboratory guidelines for the diagnosis of diphtheria. Commun Dis Public Health. 1999.
Yanai M, Ogasawasa M, Hayashi Y, Suzuki K, Takahashi H, Satomura A. Retrospective evaluation of the clinical characteristics associated with Corynebacterium species bacteremia. Braz J Infect Dis. 2018
MacGregor RR, McKee ML. Diphtheria — non-toxin mediated disease and nontoxigenic Corynebacterium diphtheriae infections.Rev Infect Dis. 1986
