Missouriwatcher
Editor, Senior Moderator
January 28, 2011 / 60(03);77
On September 12, 2010, the Idaho Department of Health and Welfare was notified of a case of respiratory diphtheria-like illness in an Idaho man aged 80 years whose pharyngeal specimens yielded Corynebacterium ulcerans. Although C. ulcerans is zoonotic, the patient reported no animal contact or consumption of an unpasteurized dairy product. His vaccination history was unknown. Respiratory diphtheria-like illness from C. ulcerans is uncommon but has been reported in industrialized countries where respiratory diphtheria is rare. The last case of diphtheria-like illness caused by C. ulcerans in the United States was reported in 2005...
...On suspicion of respiratory diphtheria, the patient was treated with azithromycin. On September 12, C. ulcerans was isolated from pharyngeal tissue surgically removed on September 9, and a 100,000 international-unit dose of diphtheria antitoxin (DAT) was requested and received from CDC... the patient had a complicated recovery and was discharged on October 6...
...Although the hallmark of respiratory diphtheria is the presence of a pseudomembrane in the pharynx, the pseudomembrane in this patient was only visible during a surgical procedure. Clinicians should consider respiratory diphtheria among patients who have low-grade fever and pseudomembranous pharyngitis. If diphtheria is suspected, patients should receive urgent treatment with DAT without waiting for laboratory confirmation. Health-care providers can obtain DAT by contacting CDC's Emergency Operations Center at 770-488-7100.
Antibiotic treatment of diphtheria-like illness caused by C. ulcerans should follow clinical guidelines for patients infected with C. diphtheriae. Unlike C. diphtheriae infections, human-to-human transmission of C. ulcerans infections has not been documented; therefore, postexposure antibiotic prophylaxis was not administered to close contacts of the Idaho patient. However, because studies on the transmission of C. ulcerans are limited, vaccination status of contacts should be assessed and brought up-to-date, if necessary, with an age-appropriate diphtheria-toxoid--containing vaccine, which prevents disease from toxigenic strains of C. diphtheriae and C. ulcerans...
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a4.htm?s_cid=mm6003a4_e&source=govdelivery
On September 12, 2010, the Idaho Department of Health and Welfare was notified of a case of respiratory diphtheria-like illness in an Idaho man aged 80 years whose pharyngeal specimens yielded Corynebacterium ulcerans. Although C. ulcerans is zoonotic, the patient reported no animal contact or consumption of an unpasteurized dairy product. His vaccination history was unknown. Respiratory diphtheria-like illness from C. ulcerans is uncommon but has been reported in industrialized countries where respiratory diphtheria is rare. The last case of diphtheria-like illness caused by C. ulcerans in the United States was reported in 2005...
...On suspicion of respiratory diphtheria, the patient was treated with azithromycin. On September 12, C. ulcerans was isolated from pharyngeal tissue surgically removed on September 9, and a 100,000 international-unit dose of diphtheria antitoxin (DAT) was requested and received from CDC... the patient had a complicated recovery and was discharged on October 6...
...Although the hallmark of respiratory diphtheria is the presence of a pseudomembrane in the pharynx, the pseudomembrane in this patient was only visible during a surgical procedure. Clinicians should consider respiratory diphtheria among patients who have low-grade fever and pseudomembranous pharyngitis. If diphtheria is suspected, patients should receive urgent treatment with DAT without waiting for laboratory confirmation. Health-care providers can obtain DAT by contacting CDC's Emergency Operations Center at 770-488-7100.
Antibiotic treatment of diphtheria-like illness caused by C. ulcerans should follow clinical guidelines for patients infected with C. diphtheriae. Unlike C. diphtheriae infections, human-to-human transmission of C. ulcerans infections has not been documented; therefore, postexposure antibiotic prophylaxis was not administered to close contacts of the Idaho patient. However, because studies on the transmission of C. ulcerans are limited, vaccination status of contacts should be assessed and brought up-to-date, if necessary, with an age-appropriate diphtheria-toxoid--containing vaccine, which prevents disease from toxigenic strains of C. diphtheriae and C. ulcerans...
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a4.htm?s_cid=mm6003a4_e&source=govdelivery