Corynebacterium hemolyticum as a Cause of Pharyngitis and Scarlatiniform Rash in Young Adults

Abstract

Over an 8-year period from 1973 through 1980, Corynebacterium hemolyticum was isolated from 103 of 24,695 throat cultures done at our hospital. Medical records were available for review from 33 of the 80 patients with a positive culture. Pharyngitis was present in all but 1, and 20 of the 32 symptomatic patients had a diffuse, erythematous, macular skin rash, often with a fine papular component, on the extremities and trunk. Screening of household contacts of 9 patients showed the presence of C. hemolyticum in the pharynges of 6 of 17 siblings but in 0 of 10 parents. Therapy with benzathine penicillin G or erythromycin resulted in rapid clinical improvement in most patients. In contrast to streptococcal pharyngitis, which is predominantly a disease of childhood, C. hemolyticum infection affects mostly teenagers and young adults: 30 of the 33 patients in this study were between the ages of 11 and 22. Within this age group, infection with C. hemolyticum is an important cause of pharyngitis associated with a scarlatiniform skin rash.

Coryneform bacteria in infectious diseases: clinical and laboratory aspects

“…The relative frequency of pharyngitis due to A. haemolyticum is between 5 and 13% of that due to Streptococcus pyogenes (7,144). Over 90% of A. haemolyticum cases occur in patients between 10 and 30 years old (7,60,144,187), whereas most group A streptococcal pharyngitis patients are <10 years old (7,144). The severity of illness associated with pharyngitis due to A. haemolyticum seems to be as varied as that with streptococcal pharyngitis, and the two cannot be differentiated on clinical findings alone.…”

“…In their recent review of pharyngitis cases due to A. haemolyticum, Miller et al raised the possibility that an unidentified toxin may be responsible for the rash in these patients (144). Early reports regarding the production of extracellular toxins by A. haemolyticum are contradictory.…”

“…Sepsis due to this organism was recently reported in a 15-year-old patient with infectious mononucleosis (73). The relative frequency of pharyngitis due to A. haemolyticum is between 5 and 13% of that due to Streptococcus pyogenes (7,144). Over 90% of A. haemolyticum cases occur in patients between 10 and 30 years old (7,60,144,187), whereas most group A streptococcal pharyngitis patients are <10 years old (7,144).…”

“…One striking feature of pharyngitis due to A. haemolyticum is the associated rash that occurs in 30 to 67% of the cases (7,60,144,187). The rash has been described as erythematous, maculopapular, or, in some patients, scarlatiniform or rubelliform.…”

Bacteriological characteristics of Arcanobacterium haemolyticum isolated from seven patients with skin and soft-tissue infections

“…Originally known as Corynebacterium haemolyticum, it was later removed from the genus Corynebacterium and assigned to the new genus Arcanobacterium (Yassin et al, 2011). It was first described in 1946 and was reported as a causative agent of acute pharyngitis and skin lesions (Maclean et al, 1946), and was considered a pathogen, causing wound infections and pharyngitis (Miller et al, 1986;Karpathios et al, 1992;Mackenzie et al, 1995;Funke et al, 1997;Linder, 1997). In some cases, A. haemolyticum can cause septicaemia, osteomyelitis, brain abscesses and endocarditis (Jobanputra & Swain, 1975;Vargas et al, 2006;Wong et al, 2011;Brown et al, 2013).…”