Cutaneous ulcers revealing diphtheria: A re-emerging disease imported from Indian Ocean countries?

Microneedle-based devices for point-of-care infectious disease diagnostics

“… Causative agent Infection name Infection type Patient specimen Current detection method(s) Ref. Bacterial Cat scratch disease ( Bartonella henselae ) Cutaneous/localised Blood draw Cell culture, immunoassay & polymerase chain reaction (PCR) 20 Cellulitis Cutaneous/localised Skin swab/biopsy & blood draw Cell culture, drug susceptibility testing & specific analyte monitoring 2 Diphtheria Cutaneous/localised Skin swab/biopsy, nasal swab and throat swab Cell culture & toxin detection by immunoassay & PCR 21 , 22 Impetigo & Ecthyma Cutaneous/localised Skin swab Visual inspection, cell culture & drug susceptibility testing 2 Leptospirosis Cutaneous/localised Skin biopsy, blood draw, urine sample & spinal fluid sample (rare) Cell culture, microscopy, immunoassay & PCR 2 , 23 Lyme disease & Erythema migrans Cutaneous/localised & Systemic/Internal Blood draw Immunoassay 2 , 24 , 25 , 26 Meningitis Systemic/Internal Cerebrospinal fluid (CSF) & blood draw Cell culture, PCR & computerised tomography (CT) scans 27 (Atypical) Mycobacteria spp . infections (Other than leprosy & tuberculosis) Cutaneous/localised Skin biopsy & sputum sample Cell culture, microscopy smear & PCR 2 , 28 Mycobacterium leprae (Leprosy) Cutaneous/localised Skin biopsy Visual ...…”

Cutaneous diphtheria: three case-reports to discuss determinants of re-emergence in resource-rich settings

“…Classical features include one or several well-delimitated ulcers classically covered with pseudo-membranes. Microbiological diagnosis relies on the identification of C. diphtheriae or ulcerans in culture from cutaneous swabs, often associated with S. pyogenes and S. aureus [ 4 ], such as in our cases. Both toxigenic and non-toxigenic strains can cause cutaneous infection, but resulting systemic complications from toxigenic strains via this route are rare [ 4 ].…”

“…Microbiological diagnosis relies on the identification of C. diphtheriae or ulcerans in culture from cutaneous swabs, often associated with S. pyogenes and S. aureus [ 4 ], such as in our cases. Both toxigenic and non-toxigenic strains can cause cutaneous infection, but resulting systemic complications from toxigenic strains via this route are rare [ 4 ]. Since C. diphtheriae is naturally susceptible to amoxicillin that is the usual treatment for cutaneous infections, cutaneous diphtheria may be cured before determination of the possible toxigenic nature of the agent.…”

“…Since C. diphtheriae is naturally susceptible to amoxicillin that is the usual treatment for cutaneous infections, cutaneous diphtheria may be cured before determination of the possible toxigenic nature of the agent. This has led several authors to question the need for anti-toxin serotherapy in association with antibiotics in cutaneous forms with toxigenic strains [ 4 ]. This is particularly relevant as anti-toxin serum is difficult to obtain and involves a high risk of severe anaphylaxis [ 4 , 6 , 7 ].…”

“…This has led several authors to question the need for anti-toxin serotherapy in association with antibiotics in cutaneous forms with toxigenic strains [ 4 ]. This is particularly relevant as anti-toxin serum is difficult to obtain and involves a high risk of severe anaphylaxis [ 4 , 6 , 7 ]. Hence, World Health Organization and Public Health England do not recommend it anymore [ 6 , 7 ], but following French guidelines, in which it is still recommended [ 8 , 9 ], patients 1 and 2 received anti-toxin, contrarily to patient 3.…”