Two Cases of Cutaneous Diphtheria Associated with Occupational Pig Contact in Germany

Abstract

In 2010, two independent cases of cutaneous diphtheria caused by toxigenic C. ulcerans were identified in Germany. Both patients had intense occupational contact with pigs. Diagnostic work-up comprising biochemical differentiation, rpoB sequencing, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) analysis, real-time tox PCR and Elek test as well as public health measures including an intensified source tracing involving 83 asymptomatic pigs of an associated pig farm are presented.

Corynebacterium species nasal carriage in pigs and their farmers in Bavaria, Germany: implications for public health

“…In conclusion, although we were not able to find any of the three potentially toxigenic Corynebacterium species in our prevalence study among pigs, the – although only sporadic – isolation of tox -positive C ulcerans from pigs, the report of three pig-linked cases of human diphtheria (Schuhegger and others 2009, Berger and others 2013), as well as the similarity of the corynebacteria carriage pattern in pigs and their farmers in our study suggest that pigs might be a rare source for toxigenic C ulcerans infections in humans having prolonged and close contact with these animals.…”

“…Their medium-sized pig-breeding farm housing 500 pigs in a non-industrialised manner was located in a remote rural village of Northern Bavaria. Moreover, two cases of cutaneous diphtheria caused by toxigenic C ulcerans in patients with occupational pig contact have recently been reported from Germany (Berger and others 2013): one involved a 63-year-old diabetic female pig farm worker with a plantar ulcer (strain number KL241), the other a 58-year-old male farmer with a calf wound infection (strain number KL203). Interestingly, non-toxigenic, but tox -positive (non-toxigenic tox-bearing (NTTB)) C ulcerans strains have been isolated from the caseous lymph nodes or organ abscesses from 12 wild boars originating from several regions in Germany (Contzen and others 2011, Eisenberg and others 2014).…”

Nontoxigenictox-bearingCorynebacterium ulceransInfection among Game Animals, Germany

“…With respect to wild boars infected with C. ulcerans , however, it is noteworthy that 3 diphtheria cases occurred in humans who had occupational contact with pigs ( 13 , 14 ). …”

Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017

“…In terms of risk factors for diphtheria in the UK, there have been documented cases following zoonotic exposure to C. ulcerans from companion animals [ 4 , 14 ]. C. ulcerans infection is also a known occupational hazard following exposure to agricultural livestock [ 15 ]. For toxigenic C. diphtheriae however, the main risk factors are travel to an endemic country, close contact with a diphtheria case and being unvaccinated or under-vaccinated.…”