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Volume 3, Number 1—March 1997
Dispatch

Exudative Pharyngitis Possibly Due to Corynebacterium pseudodiphtheriticum, a New Challenge in The Differential Diagnosis of Diphtheria

Hector S. Izurieta*, Peter M. Strebel*, Thomas Youngblood†, Dannie G. Hollis*, and Tanja Popovic*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Rogers Pediatric Clinic, Rogers, Arkansas, USA

Main Article

Table

Reported cases of infection with Corynebacterium pseudodiphtheriticum

Ref. Year# Age Sex Infection site Underlying condition(s) Treatment Outcome
4 1932 11 F Natural heart valve Rheumatic heart disease Antimeningococcic serum Died
5 1948 26 M Natural heart valve Rheumatic heart disease Penicillin Cured
10 1960 - - Natural heart valve Endocarditis Penicillin -
11 1965 11 M Natural heart valve Congenital heart disease Penicillin Cured
15 1966 48 M Natural heart valve Chronic dialysis Polymyxin B, nafcillin chloromycetin Died
12 1967 56 M Prosthetic valve Prosthetic valve Penicillin, streptomycin Died
12 1967 47 M Prosthetic valve Prosthetic valve Penicillin, streptomycin Died
6* 1969 14 M Pulmonary allograft Incompetent mitral valve Penicillin Died
7 1970 - - Natural heart valve Rheumatic heart disease Penicillin -
14 1971 33 M Prosthetic valve Prosthetic valve - Died
13 1972 49 F Prosthetic valve Prosthetic valve Cephaloridine, gentamicin Cured
6* 1981 69 M Prosthetic valve Arctic Stenosis Vancomycin Died
8 1982 46 M Natural heart valve Rheumatic heart disease, intravenous drug abuse Nafcillin, gentamicin Died
33 1982 30 F Kidney Immunosuppression after renal transplantation Metronidazole, flucloxacillin Cured
26* 1982 80 M Lungs Chronic bronchitis Fosfomycin Died
18 1983 30 M Lungs@ Immunosuppression in systemic lupus erythematosus Ampicillin, gentamicin Cured
26* 1985 25 F Lungs Chronic bronchitis Erythromycin, norfloxacin Cured
26* 1986 58 M Lungs Chronic bronchitis Oral cephem (CS-807) Cured
26* 1986 62 F Lungs Bronchitis Ticarcillin Cured
26* 1986 24 F Lungs Bronchiectasis Sultamicillin Cured
26* 1986 78 M Lungs Primary lung cancer Norfloxacin Cured
23 1986 24 M Lungs AIDS Clindamycin Cured
19 1986 29 - Lungs@ Severe trauma, pneumothorax, endotracheal intubation Moxalactam, tobramycin Cured
6* 1986 57 M Prosthetic valve Aortic incompetence Penicillin, gentamicin Cured
16 1986 71 M Natural heart valve Mitral valve disease Penicillin, tobramycin Cured
17 1987 23 M Prosthetic valve Prosthetic valve Penicillin, gentamicin vancomycin Cured
34 1987 63 F Skin Squamous cell carcinoma Topical wound care Cured
6* 1989 10 F Aortic allograft, teflon patch (septum) Tetralogy of Fallot Penicillin, gentamicin Cured
22 1989 70 M Lungs@ Anthracosilicosis endotracheal intubation Cefuroxime, netilmicin, penicillin Cured
6* 1990 82 M Natural heart valve Calcified heart valves Penicillin Cured
30 1991 63 M Trachea, bronchi Chronic obstructive pulmonary disease (prednisone user) Vancomycin, clindamycin Cured
32 1991 54 M Trachea Diabetes mellitus, endotracheal intubation Penicillin, erythromycin Cured
20 1991 6 M Lungs Leukemia chemotherapy Cefotaxime Died
31 1991 68 M Lungs@ Permanent tracheostomy, pleural calcification Gentamicin, vancomycin oxacillin Cured
24 1992 43 M Lungs@ AIDS Vancomycin Cured
24 1992 34 M Lungs@ AIDS Vancomycin Cured
25 1992 64 M Lungs@ Lymphoma (steroid user) CZON Cured
25 1992 62 F Lungs@ Polymyositis (steroid user) PIPC/CAZ Cured
25 1992 84 M Lungs Pulmonary emphysema IPM/CS Cured
25 1992 79 M Lungs Chronic pulmonary disease OFLX Cured
9 1992 82 M Natural heart valve Aortic regurgitation Penicillin, gentamicin Died
27* 1992 55 F Lungs Metastatic renal carcinoma None Died
27* 1992 61 F Lungs Radiotherapy, subglottic tumor Doxycycline Cured
27* 1992 61 M Lungs Squamous cell carcinoma of the neck None -
27* 1992 81 F Lungs Dementia Erythromycin Cured
27* 1992 75 M Lungs Cardiorespiratory failure None Died
27* 1992 59 M Lungs Metastatic prostatic carcinoma Amoxycillin Cured
27* 1992 73 M Lungs Radiotherapy, non-Hodgkin's lymphoma Amoxycillin-clavulanate Died
21 1993 33 M Lungs@ AIDS Cefotaxime, erythromycinpenicillin Cured
28* 1995 71 F Bronchi Congestive heart failure Cefazolin Cured
28* 1995 91 F Lungs@ Angina, chronic renal failure Cefazolin, tobramycin Died
28* 1995 40 M Lungs@ None Penicillin Cured
28* 1995 91 F Bronchi Chronic obstructive pulmonary disease Trimethoprim-Sulfamethoxazole Cured
28* 1995 68 M Bronchi Chronic obstructive pulmonary disease Ceftriaxone/cefaclor Cured
28* 1995 42 M Bronchi Multiple sclerosis Trimethoprim-Sulfamethoxazole Cured
28* 1995 42 F Bronchi None Oral cephalosporin Cured
28* 1995 79 F Lungs@ Congestive heart failure Erythromycin, cefazolin Cured
28* 1995 93 F Bronchi Congestive heart failure Cefazolin, cephalexin Cured
28* 1995 70 M Lungs@ Congestive heart failure Ceftriaxone, tobramycin erythromycin Cured
28* 1995 60 F Bronchi Cancer (ovary) Cefazolin Cured
28* 1995 76 M Bronchi Congestive heart failure Ceftriaxone Died
28* 1995 69 M Bronchi Chronic obstructive pulmonary disease Ceftriaxone Cured
28* 1995 78 F Bronchi Metastatic cancer None Died
28* 1995 58 M Bronchi Chronic obstructive pulmonary disease Trimethoprim-Sulfamethoxazole Cured
28* 1995 55 F Bronchi Chronic obstructive pulmonary disease Erythromycin Cured
28* 1995 71 M Lungs@ Chronic obstructive pulmonary disease Trimethoprim-Sulfamethoxazole Cured
29* 1995 75 M Bronchi Tuberculosis (healed) Piperacillin, tazobactam Cured
29* 1995 77 M Bronchi Tuberculosis (healed) Pazufloxacin Cured
29*† 1995 70 M Bronchi Cardiovascular accident Azithromycin Cured
29* 1995 68 M Lungs@ Chronic obstructive pulmonary disease Piperazillin, cefotiam ceftazidime Died
29*‡ 1995 72 M Bronchi Chronic obstructive pulmonary disease, systemic lupus erythematosus Meropenem Cured
29*‡ 1995 72 M Bronchi Chronic obstructive pulmonary disease, systemic lupus erythematosus Cefpirome Cured
29*‡ 1995 72 M Lungs@ Chronic obstructive pulmonary disease, systemic lupus erythematosus Cefcamate, pivoxil Died
29* 1995 28 F Bronchi Ventricular septal defect, pulmonary hypertension Ciprofloxacin Cured
29* 1995 70 M Bronchi Polyarteritis nodosa, interstitial pneumonitis Cefetamet, pivoxil Cured
29* 1995 44 M Bronchi Chronic sinusitis Bacampicillin Cured
29* 1995 58 M Bronchi Tuberculosis, sinusitis Cefpodoxime Cured
29* 1995 70 F Lungs@ None determined Piperacillin Cured
29* 1995 24 F Bronchi Chronic obstructive pulmonary disease Ampicillin-sulbactam Cured
29* 1995 66 F Bronchi Chronic obstructive pulmonary disease FK-037 Cured
29* 1995 43 M Bronchi Heart failure FK-037 Cured
29*† 1995 71 M Bronchi Cardiovascular accident CP-70.429 Cured
35 1995 69 F Vertebra Spondylolisthesis, nasal turbinate surgery Ampicillin, flucloxacillin Cured

# If year of onset was not available the year of publication was used instead
* Retrospective case reviews
† These 2 cases involved the same patient
‡ These 3 cases involved the same patient
@ Diagnosed as pneumonia

Main Article

References
  1. Clarridge  JE, Speigel  CA. Corynebacterium, and miscellaneous irregular gram-positive rods, Erysipelothrix, and Gardnerella. In: Manual of clinical microbiology, 6th ed. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Washington (DC): American Society for Microbiology, 1995:357-78.
  2. Austrian  R. Streptococcus pneumoniae. In: Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious Diseases. Philadelphia: W.B. Saunders Company, 1992:1412-15.
  3. Mikhailovich  VM, Melnikov  VG, Mazurova  IK, Wachsmuth  IK, Wenger  JD, Wharton  M, Application of PCR for detection of toxigenic Corynebacterium diphtheriae strains isolated during the Russian diphtheria epidemic, 1990 through 1994. J Clin Microbiol. 1995;:30613.PubMedGoogle Scholar
  4. Tow  A, Wechsler  HF. Diphtheroid bacillus as the cause of acute endocarditis. Am J Dis Child. 1932;44:15661.
  5. Olinger  MG. Mixed infections in subacute bacterial endocarditis: report of two cases. Arch Intern Med. 1948;81:33441.
  6. Morris  A, Guild  I. Endocarditis due to Corynebacterium pseudodiphtheriticum: five case reports, review, and antibiotic susceptibilities of nine strains. Rev Infect Dis. 1991;13:88792.PubMedGoogle Scholar
  7. Johnson  WD, Kaye  D. Serious infections caused by diphtheroids. Ann N Y Acad Sci. 1970;174:56876. DOIPubMedGoogle Scholar
  8. Rubler  S, Harvey  L, Avitabile  A, Abenavoli  T. Mitral valve obstruction in a case of bacterial endocarditis due to Corynebacterium hofmannii: echocardiographic diagnosis. N Y State J Med. 1982;82:15904.PubMedGoogle Scholar
  9. Wilson  ME, Shapiro  DS. Native valve endocarditis due to Corynebacterium pseudodiphtheriticum. Clin Infect Dis. 1992;15:105960.PubMedGoogle Scholar
  10. Barrit  DW, Gillespie  WA. Subacute bacterial endocarditis. BMJ. 1960;1:12359. DOIPubMedGoogle Scholar
  11. Blount  JG. Bacterial endocarditis. Am J Med. 1965;38:90922. DOIPubMedGoogle Scholar
  12. Johnson  WD, Cobbs  CG, Arditi  LI, Kaye  D. Diphtheroid endocarditis after insertion of prosthetic heart valve: report of two cases. JAMA. 1968;203:91921. DOIPubMedGoogle Scholar
  13. Boyce  JMH. A case of prosthetic valve endocarditis caused by Corynebacterium hofmannii and Candida albicans. Br Heart J. 1975;37:11957. DOIPubMedGoogle Scholar
  14. Wise  JR, Bentall  HH, Cleland  WP, Goodwin  JF, Hallidie-Smith  KA, Oakley  CM. Urgent aortic-valve replacement for acute aortic regurgitation due to infective endocarditis. Lancet. 1971;2:11521. DOIPubMedGoogle Scholar
  15. Leonard  A, Raij  L, Shapiro  FL. Bacterial endocarditis in regularly dialyzed patients. Kidney Int. 1973;4:40722. DOIPubMedGoogle Scholar
  16. Lindner  PS, Hardy  DJ, Murphy  TF. Endocarditis due to Corynebacterium pseudodiphtheriticum. N Y State J Med. 1986;86:1024.PubMedGoogle Scholar
  17. Cauda  R, Tamburrini  E, Venture  G, Ortona  L. Effective vancomycin therapy for Corynebacterium pseudodiphtheriticum endocarditis [letter]. South Med J. 1987;80:1598.PubMedGoogle Scholar
  18. Donaghy  M, Cohen  J. Pulmonary infection with Corynebacterium hofmannii complicating systemic lupus erythematosus. J Infect Dis. 1983;147:962.PubMedGoogle Scholar
  19. Miller  RA, Rompalo  A, Coyle  MB. Corynebacterium pseudodiphtheriticum pneumonia in an immunologically intact host AIDS patients. Lancet. 1992;340:1145. DOIGoogle Scholar
  20. Cimolai  N, Rogers  P, Seear  M. Corynebacterium pseudodiphtheriticum pneumonitis in a leukaemic child. Thorax. 1992;47:8389. DOIPubMedGoogle Scholar
  21. Roig  P, López  MM, Arriero  JM, Cuadrado  JM, Martín  C. Neumonía por Corynebacterium pseudodiphtheriticum en paciente diagnosticado de infección por VIH. Med Interna. 1993;10:499500.
  22. Douat  N, Labbe  M, Glupczynski  G. Corynebacterium pseudodiphtheriticum pneumonia in an anthracosilicotic man. Clin Microbiol Newsl. 1989;11:18990. DOIGoogle Scholar
  23. Andavolu  RH, Venkita  J, Lue  Y, McLean  T. Lung abcess involving Corynebacterium pseudodiphtheriticum in a patient with AIDS-related complex. N Y State J Med. 1986;86:5946.PubMedGoogle Scholar
  24. Cohen  Y, Force  G, Grox  I, Canzi  AM, Lecleach  L, Dreyfuss  D. Corynebacterium pseudodiphtheriticum pulmonary infection in AIDS patients. Lancet. 1992;340:1145. DOIPubMedGoogle Scholar
  25. Yoshitomi  Y, Higashiyama  Y, Matsuda  H, Mitsutake  K, Miyazaki  Y, Maesaki  S, Four cases of respiratory infections caused by Corynebacterium pseudodiphtheriticum. Kansenshogaku Zasshi-Journal of the Japanese Association for Infectious Diseases. 1992;66:8792.
  26. Rikitomi  N, Nagatake  T, Matsumoto  K, Watanabe  K, Mbaki  N. Lower respiratory tract infections due to nondiphtheria corynebacteria in 8 patients with underlying lung disease. Tohoku J Exp Med. 1987;153:31325. DOIPubMedGoogle Scholar
  27. Freeman  JD, Smith  HJ, Haines  HG, Hellyar  AG. Seven patients with respiratory infections due to Corynebacterium pseudodiphtheriticum. Pathology. 1994;26:3114. DOIPubMedGoogle Scholar
  28. Manzella  JP, Kellogg  JA, Parsey  KS. Corynebacterium pseudodiphtheriticum: a respiratory tract pathogen in adults. Clin Infect Dis. 1995;20:3740.PubMedGoogle Scholar
  29. Ahmed  K, Kawakami  K, Watanabe  K, Mitsushima  H, Nagatake  T, Matsumoto  K. Corynebacterium pseudodiphtheriticum: a respiratory tract pathogen. Clin Infect Dis. 1995;20:416.PubMedGoogle Scholar
  30. Craig  TJ, Maguire  FE, Wallace  MR. Tracheobronchitis due to Corynebacterium pseudodiphtheriticum. South Med J. 1991;84:5046. DOIPubMedGoogle Scholar
  31. Williams  EA, Green  JD, Salazar  S. Pneumonia caused by Corynebacterium pseudodiphtheriticum. J Tenn Med Assoc. 1991;84:2234.PubMedGoogle Scholar
  32. Colt  HG, Morris  JF, Marston  BJ, Sewell  DL. Necrotizing tracheitis caused by Corynebacterium pseudodiphtheriticum: unique case and review. Rev Infect Dis. 1991;13:736.PubMedGoogle Scholar
  33. Nathan  AW, Turner  DR, Aubrey  C, Cameron  JS, Williams  DG, Ogg  CS, Corynebacterium hofmannii infection after renal transplantation. Clin Nephrol. 1982;17:3158.PubMedGoogle Scholar
  34. Lockwood  BM, Wilson  J. Corynebacterium pseudodiphtheriticum isolation. Clin Microbiol Newsl. 1987;9:56. DOIGoogle Scholar
  35. Wright  ED, Richards  AJ, Edge  AJ. Discitis caused by Corynebacterium pseudodiphtheriticum following ear, nose and throat surgery. Br J Rheumatol. 1995;34:5856. DOIPubMedGoogle Scholar
  36. Santos  MR, Gandhi  S, Vogler  M, Hanna  BA, Holzman  RS. Suspected diphtheria in an Uzbek nacional: isolation of C. pseudodiphtheriticum resulted in a false positive presumptive diagnosis. Clin Infect Dis. 1996;22:735.PubMedGoogle Scholar
  37. Fontanarosa  PB. Diphtheria in Russia a reminder of risk. JAMA. 1995;273:1245. DOIPubMedGoogle Scholar
  38. Simmons  LE, Abbot  JD, Macaulay  ME. Diphtheria carriers in Manchester: simultaneous infection with toxigenic and nontoxigenic mitis strains. Lancet. 1980;2:3045. DOIGoogle Scholar
  39. Tiley  SM, Kociuba  KR, Heron  LG, Munro  R. Infective endocarditis due to nontoxigenic Corynebacterium diphtheriae: a report of seven cases and review. Clin Infect Dis. 1993;16:2715.PubMedGoogle Scholar
  40. Efstratiou  A, Tiley  SM, Sangrador  A, Greenacre  E, Cookson  BD, Chen  SCA, Invasive disease caused by multiple clones of Corynebacterium diphtheriae. Clin Infect Dis. 1993;17:136.PubMedGoogle Scholar
  41. Kain  KC, Noble  MA, Barteluck  RL, Tubbesing  RH. Arcanobacterium hemoliticum infection: confused with scarlet fever and diphtheria. J Emerg Med. 1991;9:335. DOIPubMedGoogle Scholar
  42. Robson  JMB, Harrison  M, Wing  LW, Taylor  R. Diphtheria: may be not! Commun Dis Intell. 1996;20:646.
  43. Barksdale  L, Garmise  L, Horibata  K. Virulence, toxinogeny, and lysogeny in Corynebacterium diphtheriae. Ann N Y Acad Sci. 1960;88:1093108. DOIPubMedGoogle Scholar
  44. Austrian  R. Streptococcus pneumoniae. In: Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious Diseases. Philadelphia: W.B. Saunders Company 1992:1412-15.
  45. Feery  BJ, Forsell  P, Gulasekharam  J. Streptococcal sore throat in general practice--a controlled study. Med J Aust. 1976;1:98991.PubMedGoogle Scholar
  46. Clarridge  JE. When, why and how far should coryneforms be identified? Clin Microbiol Newsl. 1986;8:324. DOIGoogle Scholar

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