Cutaneous diphtheria from 2018 to 2022: an observational, retrospective study of epidemiological, microbiological, clinical, and therapeutic characteristics in metropolitan France

Emerg Microbes Infect. 2024 Dec;13(1):2408324. doi: 10.1080/22221751.2024.2408324. Epub 2024 Sep 30.

Abstract

The incidence of diphtheria has been rising over the past decade, particularly in its cutaneous form. A clinical review of the case series was therefore required. We reviewed the epidemiological, clinical, microbiological and therapeutic data of cutaneous diphtheria cases, in adult patients living in metropolitan France with a skin sample positive for corynebacteria of the diphtheriae complex between 2018 and 2022. Of the 132 cases identified, 63 met the inclusion criteria. The mean age was 53.8 years, 68.3% were men and 56.7% had travelled outside mainland France. Immunization rate was 44%. Lesions involved the lower limbs (86.9%), corresponded to ulcerations in 82% of cases. Two species were identified in the study: C. diphtheriae (77%) and C. ulcerans (23%). 39% were toxigenic. Other bacteria were present in 88.9% of cases: Staphylococcus aureus (54.7%) and Streptococcus pyogenes (49.1%). 17.5% of clinicians ignored the presence of Corynebacteria of the diphtheriae species complex. Clinicians seem to be unfamiliar with this disease due to under-reporting and a lack of knowledge and awareness among clinicians, and rarely mention it, which explains the frequent failure to comply with French recommendations. Clinical data are consistent with the literature. Continued epidemiological surveillance, increased vaccination coverage in high-risk populations and better information of clinicians are essential to prevent and control this preventable disease.

Keywords: Cutaneous diphtheria; emergent; epidemiology; metropolitan France; microbiology; traveller.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Corynebacterium / classification
  • Corynebacterium / isolation & purification
  • Corynebacterium diphtheriae / isolation & purification
  • Diphtheria* / drug therapy
  • Diphtheria* / epidemiology
  • Diphtheria* / microbiology
  • Female
  • France / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Retrospective Studies
  • Skin Diseases, Bacterial / drug therapy
  • Skin Diseases, Bacterial / epidemiology
  • Skin Diseases, Bacterial / microbiology
  • Staphylococcus aureus / isolation & purification
  • Young Adult

Substances

  • Anti-Bacterial Agents

Grants and funding

This work was supported by the Centre Hospitalier Intercommunal Toulon La Seyne sur Mer (CHITS) and Hôpital d’Instruction des Armées (HIA) Ste Anne. The National Reference Center for Corynebacteria of the Diphtheriae Complex is supported financially by the Ministry of Health (Public Health France) and Institut Pasteur.