Which physical findings are characteristic of nondiphtherial Corynebacterium (diphtheroid) infections?

Updated: Jun 14, 2019
  • Author: Lynda A Frassetto, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Signs of diphtheroid-associated infection relate to the affected organ systems. Species of corynebacteria recovered from skin ulcers include C ulcerans, C bovis, and A haemolyticum. Those associated with bacteremia and sepsis include C pyogenes; C bovis; Corynebacterium xerosis; and groups D2, E, and JK. Case reports depict that these organisms are associated with endocarditis, prosthetic device infection, pneumonia, septic arthritis, and osteomyelitis.

Type D2 was originally identified as a pathogen causing chronic or recurrent cystitis, bladder stones, and pyelonephritis. People with prior urinary tract abnormalities or who have recently undergone urologic procedures are at highest risk for this disease. C urealyticum has been associated with chronic nephrolithiasis and renal failure. [29]

A haemolyticum is reported to cause as many as 10% of all pharyngitis cases in patients aged 10-30 years. These bacteria are capable of producing an extracellular toxin that can cause an erythrogenic rash associated with the pharyngitis.

C ulcerans usually causes skin infections but is occasionally associated with pharyngitis and respiratory disease. In 1996, a 54-year-old, otherwise healthy woman in Indiana who had never received diphtheria immunization developed a membranous pharyngitis with a toxin-producing strain of these bacteria. [30] More recently, a review of clinical samples from the National Microbiology Laboratory in Canada has demonstrated C ulcerans isolates from blood cultures. [31]

C striatum is found on catheters in patients who are neutropenic and have malignancies and has been recovered from the blood of patients with pleuropulmonary infections, endocarditis, and peritonitis. In one heart transplant patient, C striatum was repeatedly cultured from sputum and bronchial lavage fluid. [32] One case of C striatum meningitis was also reported recently. [33]

C pseudodiphtheriticum infection is also found in immunocompromised hosts, associated with both native and prosthetic valve endocarditis, pneumonia, lung abscesses, tracheobronchitis, and suppurative lymphadenitis. In 1995, Manzella and colleagues reviewed the clinical and microbiological features of 17 cases of bronchitis and pneumonia due to C pseudodiphtheriticum that required hospitalization. [34] A more recent study from Brazil found C pseudodiphtheriticum caused urinary tract infections in 29%, respiratory infections in 27%, and intravenous access site infections in 19%. [35]

Group JK can be found on the skin of healthy people. Patients with prolonged hospitalization, neutropenia, or on a prolonged course of antibiotics have a high prevalence for highly resistant JK bacteria. The most common manifestation is endocarditis with bacteremia, often associated with indwelling catheters. Removal of the indwelling catheter is often necessary.

Corynebacteria is often found in the semen of men with inflammatory prostatitis; Türk et al found that more than half of these were isolates were Corynebacterium seminale. [36] However, diphtheroids can be found in the semen of both healthy men and those with chronic prostatitis syndrome. [37]

Moazzez et al (2007) found that 16% of breast abscesses in an urban county hospital were due to diphtheroids. [16] Granulomatous mastitis due to Corynebacterium group G, diagnosed by fine-needle aspirate and culture, was reported by Mathelin et al (2005). [38]

Cases of Corynebacterium macginleyikeratitis following eye surgery have been reported. [39] In these cases, the bacteria was relatively resistant to extended-spectrum penicillins and fluoroquinolones.

Corynebacterium resistens is a newly described, multidrug-resistant species associated with fatal bacteremia in immunocompromised patients in Japan. [40]


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