Case reports

In early September 2018, a previously healthy school-aged child under 10 years old from a German family of Somalian origin presented in our hospital in Germany with an initially non-healing burn wound. The wound had occurred 6 days earlier when spilling hot tea on the right thigh during a flight back from Somalia to Germany. The child and close family members had spent the prior 3 weeks in Somalia. Wound swabs initially only led to growth of , but subsequent wound swabs starting 10 days later led to growth of a toxigenic, toxin-producing  biovar  strain (isolate: KL1235). Since the patient fulfilled both the German [1] and European Union [2] case definition for diphtheria, this prompted their immediate hospitalisation and isolation according to the German national guidelines [1]. The strain was identified by biochemical differentiation (API Coryne code 1010324) and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS; MALDI Biotyper; Bruker Daltonics, Bremen, Germany) [3]. Antimicrobial drug susceptibility testing of the isolate was performed on Mueller–Hinton blood agar (supplemented with 5% sheep blood) by Etest after overnight incubation at 37 °C and in 5% CO. Minimum inhibitory concentrations were determined according to Clinical and Laboratory Standards Institute (CLSI) [4] and European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines [5]. The isolate was resistant against both penicillin G and erythromycin, but sensitive towards clindamycin and amoxicillin/clavulanic acid. Toxigenicity was verified in the German Consiliary Laboratory on

Credit: Jennifer Oosthuizen CDC

Diphtheria, Oberschleißheim, by real-time PCR and a modified Elek test [6].

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