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

BACKGROUND: The incidence of diphtheria has been rising over the past decade, particularly in its cutaneous form. A clinical review of case series was therefore required.

MATERIAL AND METHODS: 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.

RESULTS: 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.

DISCUSSION: 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.

CONCLUSION: Continued epidemiological surveillance, increased vaccination coverage in high-risk populations and better information of clinicians are essential to prevent and control this preventable disease.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05798247.

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