Molecular epidemiology and characteristics of Corynebacterium diphtheriae and Corynebacterium ulcerans strains isolated in Italy during the 1990s

Five cases of diphtheria were reported in Italy between January 1990 and June 2001. Three cases were confirmed microbiologically by the isolation of toxigenic Corynebacterium diphtheriae (two cases) and Corynebacterium ulcerans (one case). Over the same period, 11 cases of non-toxigenic C. diphtheriae infection were reported to the Italian Public Health Institute, from which the causative organism was isolated from a skin infection in one case and from the throat in the other ten. Seven of the throat isolates were associated with fever, severe pharyngitis and tonsillitis and were all biotype gravis. Because there are no standardized breakpoints, the antimicrobial sensitivities of C. diphtheriae were determined in accordance with the National Committee for Clinical Laboratory Standards guidelines for Streptococcus sop, other than Streptococcus pneumoniae. MICs for penicillin ranged between 0.125 and 0.250 mgl(-1) and 7 out of 11 strains had a minimal bactericidal concentration (MBC)/MIC ratio greater than or equal to 32. All strains were sensitive to clindamycin (MIC less than or equal to 0.25 mg l(-1)), rifampicin (MIC less than or equal to 1 mg l(-1)) and tetracycline (MIC less than or equal to 2 mg l(-1)), and showed moderate susceptibility to cefotaxime (MIC 0.75-1.5 mg l(-1)). Molecular typing (ribotyping) demonstrated the presence of several distinct ribotypes. The ribotype designated 'D11' has been documented amongst strains isolated in the UK, Russia, Germany, Romania and Sweden. Ribotype 'D75' has only been documented in the UK. The C. ulcerans strain had a ribotype pattern identical to that found in recent isolates from the UK.