{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:02:37Z","timestamp":1791576157050,"version":"4.3.4"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32AI007140-45"],"award-info":[{"award-number":["5T32AI007140-45"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32AI007044-47"],"award-info":[{"award-number":["5T32AI007044-47"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32AI7044-48"],"award-info":[{"award-number":["5T32AI7044-48"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Nontoxigenic Corynebacterium diphtheriae, often associated with wounds, can rarely cause infective endocarditis (IE). Five patients with C. diphtheriae IE were identified within 12 months at a Seattle-based hospital system. We reviewed prior C. diphtheriae\u2013positive cultures to determine if detections had increased over time and evaluated epidemiologic trends.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a formal electronic health record search to identify all patients aged \u226518 years with C. diphtheriae detected in a clinical specimen (ie, wound, blood, sputum) between 1 September 2020 and 1 April 2023. We collected patient demographics, housing status, comorbidities, substance-use history, and level of medical care required at detection. We extracted laboratory data on susceptibilities of C. diphtheriae isolates and on other pathogens detected at the time of C. diphtheriae identification.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae\u2013positive clinical culture, with most detections occurring after March 2022. Patients were predominantly male (75%), White (66%), unstably housed (77%), and had a lifetime history of injecting drugs (75%). Most C. diphtheriae\u2013positive cultures were polymicrobial, including wound cultures from 36 (82%) patients and blood cultures from 6 (14%) patients, not mutually exclusive. Thirty-four patients (77%), including all 5 patients with C. diphtheriae IE, required hospital admission for C. diphtheriae or a related condition. Of the 5 patients with IE, 3 died of IE and 1 from COVID-19.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Findings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae094","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T17:23:29Z","timestamp":1708536209000},"page":"1214-1221","source":"Crossref","is-referenced-by-count":9,"title":["Cluster of Nontoxigenic <i>Corynebacterium diphtheriae<\/i> Infective Endocarditis and Rising Background <i>C. diphtheriae<\/i> Cases\u2014Seattle, Washington, 2020\u20132023"],"prefix":"10.1093","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6657-0052","authenticated-orcid":false,"given":"Ellora N","family":"Karmarkar","sequence":"first","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah T","family":"Himmelfarb","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J","family":"Chow","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"},{"name":"Communicable Disease Epidemiology and Immunization Section, Public Health\u2014Seattle & King County , Seattle, Washington , USA"},{"name":"Department of Epidemiology, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayden Z","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine F","family":"Lan","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Washington and Harborview Medical Center , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas R","family":"Graff","sequence":"additional","affiliation":[{"name":"Office of Communicable Disease Epidemiology, Washington State Department of Health , Shoreline, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chas","family":"DeBolt","sequence":"additional","affiliation":[{"name":"Center for Public Health Medical and Veterinary Science, Washington State Department of Health , Shoreline, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thao","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Washington and Harborview Medical Center , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Bourassa","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, University of Washington and Harborview Medical Center , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carey","family":"Farquhar","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"},{"name":"Department of Epidemiology, University of Washington , Seattle, Washington , USA"},{"name":"Department of Global Health, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferric C","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"},{"name":"Department of Laboratory Medicine and Pathology, University of Washington and Harborview Medical Center , Seattle, Washington , USA"},{"name":"Department of Global Health, University of Washington , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H Nina","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S","family":"Pottinger","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine , Seattle, Washington , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"key":"2024051423575305200_ciae094-B1","doi-asserted-by":"crossref","first-page":"ofab055","DOI":"10.1093\/ofid\/ofab055","article-title":"Infective endocarditis due to Corynebacterium species: clinical features and antibiotic resistance","volume":"8","author":"Blackberg","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2024051423575305200_ciae094-B2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1471-2334-7-4","article-title":"Corynebacterium endocarditis species-specific risk factors and outcomes","volume":"7","author":"Belmares","year":"2007","journal-title":"BMC Infect Dis"},{"key":"2024051423575305200_ciae094-B3","author":"Centers for Disease Control and Prevention"},{"key":"2024051423575305200_ciae094-B4","doi-asserted-by":"crossref","first-page":"e584","DOI":"10.1016\/j.ijid.2011.04.003","article-title":"Corynebacterium diphtheriae endocarditis: a case series and review of the treatment approach","volume":"15","author":"Muttaiyah","year":"2011","journal-title":"Int J Infect Dis"},{"key":"2024051423575305200_ciae094-B5","doi-asserted-by":"crossref","first-page":"3298","DOI":"10.3390\/ijms23063298","article-title":"Interactions between the re-emerging pathogen Corynebacterium diphtheriae and host cells","volume":"23","author":"Ott","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2024051423575305200_ciae094-B6","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/021849230501300205","article-title":"Corynebacterium diphtheriae endocarditis\u2014surgery for some but not all!","volume":"13","author":"Mishra","year":"2005","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"2024051423575305200_ciae094-B7","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1128\/jcm.35.2.441-445.1997","article-title":"Clinical and molecular study of Corynebacterium diphtheriae systemic infections in France. Coryne Study Group","volume":"35","author":"Patey","year":"1997","journal-title":"J Clin Microbiol"},{"key":"2024051423575305200_ciae094-B8","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1097\/01.smj.0000240699.50846.fd","article-title":"Cluster of invasive infections, including endocarditis, caused by nontoxigenic Corynebacterium diphtheriae","volume":"99","author":"Kakis","year":"2006","journal-title":"South Med J"},{"key":"2024051423575305200_ciae094-B9","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/0140-6736(92)92004-Y","article-title":"Invasive infection with non-toxigenic Corynebacterium diphtheriae among drug users","volume":"339","author":"Zuber","year":"1992","journal-title":"Lancet"},{"key":"2024051423575305200_ciae094-B10","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1086\/514997","article-title":"An outbreak of nontoxigenic Corynebacterium diphtheriae infection: single bacterial clone causing invasive infection among Swiss drug users","volume":"27","author":"Gubler","year":"1998","journal-title":"Clin Infect Dis"},{"key":"2024051423575305200_ciae094-B11","doi-asserted-by":"crossref","first-page":"235","DOI":"10.3389\/fpubh.2019.00235","article-title":"Whole genome sequencing for surveillance of diphtheria in low incidence settings","volume":"7","author":"Seth-Smith","year":"2019","journal-title":"Front Public Health"},{"key":"2024051423575305200_ciae094-B12","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.3201\/eid2908.230106","article-title":"Emerging Corynebacterium diphtheriae species complex infections, R\u00e9union Island, France, 2015\u20132020","volume":"29","author":"Garrigos","year":"2023","journal-title":"Emerg Infect Dis"},{"key":"2024051423575305200_ciae094-B13","article-title":"Genomic epidemiology of nontoxigenic Corynebacterium diphtheriae from King County, Washington State, USA between July 2018 and May 2019","volume":"6","author":"Xiaoli","year":"2020","journal-title":"Microb Genom"},{"key":"2024051423575305200_ciae094-B14","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3201\/eid2601.191241","article-title":"Phenotypic and genotypic correlates of penicillin susceptibility in nontoxigenic Corynebacterium diphtheriae, British Columbia, Canada, 2015-2018","volume":"26","author":"Zou","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2024051423575305200_ciae094-B15","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1093\/clinids\/18.1.94","article-title":"Nontoxigenic Corynebacterium diphtheriae isolated from intravenous drug users","volume":"18","author":"Gruner","year":"1994","journal-title":"Clin Infect Dis"},{"key":"2024051423575305200_ciae094-B16","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1093\/clind\/16.2.271","article-title":"Infective endocarditis due to nontoxigenic Corynebacterium diphtheriae: report of seven cases and review","volume":"16","author":"Tiley","year":"1993","journal-title":"Clin Infect Dis"},{"key":"2024051423575305200_ciae094-B17","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.3201\/eid1911.130297","article-title":"Nontoxigenic highly pathogenic clone of Corynebacterium diphtheriae, Poland, 2004\u20132012","volume":"19","author":"Zasada","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"2024051423575305200_ciae094-B18","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1093\/clinids\/17.6.1072","article-title":"Corynebacterium diphtheriae endocarditis in France","volume":"17","author":"Lortholary","year":"1993","journal-title":"Clin Infect Dis"},{"key":"2024051423575305200_ciae094-B19","doi-asserted-by":"crossref","first-page":"71","DOI":"10.7326\/0003-4819-111-1-71","article-title":"Diphtheria among alcoholic urban adults. A decade of experience in Seattle","volume":"111","author":"Harnisch","year":"1989","journal-title":"Ann Intern Med"},{"key":"2024051423575305200_ciae094-B20","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1093\/cid\/ciad271","article-title":"The 2023 Duke-ISCVID criteria for infective endocarditis: updating the modified duke criteria","volume":"77","author":"Fowler","year":"2023","journal-title":"Clin Infect Dis"},{"key":"2024051423575305200_ciae094-B21","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2024051423575305200_ciae094-B22","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"2024051423575305200_ciae094-B23","author":"R Core Team"},{"key":"2024051423575305200_ciae094-B24","volume-title":"Clinical microbiology procedures handbook","author":"Leber","year":"2023","edition":"5th ed"},{"key":"2024051423575305200_ciae094-B25","volume-title":"Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2016","edition":"3rd ed."},{"key":"2024051423575305200_ciae094-B26","author":"The European Committee on Antimicrobial Susceptibility Testing"},{"key":"2024051423575305200_ciae094-B27","volume-title":"Increase in non-toxigenic Corynebacterium diphtheriae infections reported to Washington State Department of Health, 2018\u20132023","author":"Graff","year":"2023"},{"key":"2024051423575305200_ciae094-B28","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.3201\/eid2407.172026","article-title":"Geographically diverse clusters of nontoxigenic Corynebacterium diphtheriae infection, Germany, 2016\u20132017","volume":"24","author":"Dangel","year":"2018","journal-title":"Emerg Infect Dis"},{"key":"2024051423575305200_ciae094-B29","doi-asserted-by":"crossref","first-page":"4612","DOI":"10.3390\/ijms24054612","article-title":"Genomic analysis of Corynebacterium diphtheriae strains isolated in the years 2007\u20132022 with a report on the identification of the first non-toxigenic tox gene-bearing strain in Poland","volume":"24","author":"Wo\u0142kowicz","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2024051423575305200_ciae094-B30","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1186\/s12864-018-5147-2","article-title":"Genome-wide comparison of Corynebacterium diphtheriae isolates from Australia identifies differences in the pan-genomes between respiratory and cutaneous strains","volume":"19","author":"Timms","year":"2018","journal-title":"BMC Genomics"},{"key":"2024051423575305200_ciae094-B31","doi-asserted-by":"crossref","first-page":"511","DOI":"10.3201\/eid1003.030524","article-title":"Imported cutaneous diphtheria, United Kingdom","volume":"10","author":"de Benoist","year":"2004","journal-title":"Emerg Infect Dis"},{"key":"2024051423575305200_ciae094-B32","doi-asserted-by":"crossref","first-page":"2664","DOI":"10.1128\/JCM.00362-11","article-title":"Cutaneous diphtheria in the urban poor population of Vancouver, British Columbia, Canada: a 10\u2013year review","volume":"49","author":"Lowe","year":"2011","journal-title":"J Clin Microbiol"},{"key":"2024051423575305200_ciae094-B33","doi-asserted-by":"crossref","first-page":"e00506-20","DOI":"10.1128\/JCM.00506-20","article-title":"The brief case: nontoxigenic Corynebacterium diphtheriae in a nonhealing wound","volume":"58","author":"Kates","year":"2020","journal-title":"J Clin Microbiol"},{"key":"2024051423575305200_ciae094-B34","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1128\/JCM.44.5.1625-1629.2006","article-title":"Emergence of an invasive clone of nontoxigenic Corynebacterium diphtheriae in the urban poor population of Vancouver, Canada","volume":"44","author":"Romney","year":"2006","journal-title":"J Clin Microbiol"},{"issue":"Pt 11","key":"2024051423575305200_ciae094-B35","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1099\/jmm.0.012161-0","article-title":"Corynebacterium diphtheriae as an emerging pathogen in nephrostomy catheter-related infection: evaluation of traits associated with bacterial virulence","volume":"58","author":"Gomes","year":"2009","journal-title":"J Med Microbiol"},{"issue":"Pt 2","key":"2024051423575305200_ciae094-B36","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1099\/jmm.0.46135-0","article-title":"Experimental model of infection with non-toxigenic strains of Corynebacterium diphtheriae and development of septic arthritis","volume":"55","author":"Puliti","year":"2006","journal-title":"J Med Microbiol"},{"issue":"Pt 3","key":"2024051423575305200_ciae094-B37","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1099\/mic.0.069948-0","article-title":"Invasion of endothelial cells and arthritogenic potential of endocarditis-associated Corynebacterium diphtheriae","volume":"160","author":"Peixoto","year":"2014","journal-title":"Microbiology (Reading)"},{"key":"2024051423575305200_ciae094-B38","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1093\/jpids\/pit022","article-title":"Non-toxigenic penicillin and cephalosporin-resistant Corynebacterium diphtheriae endocarditis in a child: a case report and review of the literature","volume":"3","author":"Fricchione","year":"2014","journal-title":"J Pediatric Infect Dis Soc"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciae094\/57164987\/ciae094.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciae094\/57637405\/ciae094.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciae094\/57637405\/ciae094.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T23:58:20Z","timestamp":1715731100000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/78\/5\/1214\/7611981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,21]]},"references-count":38,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,2,21]]},"published-print":{"date-parts":[[2024,5,15]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciae094","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5,15]]},"published":{"date-parts":[[2024,2,21]]}}}