{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:55:37Z","timestamp":1764251737139,"version":"3.40.5"},"reference-count":34,"publisher":"Microbiology Society","issue":"11","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,30]]},"abstract":"<jats:p>Diphtheria is a potentially fatal infection, mostly caused by diphtheria toxin (DT)-producing <jats:italic>\n                     <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.6189\" xlink:type=\"simple\">Corynebacterium diphtheriae<\/jats:ext-link>\n                     <\/jats:named-content>\n                  <\/jats:italic> strains. During the last decades, the isolation of DT-producing <jats:italic>\n                     <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.6189\" xlink:type=\"simple\">C. diphtheriae<\/jats:ext-link>\n                     <\/jats:named-content>\n                  <\/jats:italic> strains has been decreasing worldwide. However, non-DT-producing <jats:italic>\n                     <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.6189\" xlink:type=\"simple\">C. diphtheriae<\/jats:ext-link>\n                     <\/jats:named-content>\n                  <\/jats:italic> strains emerged as causative agents of cutaneous and invasive infections. Although endemic in countries with warm climates, cutaneous diphtheria is rarely reported in Brazil. Presently, an unusual case of skin lesion in a Brazilian elderly diabetic patient infected by a penicillin-resistant non-DT-producing <jats:italic>\n                     <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.6189\" xlink:type=\"simple\">C. diphtheriae<\/jats:ext-link>\n                     <\/jats:named-content>\n                  <\/jats:italic> strain was reported. Laboratory diagnosis included mass spectrometry and multiplex PCR analyses. Since cutaneous diphtheria lesions are possible sources of secondary diphtheria cases and systemic diseases and considering that penicillin is the first line of antimicrobial agent for the treatment of these infections, the detection of penicillin-resistant strains of diphtheria bacilli should be a matter of concern. Thus, cases similar to the presently reported should be appropriately investigated and treated, particularly in patients with risk factor (s) for the development of <jats:italic>\n                     <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.6189\" xlink:type=\"simple\">C. diphtheriae<\/jats:ext-link>\n                     <\/jats:named-content>\n                  <\/jats:italic> invasive infections, such as diabetes. Moreover, health professionals must be aware of the presence of <jats:italic>\n                     <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.6189\" xlink:type=\"simple\">C. diphtheriae<\/jats:ext-link>\n                     <\/jats:named-content>\n                  <\/jats:italic> in cutaneous lesions of lower limbs, a common type of morbidity in diabetic patients, especially in tropical and subtropical countries.<\/jats:p>","DOI":"10.1099\/acmi.0.000284","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T16:04:50Z","timestamp":1638288290000},"source":"Crossref","is-referenced-by-count":12,"title":["Cutaneous infection by non-diphtheria-toxin producing and penicillin-resistant Corynebacterium diphtheriae strain in a patient with diabetes mellitus"],"prefix":"10.1099","volume":"3","author":[{"given":"Max Roberto","family":"Batista Ara\u00fajo","sequence":"first","affiliation":[{"name":"Operational Technical Nucleus, Microbiology, Hermes Pardini Institute. Av. das Na\u00e7\u00f5es, 3801 - Parque Jardim Ita\u00fa, Minas Gerais, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5342-4518","authenticated-orcid":false,"given":"Mireille \u00c2ngela","family":"Bernardes Sousa","sequence":"additional","affiliation":[{"name":"Operational Technical Nucleus, Microbiology, Hermes Pardini Institute. Av. das Na\u00e7\u00f5es, 3801 - Parque Jardim Ita\u00fa, Minas Gerais, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7848-5974","authenticated-orcid":false,"given":"Luisa Ferreira","family":"Seabra","sequence":"additional","affiliation":[{"name":"Operational Technical Nucleus, Microbiology, Hermes Pardini Institute. Av. das Na\u00e7\u00f5es, 3801 - Parque Jardim Ita\u00fa, Minas Gerais, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3680-330X","authenticated-orcid":false,"given":"Let\u00edcia Aparecida","family":"Caldeira","sequence":"additional","affiliation":[{"name":"Operational Technical Nucleus, Microbiology, Hermes Pardini Institute. Av. das Na\u00e7\u00f5es, 3801 - Parque Jardim Ita\u00fa, Minas Gerais, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9587-4859","authenticated-orcid":false,"given":"Carmem Dolores","family":"Faria","sequence":"additional","affiliation":[{"name":"Bacterial and Fungal Diseases Service, Ezequiel Dias Foundation, Belo Horizonte, Minas Gerais, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5975-1165","authenticated-orcid":false,"given":"S\u00e9rgio","family":"Bokermann","sequence":"additional","affiliation":[{"name":"Center of Bacteriology, Adolfo Lutz Institute, Secretary of Health of the State of S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6933-8961","authenticated-orcid":false,"given":"Lincoln Oliveira","family":"Sant\u2019Anna","sequence":"additional","affiliation":[{"name":"Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, The Collaborating Center for Reference and Research on Diphtheria, National Health Foundation, Ministry of Health, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5303-6395","authenticated-orcid":false,"given":"Louisy Sanches","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, The Collaborating Center for Reference and Research on Diphtheria, National Health Foundation, Ministry of Health, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2522-0416","authenticated-orcid":false,"given":"Ana Lu\u00edza","family":"Mattos-Guaraldi","sequence":"additional","affiliation":[{"name":"Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences, Rio de Janeiro State University, The Collaborating Center for Reference and Research on Diphtheria, National Health Foundation, Ministry of Health, Rio de Janeiro, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"345","reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1802.110987"},{"year":"2021","key":"R2","article-title":"Immunization, vaccines and biologicals. vaccine preventable diseases vaccines monitoring system 2020 global summary reference time series: Diphtheria"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1590\/s0074-02762003000800001"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1590\/s0034-89102011000600021"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762008000400014"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1590\/S1517-83822001000300015"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268814001241"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.3201\/eid1003.030524"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.14745\/ccdr.v45i11a04"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00362-11"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1155\/1995\/646325"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2019.24.2.1800683"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1590\/S0100-879X2008001100007"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.012161-0"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000362"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1099\/mic.0.000020"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.2217\/fmb-2016-0085"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1007\/s10482-019-01240-4"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762008000500019"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1099\/acmi.ac2019.po0110"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-4675-y"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2014.05.006"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1590\/S0074-02762013000300003"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.2008\/000414-0"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/45.4_ts.493"},{"year":"2018","key":"R26","article-title":"Orienta\u00e7\u00f5es do EUCAST para a detec\u00e7\u00e3o de mecanismos de resist\u00eancia e resist\u00eancias espec\u00edficas de import\u00e2ncia cl\u00ednica e\/ou epidemiol\u00f3gica. 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