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Corynebacterium ulcerans in ferrets.

To the Editor: Infection with Corynebacterium ulcerans occurs sporadically throughout the world, and in the United Kingdom it has emerged as the most common cause of diphtheria-like disease (1). C. ulcerans, along with C. diphtheriae and C. pseudotuberculosis, can be lysogenized by diphtheria toxin-encoding bacteriophages; this process enables the organism to induce its characteristic sequela (the diphtheritic membrane) in the host. C. ulcerans in the environment has been a source of mastitis in cattle and a cause of diphtheria in humans who consume unpasteurized, contaminated milk. The organism has been isolated from various domestic, wild, and laboratory animals; additional definitive sources are dogs, cats, and pigs (2). C. ulcerans has been isolated from bonnet macaques with mastitis and from the cephalic implants of purpose-bred macaques used in cognitive neuroscience experiments (3,4). We report isolation of C. ulcerans from cephalic implants in 4 ferrets (Mustela putorius furo) and the oropharynx of 1 ferret, all used in imaging experiments in Massachusetts, USA, during 2007-2008.

All ferrets described here were purpose-bred, domestic ferrets, purchased from a commercial vendor. The index case occurred in a ferret with a cephalic implant. Microbiological culture of a purulent discharge from the implant margin yielded a polymicrobial infection that included an organism identified as C. ulcerans by the API Coryne strip system (bio-Merieux, Durham, NC, USA) (Table). This isolate and additional isolates from mixed infections of the implants of 3 other ferrets were subsequently identified as C. ulcerans by our diagnostic laboratory (Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA) and by the Centers for Disease Control and Prevention (Atlanta, GA, USA) by use of the API Coryne strip system. The oropharyngeal isolate was originally identified by our laboratory as C. pseudotuberculosis (99.5%); the same test performed at the Centers for Disease Control and Prevention yielded ambiguous results (C. ulcerans [87.3%] and C. pseudotuberculosis [12.5%]).

Three isolates (2 implant isolates and the oropharyngeal isolate) were subsequently characterized by MALDI-TOF-MS (matrix-assisted laser desorption-ionization time-of-flight mass spectroscopy) Bruker Dalton ics, Fremont, CA, USA) and by 16S rRNA sequencing (5) and partial rpoB (6) gene sequencing (Table). The conserved primers C2700F and C3130R from the rpoB gene were used to amplify the PCR products (6). All were confirmed to be C. ulcerans. The presence of toxin genes for diphtheria toxin (tox) (7) and phospholipase D (pld) (3) were evaluated by PCR. Diphtheria toxin production was evaluated by a modified Elek test (4). None of the isolates produced diphtheria toxin or contained the diphtheria toxin gene; all isolates were phospholipase-D positive for the 720-bp product.

To determine the source of the isolates, we tested the ferret isolates along with 3 select isolates from our macaque colony by BOX PCR and random amplified polymorphic DNA analysis. Neither type of analysis of the ferret and macaque C. ulcerans strains identified any common patterns (data not shown). Ferrets and macaques were housed in separate rooms in the same vivarium; animal care technicians were dedicated to 1 of the 2 species during any particular month. The prevalence of C. ulcerans in our macaque population and the precedence of its isolation from those animals more than a decade ago strongly suggests that the isolates are of macaque origin (3,4). More exhaustive comparison of the ferret isolates with archived macaque isolates might provide a match. The possibility also exists that newly acquired ferrets arrived infected with C. ulcerans or contracted it from an animal technician, veterinarian, or researcher. These possible sources of C. ulcerans infection have not been investigated.

An organism recently isolated from the lung, liver, and kidney tissue of a ferret that died of sepsis has been designated as a novel species, C. mustelae (8). C. mustelae is 96.78% related to C. ulcerans in 16S rRNA gene sequence similarity and is the first member of the genus to be implicated in disease of ferrets. C. ulcerans must now also be considered a potential pathogen of ferrets, although the mixed nature of these implant infections precludes definitive etiologic statements. Implant infection and oropharyngeal carriage in ferrets potentially represent additional zoonotic sources of this organism, underscoring the need for accurate and complete characterization of coryneform bacteria. Notably, the API Coryne test was unable to definitively identify the oropharyngeal isolate, a result reported by our group for other studies and by other investigators (4). The results of additional characterization modalities were all concordant. The C. ulcerans isolates from this study were nontoxigenic, and their potential for causing classical diphtheria is unlikely (Table). In contrast, a non-diphtheria toxin-producing C. ulcerans skin infection mimicking cutaneous diphtheria in a 29-year-old man was recently reported (9). Although the source of C. ulcerans was not definitively determined, nontoxigenic C. ulcerans was later isolated from the oral cavity of the patient's pet cat. Identity of these 2 isolates was not confirmed by molecular identification techniques (9). In another case, strain identity was established between a toxigenic isolate cultured from a woman with clinical diphtheria and the same organism cultured from her asymptomatic cat (2). Toxigenic and nontoxigenic isolates of C. diphtheriae have been reported to cause the cutaneous form of this disease (10).

Robert P. Marini, Pamela K. Cassiday, Jaime Venezia, Zeli Shen, Ellen M. Buckley, Yaicha Peters, Nancy Taylor, Floyd E. Dewhirst, Maria L. Tondella, and James G. Fox

Author affiliations: Massachusetts Institute of Technology, Cambridge, Massachusetts, USA (R.P. Marini, J. Venezia, Z. Shen, E.M. Buckley, Y. Peters, N. Taylor, J.G. Fox); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P.K. Cassiday, M.L. Tondella); The Forsyth Institute, Cambridge (F.E. Dewhirst); and Harvard School of Dental Medicine, Boston, Massachusetts, USA (F.E. Dewhirst)



(1.) Wagner KS, White JM, Crowcroft NS, De Martin S, Mann G, Efstratiou A. Diphtheria in the United Kingdom, 1986-2008: the increasing role of Corynebacterium ulcerans. Epidemiol Infect. 2010; 138:1519-30. S0950268810001895

(2.) Berger A, Huber I, Merbecks S-S, Konrad R, Hormansdorfer S, Hogardt M, et al. Toxigenic Corynebacterium ulcerans in woman and cat. Emerg Infect Dis. 2011;17:1767-9. http://dx.doi. org/10.3201/eid1709.110391

(3.) Bergin IL, Chien C-C, Marini RP, Fox JG. Isolation and characterization of Corynebacterium ulcerans from cephalic implants in macaques. Comp Med. 2000;50:530-5.

(4.) Venezia J, Cassiday PK, Marini RP, Shen Z, Buckley EM, Peters Y, et al. Characterization of Corynebacterium species in macaques. J Med Microbiol. 2012;61:1401-8. jmm.0.045377-0

(5.) Dewhirst FE, Chen T, Izard J, Paster BJ, Tanner ACR, Yu W-H, et al. The human oral microbiome. J Bacteriol. 2010;192:5002-17. 1128/JB.00542-10

(6.) Khamis A, Raoult D, La Scola B. rpoB gene sequencing for identification of Corynebacterium species. J Clin Microbiol. 2004;42:3925-31. 1128/JCM.42.9.3925-3931.2004

(7.) Schuhegger R, Lindermayer M, Kugler R, Heesemann J, Busch U, Sing A. Detection of toxigenic Corynebacterium diphtheriae and Corynebacterium ulcerans strains by a novel real-time PCR. J Clin Microbiol. 2008;46:2822-3. http://

(8.) Funke G, Frodi R, Bernard KA. Corynebacterium mustelae sp. nov., isolated from a ferret with lethal sepsis. Int J Syst Evol Microbiol. 2010;60:871-3. http://dx.doi. org/10.1099/ijs.0.010942-0

(9.) Corti MAM, Bloemberg GV, Borelli S, Kutzner H, Eich G, Hoelzle L, et al. Rare human skin infection with Coryne bacterium ulcerans: transmission by a domestic cat. Infection. 2012;40:575-8. 0254-5

(10.) Gordon CL, Fagan P, Hennessy J, Baird R. Characterization of Corynebacterium diphtheriae isolates from infected skin lesions in the Northern Territory of Australia. J Clin Microbiol. 2011;49:3960-2.

Address for correspondence: James G. Fox, Massachusetts Institute of Technology, Division of Comparative Medicine, Building 16-825C, 77 Massachusetts Ave, Cambridge, MA 02139, USA; email:
Table. Identification of Corynebacterium ulcerans strains isolated from
ferrets *

accession   CDC API               CDC interpretation
no.         code                  (confidence limit, %)

07-3331     0101326               C. ulcerans (87.3), C.
              ([double dagger])   pseudotuberculosis (12.5)
08-0584     0111326               C. ulcerans (99.7)

07-3276     0111326               C. ulcerans (99.7)

                                              16S rRNA
MIT                                           (confidence limit, %),
accession   Isolate      CDC MALDI-TOF-MS     GenBank accession
no.         source       (score) ([dagger])   no.

07-3331     Oropharynx   C. ulcerans (2.13)   C. ulcerans (99.5)
08-0584     Cephalic     C. ulcerans (2.35)   C. ulcerans (99.5)
            implant                           KF564647
07-3276     Cephalic     C. ulcerans (2.24)   C. ulcerans (99.7)
            implant                           KF564645

MIT         (confidence limit, %),
accession   GenBank accession
no.         no.

07-3331     C. ulcerans (99.5)
08-0584     C. ulcerans (99.5)
07-3276     C. ulcerans (99.5)

* Identification was performed by use of the API Coryne strip system
(bioMerieux, Durham, NC, USA), MALDI-TOF-MS (matrix-assisted laser
desorption-ionization time-of-flight mass spectroscopy) (Bruker
Daltonics; Fremont, CA, USA), and gene sequencing. Percentages after
the API identification refer to confidence limits. Percentages after
the gene sequencing results refer to percentage identities with a
reference strain (4). MIT, Massachusetts Institute of Technology; CDC,
Centers for Disease Control and Prevention.

([dagger]) 2.000-2.299, secure genus identification, probable species
identification; 2.300-3.000, highly probable species identification

([double dagger]) The API code generated at MIT was 0101320,
interpreted as C. pseudotuberculosis (99.5%).
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Title Annotation:LETTERS
Author:Marini, Robert P.; Cassiday, Pamela K.; Venezia, Jaime; Shen, Zeli; Buckley, Ellen M.; Peters, Yaich
Publication:Emerging Infectious Diseases
Article Type:Letter to the editor
Geographic Code:1USA
Date:Jan 1, 2014
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