A 5-year-old girl was brought to the emergency room at Evelina London Children’s Hospital with itchy, rather unsightly sores on both legs. She had recently returned from a weekslong trip to Sierra Leone, and the lesions, which first appeared three weeks into her stay there, had become larger and ulcerated.
Diagnosis: cutaneous diphtheria, a disease rarely seen in many industrialized countries, including Britain and the United States, where most children are protected by the diphtheria toxoid vaccine, DTaP, and a booster shot of the tetanus-diphtheria-pertussis vaccine, Tdap.
Still, as more and more Americans of all ages travel abroad, often to less developed areas, travelers and doctors in this country need to be alert to unusual and often perplexing skin infections. Even though cutaneous diphtheria is not a notifiable disease here, between September 2015 and March 2018, four cases were reported to the Centers for Disease Control and Prevention.
The patients, two from Minnesota and one each from Washington and New Mexico, had recently returned from Somalia, Ethiopia and the Philippines, respectively.
The C.D.C. noted in its weekly report in March that reported cases of this highly contagious infection had recently increased 10-fold, from an average of only three a year during the period 1998 to 2011, to 33 a year during 2012 to 2017. Still, the agency said, these numbers underestimate the true incidence of such infections. Although the four new cases were confined to the skin, the lesions can be a source of a life-threatening respiratory infection in people not adequately immunized against diphtheria.
Thus, everyone who might have had close contact with the patients needed to be checked, perhaps treated with antibiotics, and if they lacked immunity to diphtheria, immunized with diphtheria toxoid-containing vaccine.
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