Evidence map›Paper›PMID 38381586›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2024

Cluster of Nontoxigenic Corynebacterium diphtheriae Infective Endocarditis and Rising Background C. diphtheriae Cases-Seattle, Washington, 2020-2023.

Ellora N Karmarkar, Thomas Fitzpatrick, Sarah T Himmelfarb, Eric J Chow, Hayden Z Smith, Kristine F Lan, Jason Matsumoto, Nicholas R Graff, Chas DeBolt, Thao Truong and 5 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
3.7field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 6 citations in OpenAlex.

  1. Epidemiology and Trends ofOpen forum infectious diseases · 2026
    Article
  2. Article
  3. Fulminant infective endocarditis with toxin-negativeEuro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025
    Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 3 institutions in 1 country.

Ellora N KarmarkarDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.ORCID 0000-0002-6657-0052
Thomas FitzpatrickDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Sarah T HimmelfarbDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Eric J ChowDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Hayden Z SmithDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Kristine F LanDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Jason MatsumotoDepartment of Laboratory Medicine and Pathology, University of Washington and Harborview Medical Center, Seattle, Washington, USA.
Nicholas R GraffOffice of Communicable Disease Epidemiology, Washington State Department of Health, Shoreline, Washington, USA.
Chas DeBoltCenter for Public Health Medical and Veterinary Science, Washington State Department of Health, Shoreline, Washington, USA.
Thao TruongDepartment of Laboratory Medicine and Pathology, University of Washington and Harborview Medical Center, Seattle, Washington, USA.
Lori BourassaDepartment of Laboratory Medicine and Pathology, University of Washington and Harborview Medical Center, Seattle, Washington, USA.
Carey FarquharDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Ferric C FangDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
H Nina KimDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Paul S PottingerDivision of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
University of Washington · USWashington State Department of Health · USPublic Health – Seattle & King County · US

Funding

VENEREAL DISEASET32AI007140 · NIAID · UNIVERSITY OF WASHINGTON · PI Julia Cook Dombrowski · 1985 to 2026
$19.4M
HOST DEFENSE TRAINING IN ALLERGY AND INFECTIOUS DISEASEST32AI007044 · NIAID · UNIVERSITY OF WASHINGTON · PI DAVID Neal FREDRICKS · 1985 to 2026
$14.6M
NIAID NIH HHS T32 AI007044NIAID NIH HHS T32 AI007140NIH HHS 5T32AI007140-45
6 · The paper itself

Abstract

backgroundNontoxigenic 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-positive cultures to determine if detections had increased over time and evaluated epidemiologic trends.

methodsWe conducted a formal electronic health record search to identify all patients aged ≥18 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.

resultsBetween 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae-positive 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-positive 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.

conclusionsFindings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.

Indexed as

Corynebacterium diphtheriaeDiphtheriaAdultAgedAnti-Bacterial AgentsEndocarditisEndocarditis, BacterialFemaleHumansMaleMiddle AgedWashingtonYoung AdultAnti-Bacterial AgentsCorynebacterium diphtheriaeendocarditisepidemiologyoutbreakpersons experiencing homelessnessskin and soft tissue infectionsubstance use

Identifiers

PMID38381586
PMCPMC11093663
OpenAlexW4391993957

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.