Evidence map›Paper›PMID 39190269›Full record

ArticleInfection2025

Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 - October 2023.

Alicia Zink, Juliana Hofer, Christian Schneider, Franziska Kessler, Hannes Klenze, Dietrich Klauwer, Klaudia Maleki, Andreas Müller, Sarah Goretzki, Shubei Wang and 12 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Infection, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
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

5 citing papers in PubMed.

  1. Observational
  2. Article
  3. Article
  4. Autochthonous outbreak of respiratory diphtheria caused byEuro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025
    Article
  5. 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

22 authors.

Alicia ZinkDivision for Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany.
Juliana HoferInstitute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany.
Christian SchneiderInstitute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany.
Franziska KesslerCentre for Child and Adolescent Health, Hegau-Bodensee Clinic Singen, Constance District Health Association, Singen, Germany.
Hannes KlenzeCentre for Child and Adolescent Health, Hegau-Bodensee Clinic Singen, Constance District Health Association, Singen, Germany.
Dietrich KlauwerCentre for Child and Adolescent Health, Hegau-Bodensee Clinic Singen, Constance District Health Association, Singen, Germany.
Klaudia MalekiDepartment of General Medicine and Health Services Research, Heidelberg University Hospital, Interdisciplinary Refugee Outpatient Clinic at the Patrick-Henry-Village State Initial Reception Centre, Heidelberg, Germany.
Andreas MüllerInitial Reception Centre of the State of Hesse, Giessen Regional Council, Giessen, Germany.
Sarah GoretzkiClinic for Paediatrics I, Essen University Hospital, Essen, Germany.
Shubei WangPediatrics 2: General and Special Pediatrics including Pediatric Infectious Diseases, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany.
Robin KobbeInstitute for Infection Research and Vaccine Development, University Medical Centre Hamburg- Eppendorf, Hamburg, Germany.
Andrea Vanegas RamirezBundeswehr Hospital Hamburg, Tropical Dermatology at the Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
Sebastian BodeDepartment of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm University, Ulm, Germany.
Ales JandaDepartment of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm University, Ulm, Germany.
Roland FresslePaediatric and Adolescent Practice Dr Roland Fressle, Freiburg, Germany.
Jonathan RemppisDepartment of Neuropaediatrics, General Paediatrics, Diabetology, Endocrinology, Social Paediatrics, University Children's Hospital Tübingen, Tübingen, Germany.
Philipp HennekeInstitute for Infection Prevention and Control, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Siegbert RiegDepartment of Medicine II, Division of Infectious Diseases, Medical Centre-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Anja BergerConsultant Laboratory for Diphtheria, WHO Collaborating Centre for Diphtheria, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.
Andreas SingConsultant Laboratory for Diphtheria, WHO Collaborating Centre for Diphtheria, Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.
Markus HufnagelDivision for Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany.
Benedikt D SpielbergerDivision for Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany. benedikt.spielberger@uniklinik-freiburg.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesFrom September 2022 an increase in Corynebacterium diphtheriae (C. diphtheriae) infections was reported in Europe. Our study focuses on 31 adolescent and young adult refugees with cutaneous C. diphtheriae infections detected in Germany. We examined treatment regimens and outcomes to provide targeted insights into the management of this infection.

methodsWe distributed a standardized survey, focused on children and adolescents presenting to paediatric clinics through the German Paediatric Infectious Diseases Society (DGPI) and additional professional contacts in Germany. Data were extracted from routine medical documentation and reported anonymously.

resultsA total of 31 individuals with cutaneous C. diphtheriae infection were reported by 9 centres. Two of these showed diphtheria toxin (DT) related systemic symptoms and four exhibited systemic inflammation requiring complex management. The remaining 25 cases, with exclusively cutaneous manifestations, were afebrile. Treatment with topical antiseptics and systemic antibiotics, mainly aminopenicillin/beta-lactamase inhibitors (BLI) (35%) or clindamycin (25%), achieved eradication in all but two cases treated with aminopenicillin/BLI. Treatment duration varied between 5 and 17 days.

conclusionsIn refugees presenting with chronic skin wounds, C. diphtheriae should be included into the differential diagnosis. Fever seems to be a valuable marker to differentiate severe cases with potentially DT-mediated sequelae from exclusively cutaneous diphtheria (CD). For afebrile CD, topical antiseptics and oral antibiotic therapy with clindamycin for 7 days, followed by clinical surveillance appears to be a safe treatment regimen. Patients with CD who present with fever or pharyngitis should be thoroughly investigated including blood and pharyngeal swab cultures.

Indexed as

DiphtheriaRefugeesSkin Diseases, BacterialAdolescentAdultAnti-Bacterial AgentsChildChild, PreschoolCorynebacterium diphtheriaeFemaleGermanyHumansMaleTreatment OutcomeYoung AdultAnti-Bacterial AgentsBalkan routeCutaneous diphtheriaDiphtheriaMinor refugeeThroat diphtheriaToxigenic C. diphtheriae

Identifiers

PMID39190269
PMCPMC11825593

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.