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Background: Toxigenic Corynebacterium ulcerans is an emerging zoonosis globally, causing both cutaneous and respiratory diphtheria-like illness. In Queensland, human infection with toxigenic C. ulcerans is rare, with only three cases reported before October 2015. This case series describes five subsequent cases of toxigenic C. ulcerans in Queensland with links to companion animals., Methods: All data were collected as part of routine public health response, and strains were whole genome sequenced for further characterisation. Household contacts were screened, treated with appropriate antibiotics, and received a diphtheria toxoid-containing vaccine if more than five years had elapsed since their last dose., Findings: No epidemiological or genomic links could be established between any of the five patients, including between the two cases notified from the same locality within eight days of each other. The C. ulcerans strains from Cases Two, Four and Five were closely related to the strains isolated from their respective pets by whole genome sequencing. Domestic dogs were identified as the most likely mode of transmission for Cases One and Three; however, this was unable to be laboratory confirmed, since Case One's dog was treated with antibiotics before it could be tested, and Case Three's dog was euthanised and cremated prior to case notification., Interpretation: These are the first reported Australian cases of this emerging zoonosis with links to companion animals. These cases demonstrate the likely transmission route between companion animals and humans, with no evidence of human-to-human transmission. The existing requirement in the Queensland Health Public Health Management Guidelines, of restrictions on cases and some contacts while awaiting swab results, is currently under review., (© Commonwealth of Australia CC BY-NC-ND)

Alternative postmortem inspection procedures for the detection of gross abnormalities due to Caseous Lymphadenitis (CLA) of sheep and goats were compared quantitatively against the current Australian Standard (AS4696). Studies on sheep and goats in Australia during 2016 addressed data gaps regarding current prevalence, combinations of multiple lesions within affected carcases and sensitivity of inspection procedures enabling a comparison of alternative with current procedures. Using these contemporary inspection data from 54 915 sheep and 48 577 goats a desktop study estimated the effect of implementing alternative procedures of reduced palpation from eleven carcase sites to the four sites most commonly affected. Under current procedures it was estimated that 86 sheep and 34 goat carcases with CLA lesions are missed per 10,000 carcases. Under alternative procedures it is estimated that an additional 48.4 sheep and 10.5 goat carcases with CLA lesions would be missed per 10 000 carcases. Of these, 38.2 sheep and 5.6 goat per 10 000 carcases would contain CLA only in routinely discarded, non-edible tissue sites. Hence, only an additional 10.2 sheep and 4.9 goat carcases per 10 000 inspected, with CLA in edible tissue sites are estimated to be missed. These alternative procedures have now been officially implemented in the Australian domestic standard., Competing Interests: Competing interests: None declared., (© British Veterinary Association 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Infection due to Corynebacterium species has been reported with increasing frequency over recent decades. The impacts of enhanced laboratory detection together with widespread use of new peritoneal dialysis (PD) connection technology and antimicrobial prophylaxis strategies on Corynebacterium PD-associated peritonitis have not been well studied., Methods: We investigated the frequency, predictors, treatment and clinical outcomes of Corynebacterium peritonitis in all Australian adult patients involving 66 centres who were receiving PD between 1 October 2003 and 31 December 2006., Results: Eighty-two episodes of Corynebacterium peritonitis (2.3% of all peritonitis episodes) occurred in 65 (1.4%) PD patients. Ten (15%) patients experienced more than one episode of Corynebacterium peritonitis and additional organisms were isolated in 12 (15%) episodes of Corynebacterium peritonitis. The incidence of Corynebacterium peritonitis was significantly and independently predicted only by BMI: RR 2.72 (95% CI 1.38-5.36) for the highest tertile BMI compared with the lowest tertile. The overall cure rate with antibiotics alone was 67%, which was similar to that of peritonitis due to other organisms. Vancomycin was the most common antimicrobial agent administered in the initial empiric and subsequent antibiotic regimens, although outcomes were similar regardless of antimicrobial schedule. Corynebacterium peritonitis not infrequently resulted in relapse (18%), repeat peritonitis (15%), hospitalization (70%), catheter removal (21%), permanent haemodialysis transfer (15%) and death (2%). The individuals who had their catheters removed more than 1 week after the onset of Corynebacterium peritonitis had a significantly higher risk of permanent haemodialysis transfer than those who had their catheters removed within 1 week (90% versus 43%, P < 0.05)., Conclusions: Corynebacterium is an uncommon but significant cause of PD-associated peritonitis. Complete cure with antibiotics alone is possible in the majority of patients, and rates of adverse outcomes are comparable to those seen with peritonitis due to other organisms. Use of vancomycin rather than cephazolin as empiric therapy does not impact outcomes, and a 2-week course of antibiotic therapy appears sufficient. If catheter removal is required, outcomes are improved by removing the catheter within 1 week of peritonitis onset.

Objective: To determine the prevalence and clonality of non-toxigenic Corynebacterium diphtheriae biovar gravis in a community with two cases of endocarditis caused by this organism., Setting: A Koorie (Aboriginal) community in Gippsland, eastern Victoria, in 1994., Methods: Nose and throat swabs were collected from 359 community contacts of the cases and cultured for C. diphtheriae. Strains isolated from the contacts were compared by pulsed-field gel electrophoresis (after digestion with Sma1, Not1 and Sfi1) with those from the invasive cases in the same community, another invasive case in Victoria, a cluster of invasive cases in New South Wales (NSW) (1990-1991), and other stored strains isolated from skin ulcers and sore throats., Results: Non-toxigenic strains of C. diphtheriae biovar gravis were isolated from throat swabs of five of the case contacts. Uniform DNA patterns were found for the two community cases, the other Victorian case, nine of ten isolates from NSW, and the five throat isolates from case contacts., Conclusion: An invasive clone of C. diphtheriae biovar gravis appears to have been responsible for the three Victorian cases of endocarditis. It was also present among case contacts and responsible for previous invasive cases in NSW. Prophylactic treatment should be considered for clearly defined contacts in all instances where C. diphtheriae is isolated from a normally sterile site, regardless of the toxigenic nature of the strain.

A total of 2,920 feral goats from pastoral areas of Western Australia were examined and the prevalence of caseous lymphadenitis was estimated to be 7.8 +/- 0.9% in goats presented for slaughter. Head, body and visceral lesions were present in 49.3%, 46.7% and 12.3% of affected goats, respectively. A comparison with previously reported data from sheep has been made and significant differences are discussed. Lung lesions were relatively uncommon in goats, whereas the distribution of carcase lesions was similar between the species. Multiple lesions appear to be less common in goats than in sheep.

A total of 8,711 sheep in 3 distinct age/sex groups were examined to determine for occurrence and extent of caseous lymphadenitis after slaughter at a major Western Australian abattoir. An adaptation of current mean inspection procedures to provide a numerical weighted evaluation according to number, site, and size of lesions was used to determine extent of involvement. Frequency in slaughter populations was estimated to be 3.4 +/- 0.6% for lambs, 41.8 +/- 3.9% for mixed-age rams, and 53.7 +/- 1.5% for adult ewes at 95% confidence intervals. The results confirmed that frequency increased with age, but also revealed increases in extent of involvement and occurrence of visceral lesions, particularly in association with lesions of the body. Nevertheless, lesions occurred more frequently in the body than in the viscera. However, the mean visceral involvement was greater than mean body involvement in all groups, and the ratio was found to be more or less constant. Visceral involvement was found to be more extensive in rams than in ewes. Difficulties associated with complexity of current inspection procedures were also recorded. The relevance of these findings to pathogenesis and postmortem disposition after slaughter is discussed. It is suggested that current postmortem inspection criteria should be reevaluated.

Two dairy goat stud herds were surveyed for Corynebacterium ovis infection by clinical examination and serum tests using both the haemolysis inhibition and double immunodiffusion techniques for detection of C. ovis antitoxin. In one herd, of 53 goats 11 had abscesses from which C. ovis was recorded; 33 and 29 goats were positive to the haemolysis inhibition and double immunodiffusion tests respectively. Serums from 10 and 9 of 23 kids gave reactions positive to the respective tests with 19 of 23 kids having been born to does with demonstrable antibody. In a second herd of 57 goats 16 had superficial abscesses containing C. ovis; serums from 34 and 45 goats gave positive reactions to the haemolysis inhibition and double immunodiffusion tests respectively. The prevalence of caseous lymphadenitis in these stud herds was a cause of economic loss to the owners through euthanasia of severely affected goats, reduced milk production and emaciation, the cost of labour and drugs for treatment, jeopardisation of income from boarding or mating with outside stock and the appearance of goats at stud shows, and sale of valuable breeding stock to local and export markets.