Hedgehog with ulcers on their legs caused by the bacterium C. ulcerans



On January 2nd a male hedgehog (Erinaceus europaeus) was found in Limburg. The animal was in poor condition and therefore euthanized, after which it was sent to DWHC for examination.

The hedgehog had little muscle and no fat reserves. The animal had very extensive skin ulcers on their legs, and pneumonia due to a worm infection. The combination of pneumonia and skin ulcers causes difficulty eating and a poorer appetite. This explains the emaciation of this hedgehog.

What was very noticeable were the animal’s legs: the skin was red, thickened, and had ulcers (see picture). Using bacteriological research, the presence of Corynebacterium ulcerans (C. ulcerans) was determined. This bacterium secretes a toxin (exotoxin) that damages tissues and belongs to the same family as the C. diphtheriae bacterium. The site of infection, where the toxins are produced, affects the type of symptoms you will find. Infection around the respiratory tract can cause difficulty breathing or eating, while infection of the skin can cause ulcers. In this hedgehog, the bacteria was found in the paws where it led to ulcers.

Hedgehog with ulcers on their legs caused by C. ulcerans. Photo: DWHC

C. ulcerans is found in several wild mammal species, including hedgehogs (1,2), wild boar, and deer (3). The bacteria is also found in kept mammals, such as cats, dogs, horses, cattle, and pigs (4-8).

C. ulcerans in humans

C. ulcerans is a zoonosis and, like C. diphtheriae, can produce an exotoxin that causes diphtheria in humans. This can cause damage to tissues where the bacteria are present, such as the skin or lungs. As far as is known, humans do not transmit the bacteria C. ulcerans through human-to-human contact (9).

References


1. Eisenberg, T., Kutzer, P., Peters, M., Sing, A., Matthias, C., & Rau, J. (2014). Nontoxigenic tox-bearing Corynebacterium ulcerans Infection among Game Animals, Germany. Emerging Infectious Diseases, 20(3), 448-452. http://dx.doi.org/10.3201/eid2003.130423

2. Berger, A., Dangel, A., Peters, M., Mühldorfer, K., Braune, S., Eisenberg, T., Szentiks, C.A., Rau, J., Konrad, R., Hörmansdorfer, S., Ackermann, N., & Sing, A. (2019). Tox-positive Corynebacterium ulcerans in hedgehogs, Germany. Emerging Microbes & Infections, 8(1), 211-217. https://doi.org/10.1080/22221751.2018.1562312

3. Martel, A., Boyen, F., Rau, J., Eisenberg, T., Sing, A., Berger, A., Chiers, K., Van Praet, S., Verbanck, S., Vervaeke, M., & Pasmans, F. (2021). Widespread Disease in Hedgehogs (Erinaceus europaeus) Caused by Toxigenic Corynebacterium ulcerans. Emerging Infectious Diseases, 27(10), 2686-2690. http://dx.doi.org/10.3201/eid2710.203335

4. De Zoysa, A., Hawkey, P. M., Engler, K., George, R., Mann, G., Reilly, W., Taylor, D., & Efstratiou, A. (2005). Characterization of toxigenic Corynebacterium ulcerans strains isolated from humans and domestic cats in the United Kingdom. Journal of Clinical Microbiology, 43(9), 4377-4381. https://doi.org/10.1128/jcm.43.9.4377-4381.2005

5. Abbott, Y., Efstratiou, A., Brennan, G., Hallanan, S., Leggett, B., Leonard, F. C., Markey, B.K., Tuite, C., & Fry, N. K. (2020). Toxigenic Corynebacterium ulcerans associated with upper respiratory infections in cats and dogs. Journal of Small Animal Practice, 61(9), 554-560.  https://doi.org/10.1111/jsap.13185

6. Zendri, F., Isgren, C. M., Sinovich, M., Richards-Rios, P., Hopkins, K. L., Russell, K., Groves, N., Litt, D., Fry, N.K., & Timofte, D. (2021). Case report: Toxigenic Corynebacterium ulcerans diphtheria-like infection in a horse in the United Kingdom. Frontiers in Veterinary Science, 8, 650238. https://doi.org/10.3389/fvets.2021.650238

7. Hommez, J., Devriese, L. A., Vaneechoutte, M., Riegel, P., Butaye, P., & Haesebrouck, F. (1999). Identification of nonlipophilic corynebacteria isolated from dairy cows with mastitis. Journal of clinical microbiology, 37(4), 954-957. https://doi.org/10.1128/jcm.37.4.954-957.1999

8.  Schuhegger, R., Schoerner, C., Dlugaiczyk, J., Lichtenfeld, I., Trouillier, A., Zeller-Peronnet, V., Busch, U., Berger, A., Kugler, R., Hörmansdorfer, S., & Sing, A. (2009). Pigs as source for toxigenic Corynebacterium ulcerans. Emerging infectious diseases, 15(8), 1314. https://doi.org/10.3201/eid1508.081568

9. Rijksinstituut voor Volksgezondheid en Milieu. (z.d.). Infecties veroorzaakt door Corynebacterium ulcerans en andere zoönotische Corynebacterium species. Geraadpleegd op 12 februari 2025, van https://lci.rivm.nl/difterie-bijlage-c-ulcerans