Pequignot, B., Barraud, D., Stephan, C. et al.<\/em><\/h3>\n\n\n\nIntensive Care Med<\/em> (2026). https:\/\/doi.org\/10.1007\/s00134-026-08484-5<\/h3>\n\n\n\n![\"\"\/](\"https:\/\/media.springernature.com\/lw685\/springer-static\/image\/art%3A10.1007%2Fs00134-026-08484-5\/MediaObjects\/134_2026_8484_Figa_HTML.png?as=webp\")
<\/figure>\n\n\n\n\n- Unusual pathogens matter:<\/strong> Corynebacterium<\/em> spp., including Corynebacterium diphtheriae<\/em>, can cause invasive infections beyond classical diphtheria, including bacteremia and prosthetic infections. Recent epidemiological and clinical studies report a resurgence of diphtheria in the European Union, with a notable increase in cutaneous forms. Toxin-producing strains may lead to severe systemic complications. In suspected toxigenic forms, early administration of diphtheria antitoxin is crucial.<\/li>\n\n\n\n
- Microbiological clues are essential:<\/strong> Gram-positive bacilli isolated from blood cultures should not automatically be dismissed as contaminants. Irregular, club-shaped organisms arranged in palisades or \u201cChinese letter\u201d formations should prompt consideration of Corynebacterium<\/em> spp. Definitive species identification requires dedicated microbiological methods, including MALDI-TOF mass spectrometry, while additional toxin testing may be required in suspected toxigenic strains (Fig. 1<\/a>).<\/li>\n\n\n\n
- Think beyond the valves:<\/strong> Infection may involve prosthetic conduits or vascular grafts, not only native or prosthetic valves<\/li>\n\n\n\n
- Imaging pitfalls:<\/strong>\n
\n- TOE may be limited in assessing extracardiac prosthetic material<\/li>\n\n\n\n
- 18F-FDG PET\/CT can be a useful adjunct imaging modality<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- ARDS can be misleading:<\/strong> Severe respiratory failure may reflect systemic sepsis rather than primary pulmonary infection alone.<\/li>\n\n\n\n
- Management implications:<\/strong> Appropriate antimicrobial therapy (e.g., amoxicillin; linezolid in suspected toxin-producing strains), multidisciplinary evaluation, and careful assessment of potential prosthetic involvement<\/li>\n<\/ul>\n\n\n\n
![\"\"\/](\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-026-08484-5\/MediaObjects\/134_2026_8484_Fig1_HTML.jpg?as=webp\")
<\/figure>\n\n\n\nA<\/strong> 18F-FDG PET\/CT Maximum intensity projection image demonstrating intense focal hypermetabolism along the RV\u2013PA prosthetic, without evidence of other hypermetabolic. B<\/strong> Blood culture gram staining revealing Gram-positive bacilli with characteristic irregular, club-shaped morphology arranged in palisades (\u201cChinese letters\u201d appearance) suggestive of Corynebacterium<\/em> spp. C<\/strong> Fused PET\/CT axial image shows increased 18F-FDG uptake surrounding the prosthetic material, with elevated standardized uptake values, consistent with prosthetic infection<\/p>\n","protected":false},"excerpt":{"rendered":"Article A misleading acute respiratory failure: when in […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[16,13],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31068"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31068"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31068\/revisions"}],"predecessor-version":[{"id":31072,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31068\/revisions\/31072"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31068"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31068"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31068"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
<\/figure>\n\n\n\n- \n
- Unusual pathogens matter:<\/strong> Corynebacterium<\/em> spp., including Corynebacterium diphtheriae<\/em>, can cause invasive infections beyond classical diphtheria, including bacteremia and prosthetic infections. Recent epidemiological and clinical studies report a resurgence of diphtheria in the European Union, with a notable increase in cutaneous forms. Toxin-producing strains may lead to severe systemic complications. In suspected toxigenic forms, early administration of diphtheria antitoxin is crucial.<\/li>\n\n\n\n
- Microbiological clues are essential:<\/strong> Gram-positive bacilli isolated from blood cultures should not automatically be dismissed as contaminants. Irregular, club-shaped organisms arranged in palisades or \u201cChinese letter\u201d formations should prompt consideration of Corynebacterium<\/em> spp. Definitive species identification requires dedicated microbiological methods, including MALDI-TOF mass spectrometry, while additional toxin testing may be required in suspected toxigenic strains (Fig. 1<\/a>).<\/li>\n\n\n\n
- Think beyond the valves:<\/strong> Infection may involve prosthetic conduits or vascular grafts, not only native or prosthetic valves<\/li>\n\n\n\n
- Imaging pitfalls:<\/strong>\n
- \n
- TOE may be limited in assessing extracardiac prosthetic material<\/li>\n\n\n\n
- 18F-FDG PET\/CT can be a useful adjunct imaging modality<\/li>\n<\/ul>\n<\/li>\n\n\n\n
- ARDS can be misleading:<\/strong> Severe respiratory failure may reflect systemic sepsis rather than primary pulmonary infection alone.<\/li>\n\n\n\n
- Management implications:<\/strong> Appropriate antimicrobial therapy (e.g., amoxicillin; linezolid in suspected toxin-producing strains), multidisciplinary evaluation, and careful assessment of potential prosthetic involvement<\/li>\n<\/ul>\n\n\n\n
<\/figure>\n\n\n\nA<\/strong> 18F-FDG PET\/CT Maximum intensity projection image demonstrating intense focal hypermetabolism along the RV\u2013PA prosthetic, without evidence of other hypermetabolic. B<\/strong> Blood culture gram staining revealing Gram-positive bacilli with characteristic irregular, club-shaped morphology arranged in palisades (\u201cChinese letters\u201d appearance) suggestive of Corynebacterium<\/em> spp. C<\/strong> Fused PET\/CT axial image shows increased 18F-FDG uptake surrounding the prosthetic material, with elevated standardized uptake values, consistent with prosthetic infection<\/p>\n","protected":false},"excerpt":{"rendered":"
Article A misleading acute respiratory failure: when in […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[16,13],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31068"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31068"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31068\/revisions"}],"predecessor-version":[{"id":31072,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31068\/revisions\/31072"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31068"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31068"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31068"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- Management implications:<\/strong> Appropriate antimicrobial therapy (e.g., amoxicillin; linezolid in suspected toxin-producing strains), multidisciplinary evaluation, and careful assessment of potential prosthetic involvement<\/li>\n<\/ul>\n\n\n\n
- Microbiological clues are essential:<\/strong> Gram-positive bacilli isolated from blood cultures should not automatically be dismissed as contaminants. Irregular, club-shaped organisms arranged in palisades or \u201cChinese letter\u201d formations should prompt consideration of Corynebacterium<\/em> spp. Definitive species identification requires dedicated microbiological methods, including MALDI-TOF mass spectrometry, while additional toxin testing may be required in suspected toxigenic strains (Fig. 1<\/a>).<\/li>\n\n\n\n