NOTES Cutaneous Diphtheria in the Urban Poor Population of Vancouver,

were reviewed. Cases were associated with injection drug use and poverty. Coinfections with Staphylococcus aureus, Streptococcus pyogenes, and Arcanobacterium haemolyticum occurred. Corynebacterium diphtheriae is endemic in Vancouver’s urban core, with strains of multilocus sequence type (MLST) 76 predominating. Corynebacterium diphtheriae is a reemerging pathogen (11). It is endemic in many developing countries and has been as-sociated with outbreaks in developed countries (19). Cutane-ous diphtheria is characterized by a chronic, nonhealing ulcer, often a source for persistent colonization (6). It has the poten-tial to cause systemic disease and may be an important reser-voir for ongoing transmission within a susceptible population (23). In Vancouver, Canada, a susceptible population exists in the “downtown eastside ” (DTES), which represents a poor inner-city community with high rates of injection drug use, HIV infection, and homelessness (3, 25, 28). Outbreaks of C. diph-theriae have been previously reported in this community (5, 23). Thus, a clinical, microbiological, and molecular review of cutaneous diphtheria patients presenting to St. Paul’s Hospital