Changes in MLST profiles and biotypes of Corynebacterium diphtheriae isolates from the diphtheria outbreak period to the period of invasive infections caused by nontoxigenic strains in Poland (1950–2016)

Czajka, Urszula; Wiatrzyk, Aldona; Mosiej, Ewa; Formińska, Kamila; Zasada, Aleksandra Anna

doi:10.1186/s12879-018-3020-1

Cited by 25 publications

(10 citation statements)

References 22 publications

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“…Mitis biotypes were predominant in this study, similar to several results from France, [39], Algeria, [40], Malaysia, [41], Brazil, [3], United Kingdom, [15], and previous studies in Indonesia [42, 43]. In Poland and another study in United Kingdom, the majority of the biotypes were gravis [4, 44]. Gravis biotypes in Vietnam and Algeria caused more severe clinical forms [5, 40].…”

Section: Discussionsupporting

confidence: 90%

First-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae in Indonesia

et al. 2019

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BackgroundDiphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates.MethodsThis descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard.ResultsFrom 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1–14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range, < 0.016 to 2 μg/L) and for erythromycin (MIC range, < 0.016 to > 256 μg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 μg/L, while for both azithromycin and clarithromycin were < 0.016 to > 256 μg/L.ConclusionThe susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed.

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Section: Discussionsupporting

confidence: 90%

First-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae in Indonesia

et al. 2019

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“…In this outbreak, a high proportion of adults were affected, potentially due to disruption of health services resulting in poor vaccine coverage (114, 115) and reduced “natural” exposure over the preceding decades, resulting in antibody titers below protective levels (116–118). In recent years, multiple outbreaks, or potential transmission clusters have been reported in: Bangladesh (119, 120), Brazil (121), Colombia (122), Germany (30, 35), India (123–125), Indonesia (126), Laos (127), Norway (128), Nigeria (129), Poland (130), Spain (38), South Africa (36, 131), Syria (132), Switzerland (31), Thailand (114), the United Kingdom (37), Venezuela (133, 134), and Yemen (135). The global list of affected countries indicates that (i) the disease is remains poorly controlled, (ii) the main burden lies in low-income countries, and (iii) local and global surveillance should be intensified in order to better control the disease.…”

Section: The Return Of An Old Foementioning

confidence: 99%

Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings

Seth-Smith

Egli

2019

Front. Public Health

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Corynebacterium diphtheriae ( C. diphtheriae ) is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by Corynebacterium ulcerans and Corynebacterium pseudotuberculosis . Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic C. diphtheriae diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of C. diphtheriae and share our own experience with the coordination of a Swiss-German outbreak.

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“…There is the potential for in situ phage conversion of tox -negative strains, even though it was never proven. Even without converting to toxigenicity, some nontoxigenic C. diphtheriae strains can also cause severe disease in both vaccinated and unvaccinated patients, with a mortality rate of up to 40% ( 12 , 13 ). Therefore, even in countries with high vaccination coverage, close monitoring of C. diphtheriae is still necessary.…”

Section: Introductionmentioning

confidence: 99%

Assessing the Genetic Diversity of Austrian Corynebacterium diphtheriae Clinical Isolates, 2011 to 2019

et al. 2021

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Background: Diphtheria is a vaccine preventable disease with a high potential for re-emergence. One of its causative agent is Corynebacterium diphtheriae, some strains producing the diphtheria toxin. From 2011 to 2019, 57 clinical C. diphtheriae strains were isolated in Austria, either from the respiratory track or from skin infections. Objectives: The aim of the study was to investigate the genetic diversity of these C. diphtheriae isolates using whole genome sequencing. Methods: Isolates were characterized by genome wide comparison using single nucleotide polymorphism or core genome multilocus sequence typing, and by searching sequence data for antimicrobial resistance genes and genes involved in diphtheria toxin production. Results: Genetic diversity between the isolates was high, with no clear distribution over time or place. C. belfantii isolates were separated from other strains, and were strongly associated with respiratory infections (OR = 57). Two clusters, limited in time and space, were identified. Almost 40% of strains carried resistance genes against tetracycline or sulfonamides, mostly from skin infections. Microbiological tests showed that 55% of isolates were resistant to penicillin, but did not carry genes conferring β-lactam resistance. Diphtheria toxin gene with no non-synonymous mutation was found in three isolates only. Conclusion: This study showed that sequencing can provide valuable information complementing routine microbiological and epidemiological investigations. It allowed us to identify unknown clusters, evaluate antimicrobial resistances more broadly and support toxigenicity results obtained by PCR. For these reasons, C. diphtheriae surveillance could strongly benefit from the routine implementation of whole genome sequencing.

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Changes in MLST profiles and biotypes of Corynebacterium diphtheriae isolates from the diphtheria outbreak period to the period of invasive infections caused by nontoxigenic strains in Poland (1950–2016)

Cited by 25 publications

References 22 publications

First-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae in Indonesia

First-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae in Indonesia

Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings

Assessing the Genetic Diversity of Austrian Corynebacterium diphtheriae Clinical Isolates, 2011 to 2019

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