Diphtheria outbreak in Maranhão, Brazil: microbiological, clinical and epidemiological aspects

Abstract

We describe microbiological, clinical and epidemiological aspects of a diphtheria outbreak that occurred in Maranhão, Brazil. The majority of the 27 confirmed cases occurred in partially (n = 16) or completely (n = 10) immunized children (n = 26). Clinical signs and characteristic symptoms of diphtheria such as cervical lymphadenopathy and pseudomembrane formation were absent in 48% and 7% of the cases, respectively. Complications such as paralysis of lower limbs were observed. Three cases resulted in death, two of them in completely immunized children. Microbiological analysis identified the isolates as Corynebacterium diphtheriae biovar intermedius with a predominant PFGE type. Most of them were toxigenic and some showed a decrease in penicillin G susceptibility. In conclusion, diphtheria remains endemic in Brazil. Health professionals need to be aware of the possibility of atypical cases of C. diphtheriae infection, including pharyngitis without pseudomembrane formation.

An isolated outbreak of diphtheria in South Africa, 2015

“…The targeted vaccination campaign occurred in May and June, during epidemiological weeks 21-25. During the campaign, the four cases (cases [11][12][13][14] that were identified were not from the schools, or communities near the schools, that had been visited as part of the campaign. There were no further cases reported after the targeted vaccination campaign ended.…”

Genome-wide comparison of toxigenic and non-toxigenicCorynebacterium diphtheriaeisolates identifies differences in the pan genomes between respiratory and cutaneous strains

“…Antibiotic resistance in C. diphtheriae remains relatively uncommon, however, a recent report (25) found that C. diphtheriae isolates showed a decreased susceptibility to penicillin and resistance to tetracycline in Rio de Janeiro (25). Multidrug resistant isolates involved in cutaneous and respiratory diphtheria have also been described (26, 27).…”

Evolution, epidemiology and diversity of Corynebacterium diphtheriae : New perspectives on an old foe

“…A diphtheria epidemic in the former Soviet Union in the 1990s resulted in N 157.000 cases claiming~5000 lives (Dittmann et al, 2000). Yet, this pathogen is not under control, and the have been multiple outbreaks in different countries since 2000 including Colombia (Landazabal et al, 2001), India (Parande et al, 2014;Saikia et al, 2010), Norway (Rasmussen et al, 2011), Nigeria (Besa et al, 2014), Thailand (Wanlapakorn et al, 2014), and more recently in Brazil (Santos et al, 2015), Laos (Nanthavong et al, 2015) and Indonesia (Hughes et al, 2015).…”