Ongoing toxin-positive diphtheria outbreaks in a federal asylum centre in Switzerland, analysis July to September 2022

Kofler, Jacob; Ramette, Alban; Iseli, Patricia; Stauber, Lea; Fichtner, Jens; Droz, Sara; Berner, Annina Zihler; Meier, Anna Bettina; Begert, Michelle; Negri, Sabine; Jachmann, Anne; Keller, Peter M.; Staehelin, Cornelia; Grützmacher, Barbara

doi:10.2807/1560-7917.es.2022.27.44.2200811

Cited by 20 publications

(27 citation statements)

References 9 publications

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“…All isolates in Cluster 4 were phenotypically resistant to erythromycin and clindamycin. In line with the phenotypic results and recently published data from a similar cluster with ST-377 among migrants in Switzerland [ 6 ], our search for acquired resistance genes in Cluster 4 isolates found, among others, genes for resistance against macrolides/lincosamides and beta-lactams ( ermX , OXA-2 ) (data not shown).…”

Section: Laboratory Analysis and Phylogenysupporting

confidence: 88%

“…Analyses from pooled molecular data from different countries may also help narrow down where infections might have been acquired. In this respect, a study on diphtheria outbreaks in a Swiss asylum centre has just been published [ 6 ], with identification of a number of identical STs to our study. Moreover, active case finding is necessary, not only in Germany and other destination countries, but also in the main countries of origin and countries along the Balkan route.…”

Section: Discussionmentioning

confidence: 93%

“…Also, isolates from Austria matched with Clusters 1, 2, and 3, and an isolate from Norway matched with Cluster 1. Additionally, the molecular clock also indicates an origin abroad; in a recent publication of a similar outbreak situation in Switzerland, a molecular clock model of 1.67 × 10 − 6 substitutions per site and year [ 17 ] was used in a phylogeny based on single nucleotide polymorphism (SNP) to date back the occurrence of 1 SNP between two isolates to ≥ 6 weeks, 2 SNPs to 5 months and 5 SNPs to 1 year [ 6 ]. In our study, the phylogenetic relationship was analysed by cgMLST, based on AD, not SNPs, which have been shown to be within a similar range as the used cgMLST scheme [ 18 ], although they generally tend to be slightly smaller in numbers than corresponding SNP distances.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the phylogenetic relationship was analysed by cgMLST, based on AD, not SNPs, which have been shown to be within a similar range as the used cgMLST scheme [ 18 ], although they generally tend to be slightly smaller in numbers than corresponding SNP distances. Therefore, the model proposed in the Swiss study [ 6 ] can be used as an approximation. Maximum AD in Clusters 1, 2, 3, and 4 were 4, 5, 7, and 3, respectively, suggesting transmission events within the last year.…”

Section: Discussionmentioning

confidence: 99%

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Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022

Badenschier

Berger²,

Dangel³

et al. 2022

Eurosurveillance

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From July 2022, cases of imported diphtheria with toxigenic Corynebacterium diphtheriae remarkably increased among migrants arriving in Germany. Up to 30 September 2022, 44 cases have been reported to the national public health institute, all laboratory-confirmed, male, and mainly coming from Syria (n = 21) and Afghanistan (n = 17). Phylogeny and available journey information indicate that most cases (n = 19) were infected along the Balkan route. Active case finding, increased laboratory preparedness and epicentre localisation in countries along this route are important.

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Section: Laboratory Analysis and Phylogenysupporting

confidence: 88%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022

Badenschier

Berger²,

Dangel³

et al. 2022

Eurosurveillance

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“…In contrast, SL698 was absent from the global dataset. Of the 10 tox-positive France-2022 sublineages, five were associated with travel from Afghanistan, and were recently described in other European countries too (Kofler et al, 2022;Badenschier et al, 2022).…”

Section: Genomic Clusters Represent a Much Narrower Genetic Classific...mentioning

confidence: 93%

A globalCorynebacterium diphtheriaegenomic framework sheds light on current diphtheria reemergence

Hennart

Crestani

Bridel

et al. 2023

Preprint

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Background Diphtheria, caused by Corynebacterium diphtheriae, reemerges in Europe since 2022. Genomic sequencing can inform on transmission routes and genotypes of concern, but currently, no standard approach exists to detect clinically important genomic features and to interpret emergence in the global C. diphtheriae population framework. Methods We developed the bioinformatics pipeline DIPHTOSCAN (available at https://gitlab.pasteur.fr/BEBP/diphtoscan) to extract from genomes of Corynebacteria of the diphtheriae species complex, medically relevant features including tox gene presence and disruption. We analyzed 101 human C. diphtheriae isolates collected in 2022 in metropolitan and overseas France (France-2022). To define the population background of this emergence, we sequenced 379 additional isolates (mainly from France, 2018-2021) and collated 870 publicly-available genomes. Results The France-2022 isolates comprised 45 tox-positive (44 toxigenic) isolates, mostly imported, belonging to 10 sublineages (<500 distinct core genes). The global dataset comprised 245 sublineages and 33.9% tox-positive genomes, with DIPHTOSCAN predicting non-toxigenicity in 16.0% of these. 12% of the global isolates, and 43.6% of France-2022 ones, were multidrug resistant. Convergence of toxigenicity with penicillin and erythromycin resistance was observed in 2 isolates from France-2022. Phylogenetic lineages Gravis and Mitis contrasted strikingly in their pathogenicity-associated genes. Conclusions This work provides a bioinformatics tool and global population framework to analyze C. diphtheriae genomes, revealing important heterogeneities in virulence and resistance features. Emerging genotypes combining toxigenicity and first-line antimicrobial resistance represent novel threats. Genomic epidemiology studies of C. diphtheriae should be intensified globally to improve understanding of reemergence and spatial spread.

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Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 – October 2023

Zink,

Hofer,

Schneider

et al. 2024

Infection

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Objectives From September 2022 an increase in Corynebacterium diphtheriae (C. diphtheriae) infections was reported in Europe. Our study focuses on 31 adolescent and young adult refugees with cutaneous C. diphtheriae infections detected in Germany. We examined treatment regimens and outcomes to provide targeted insights into the management of this infection. Methods We distributed a standardized survey, focused on children and adolescents presenting to paediatric clinics through the German Paediatric Infectious Diseases Society (DGPI) and additional professional contacts in Germany. Data were extracted from routine medical documentation and reported anonymously. Results A total of 31 individuals with cutaneous C. diphtheriae infection were reported by 9 centres. Two of these showed diphtheria toxin (DT) related systemic symptoms and four exhibited systemic inflammation requiring complex management. The remaining 25 cases, with exclusively cutaneous manifestations, were afebrile. Treatment with topical antiseptics and systemic antibiotics, mainly aminopenicillin/beta-lactamase inhibitors (BLI) (35%) or clindamycin (25%), achieved eradication in all but two cases treated with aminopenicillin/BLI. Treatment duration varied between 5 and 17 days. Conclusions In refugees presenting with chronic skin wounds, C. diphtheriae should be included into the differential diagnosis. Fever seems to be a valuable marker to differentiate severe cases with potentially DT-mediated sequelae from exclusively cutaneous diphtheria (CD). For afebrile CD, topical antiseptics and oral antibiotic therapy with clindamycin for 7 days, followed by clinical surveillance appears to be a safe treatment regimen. Patients with CD who present with fever or pharyngitis should be thoroughly investigated including blood and pharyngeal swab cultures.

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Ongoing toxin-positive diphtheria outbreaks in a federal asylum centre in Switzerland, analysis July to September 2022

Cited by 20 publications

References 9 publications

Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022

Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022

A globalCorynebacterium diphtheriaegenomic framework sheds light on current diphtheria reemergence

Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 – October 2023

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