1. Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017-2019
- Author
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Gladys Maldonado-Quiles, Meerjady Sabrina Flora, Arifa Akram, Nicholas Cook, Tanvir Hossen, Janessa S. Aneke, Michael Friedman, Margaret M. Williams, Ahmed Nawsher Alam, Zakir Hossain Habib, David Lonsway, Tahmina Shirin, Marlon Lawrence, Lauren M Weil, Quazi Ahmed Zaki, LeAnne M. Fox, Anna M Acosta, Leora R. Feldstein, Susan Hariri, Stephanie Doan, Mirza Farrque, Laura Conklin, A. K. M. Muraduzzaman, Tejpratap S P Tiwari, Maria Lucia Tondella, and Pamela K. Cassiday
- Subjects
0301 basic medicine ,medicine.medical_specialty ,030106 microbiology ,Corynebacterium ,Severe disease ,Myanmar ,Real-Time Polymerase Chain Reaction ,Microbiology ,Disease Outbreaks ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,Clinical information ,medicine ,Immunology and Allergy ,Humans ,Diphtheria Toxin ,030212 general & internal medicine ,Corynebacterium diphtheriae ,biology ,business.industry ,Diphtheria ,Outbreak ,biology.organism_classification ,medicine.disease ,Infectious Diseases ,business ,Corynebacterium pseudodiphtheriticum - Abstract
Background Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh. Methods Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation. Results Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum. Conclusions We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.
- Published
- 2020