Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017–2019

Details

• Alternative Title:
  J Infect Dis
• Personal Author:
  Weil, Lauren M. ; Williams, Margaret M. ; Shirin, Tahmina ; Lawrence, Marlon ; Habib, Zakir H. ; Aneke, Janessa S. ; Tondella, Maria L. ; Zaki, Quazi ; Cassiday, Pamela K. ; Lonsway, David ; Farrque, Mirza ; Hossen, Tanvir ; Feldstein, Leora R. ; Cook, Nicholas ; Maldonado-Quiles, Gladys ; Alam, Ahmed N. ; Muraduzzaman, A. K. M. ; Akram, Arifa ; Conklin, Laura ; Doan, Stephanie ; Friedman, Michael ; Acosta, Anna M. ; Hariri, Susan ; Fox, LeAnne M. ; Tiwari, Tejpratap S. P. ; Flora, Meerjady S.
• Description:
  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.
  
  
• Keywords:
  Corynebacterium Corynebacterium Diphtheriae Corynebacterium Pseudodiphtheriticum Diphtheria Diphtheria Outbreak Diphtheria Toxin Disease Outbreaks Humans Myanmar Real-Time Polymerase Chain Reaction
• Source:
  J Infect Dis. 224(2):318-325
• Pubmed ID:
  33245764
• Pubmed Central ID:
  PMC10846527
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  224
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:408fb31862e3766f4aca922885794aa8b6cdef0f7162f87e7883f524c893d75f
• Download URL:
  https://stacks.cdc.gov/view/cdc/147746/cdc_147746_DS1.pdf
• File Type:
  [PDF - 112.79 KB ]