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. 2021 Jul 15;224(2):318-325.
doi: 10.1093/infdis/jiaa729.

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

Lauren M Weil  1 , Margaret M Williams  2 , Tahmina Shirin  3 , Marlon Lawrence  4 , Zakir H Habib  3 , Janessa S Aneke  5 , Maria L Tondella  2 , Quazi Zaki  3 , Pamela K Cassiday  2 , David Lonsway  6 , Mirza Farrque  7 , Tanvir Hossen  7 , Leora R Feldstein  1 , Nicholas Cook  5 , Gladys Maldonado-Quiles  5 , Ahmed N Alam  3 , A K M Muraduzzaman  3 , Arifa Akram  3 , Laura Conklin  8 , Stephanie Doan  9 , Michael Friedman  9 , Anna M Acosta  2 , Susan Hariri  2 , LeAnne M Fox  2 , Tejpratap S P Tiwari  2 , Meerjady S Flora  3
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Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017-2019

Lauren M Weil et al. J Infect Dis. .

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.

Keywords: Corynebacterium diphtheriae; Corynebacterium pseudodiphtheriticum; diphtheria outbreak.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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