Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 2.
doi: 10.1007/s15010-025-02522-y. Online ahead of print.

A case of fatal respiratory diphtheria imported from Poland to Germany: possible link to an undetected imported diphtheria cluster in Poland?

Anja Berger #  1   2   3   4 , Aleksandra A Zasada #  5 , Alexandra Dangel #  3   6 , Katarzyna Piekarska  7 , Iwona Paradowska-Stankiewicz  8 , Katja Bengs  3 , Christine Noll  9 , Andreas Sing  10   11   12   13
Affiliations

A case of fatal respiratory diphtheria imported from Poland to Germany: possible link to an undetected imported diphtheria cluster in Poland?

Anja Berger et al. Infection. .

Abstract

Purpose: Diphtheria is a re-emerging vaccine-preventable disease, mainly caused by toxigenic Corynebacterium diphtheriae.

Methods: Here, we report a fatal respiratory diphtheria infection in a Polish woman travelling to Germany possibly linked to a cutaneous diphtheria infection in a homeless man living in the same geographic area. Laboratory diagnostics involving MALDI-TOF MS, tox-gene PCR, Lateral Flow Immuno Assay, a modified Elek test and Next Generation Sequencing (NGS) identified the causative strain as cotrimoxazole-resistant toxigenic Corynebacterium diphtheriae biotype mitis, sequence type ST574. Moreover, a review on the diphtheria situation in Poland is presented.

Results: NGS data suggest a common source of infection in Poland and a possible link to the Europe-wide outbreak of imported diphtheria with C. diphtheriae since 2022. This is the first diphtheria case in Poland since 2000.

Keywords: Corynebacterium diphtheriae; Diphtheria; MLST; NGS; Outbreak; Toxigenic; WGS.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical approval: Ethical approval was not necessary for this study as it was performed as part of routine surveillance activities, outbreak investigation and diphtheria diagnostics in Germany and Poland. Consent to participate: Not applicable. Consent to publish: Not applicable. Competing interests: The authors declare no competing interests.

References

    1. Truelove SA, Keegan LT, Moss WJ, Chaisson LH, Macher E, Azman AS, et al. Clinical and epidemiological aspects of diphtheria: a systematic review and pooled analysis. Clin Infect Dis. 2020;71:89–97. - PubMed
    1. Pan´stwowy Zakład, Higieny. Instytut Naukowo-Badawczy – Zakład Epidemiologii; Główny Inspektorat Sanitarny – Departament Przeciwepidemiczny i Os´wiaty Zdrowotnej (National Institute of Hygiene, National Research Center of Public Health – Department of Epidemiology; Chief Sanitary Inspectorate – Departament of Diseases Surveillance and Health Promotion). Choroby Zakaz´ne i Zatrucia w Polsce w 2000 Roku. (Infectious diseases and poisonings in Poland in 2000). [Accessed 18.03.2025]. Available from: https://wwwold.pzh.gov.pl/oldpage/epimeld/2000/Ch_2000.pdf ).
    1. Robert Koch-Institut. SurvStat@RKI 2.0. https://survstat.rki.de , accessed: 10.12.2024.
    1. Hoefer A, Seth-Smith H, Palma F, Schindler S, Freschi L, Dangel A et al. Phenotypic and genomic analysis of a large-scale Corynebacterium diphtheriae outbreak among migrant populations in Europe. [accessed 13.01.2025; available from: https://www.medrxiv.org/content/ https://doi.org/10.1101/2023.11.10.23297228v1.full.pdf)
    1. Badenschier F, Berger A, Dangel A, Sprenger A, Hobmaier B, Sievers C, et al. Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022. Euro Surveill. 2022;27(46):2200849. - PubMed - PMC

LinkOut - more resources