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

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 outbreak...

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Published in:The Journal of infectious diseases 2021-07, Vol.224 (2), p.318-325
Main Authors: 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
Format: Article
Language:English
Subjects:
Corynebacterium
Corynebacterium - isolation & purification
Corynebacterium diphtheriae - isolation & purification
Diphtheria
Diphtheria - epidemiology
Diphtheria Toxin
Disease Outbreaks
Epidemics
Epidemiology
Humans
Laboratories
Myanmar - epidemiology
Outbreaks
Patients
Polymerase chain reaction
Real-Time Polymerase Chain Reaction
Respiratory diseases
Species
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Summary: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. We confirmed a large diphtheria outbreak among the forcibly displaced Myanmar nationals in Bangladesh and identified frequent cocirculation with azithromycin-resistant C. pseudodiphtheriticum among cases. Our investigation highlights the need to better understand the role of C. pseudodiphtheriticum as a pathogen.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiaa729