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Khalili E, Lakzaei M, Aminian M. Neutralizing anti-diphtheria toxin scFv produced by phage display. Biotechnol Lett 2024; 46:385-398. [PMID: 38607601 DOI: 10.1007/s10529-024-03476-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 01/10/2024] [Accepted: 02/10/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Diphtheria can be prevented by vaccination, but some epidemics occur in several places, and diphtheria's threat is considerable. Administration of diphtheria antitoxin (DAT) produced from hyperimmunized animals is the most common treatment. Recombinant human antibody fragments such as single-chain variable fragments (scFv) produced by phage display library may introduce an interesting approach to overcome the limitations of the traditional antibody therapy. In the present study, B cells of immunized volunteers were used to construct a human single-chain fragment (HuscFv) library. MATERIALS AND METHODS The library was constructed with the maximum combination of heavy and light chains. As an antigen, Diphtheria toxoid (DTd) was used in four-round phage bio-panning to select phage clones that display DTd bound HuscFv from the library. After panning, individual scFv clones were selected. Clones that were able to detect DTd in an initial screening assay were transferred to Escherichia coli HB2151 to express the scFvs and purification was followed by Ni metal ion affinity chromatography. Toxin neutralization test was performed on Vero cells. The reactivity of the soluble scFv with diphtheria toxin were done and affinity calculation based on Beatty method was calculated. RESULTS The size of the constructed scFv library was calculated to be 1.3 × 106 members. Following four rounds of selection, 40 antibody clones were isolated which showed positive reactivity with DTd in an ELISA assay. Five clones were able to neutralize DTd in Vero cell assay. These neutralizing clones were used for soluble expression and purification of scFv fragments. Some of these soluble scFv fragments show neutralizing activity ranging from 0.6 to 1.2 µg against twofold cytotoxic dose of diphtheria toxin. The affinity constant of the selected scFv antibody was determined almost 107 M-1. CONCLUSION This study describes the prosperous construction and isolation of scFv from the immune library, which specifically neutralizes diphtheria toxin. The HuscFv produced in this study can be a potential candidate to substitute the animal antibody for treating diphtheria and detecting toxins.
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Affiliation(s)
- Ehsan Khalili
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Lakzaei
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Aminian
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Omega A, Ramadian F, Hakim PNK. The Role of Dexmedetomidine in Airway Management for Tracheostomy in Pediatric Patient with Obstructed Airway Due to Diphtheria: A Case Report. Anesth Pain Med 2023; 13:e136360. [PMID: 38024006 PMCID: PMC10676652 DOI: 10.5812/aapm-136360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/17/2023] [Accepted: 07/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Diphtheria is an infectious disease caused by exotoxin-producing Corynebacterium diphteriae and was a leading cause of death in childhood during the prevaccine era. This toxin is usually localized in the upper respiratory tract and may cause fatal airway obstruction. Many have used orotracheal intubation to secure the airway in diphtheria cases. However, the efficacy of tracheostomy under sedation while maintaining spontaneous ventilation and analgesia using trans-tracheal and superficial cervical block remains to be elucidated. Case Presentation A 6-year-old presented to the emergency room with respiratory distress and was diagnosed with diphtheria. A thick membrane in the oropharyngeal area and chest X-ray showed infiltrations indicative of pneumonia. The patient successfully underwent emergency tracheostomy under sedation using a combination of sevoflurane and dexmedetomidine to achieve prompt sedation and trans-tracheal injection and bilateral superficial cervical block as analgesia for the intra-tracheal and the incision. The patient's condition deteriorated the next day, and the bronchoscopy showed that the carina and main bronchus were covered by a pseudomembrane, obstructing the airway below the tracheostomy. The patient eventually died two days after admission. Conclusions Dexmedetomidine has minimal impact on ventilatory function and anti-sialagogue properties, while sevoflurane has minimal effect on respiratory depression. This case presentation showed that a combination of sevoflurane and dexmedetomidine with spontaneous assisted ventilation could be helpful in tracheostomy procedures in pediatric patients with airway obstruction due to diphtheria, along with the use of trans-tracheal and superficial cervical block as the analgesia. This report also indicates that being vigilant in rapidly-progressing and fatal pediatric diphtheria cases is vital.
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Affiliation(s)
- Andy Omega
- Department of Anesthesiology and Intensive Care, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, DKI Jakarta, Indonesia
| | - Faradila Ramadian
- Department of Anesthesiology and Intensive Care, Universitas Indonesia Hospital, Depok, Indonesia
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Sharma S, Jammar S, Kataria T, Agarwal S, Gupta A, Pareek Y, Singh SN. An Observational Study on Association of Clinical Outcome of Diphtheria Cases with Immunization Status: A Tertiary Care Hospital, Jaipur. Indian J Otolaryngol Head Neck Surg 2022; 74:5460-5464. [PMID: 36742622 PMCID: PMC9895576 DOI: 10.1007/s12070-021-02769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diphtheria is an important vaccine preventable disease with varied outcome from mild to death. It was observed that the outcome also gets affected with status of immunization. The outcome is relatively milder in immunized children. OBJECTIVE To find out the clinical presentation and outcome of diphtheria cases and its association with the immunization status. METHODS A descriptive analysis of 64 diphtheria cases admitted from January 2019 to May 2020 at SMS hospital, a tertiary care referral hospital in Jaipur. RESULTS Half of (51.56%, 33/60) patients were in the age group of 6-10 years. The peak load (48.44%) of diphtheria cases was seen in the monsoon season. Around 60% of the patients were fully immunized and around 10% partially immunized, every third case was un-immunized. The most common complication was neurological in 13 cases (20.31%), followed by cardiac complications in 11 cases (17.19%), and respiratory (7.81%). The proportion of complication was much lower (26.3%) in immunized cases as compare to partially immunized and un immunized. The proportion of myocarditis was significantly higher in un immunized cases (40%) than partially immunized (16.7%) and filly immunized group (5.3%). Similarly, Bronchopneumonia was also significantly higher (20%) in unimmunized. CONCLUSION Our study depicted that there has been a shift of age above 5 years for diphtheria which suggests the need for the booster dose. Also high chances of complications are seen in unimmunized and partially immunized calling for public awareness regarding complete immunization.
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Affiliation(s)
- Shraddha Sharma
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Saket Jammar
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Tanmaya Kataria
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Sunita Agarwal
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Ajay Gupta
- Department of Community Medicine, SMS Medical College, Jaipur, Rajasthan India
| | - Yogendra Pareek
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Shashank Nath Singh
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
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4
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Jammar SK, Kataria T, Agarwal S, Sharma S, Meena R, Singh SN, Harshvardhan R, Gupta A. "An Observational Study on Association of Clinical Diagnosis of Diphtheria with Smear and Culture Test: A Tertiary Care Hospital, Jaipur". Indian J Otolaryngol Head Neck Surg 2022; 74:5375-5380. [PMID: 36742836 PMCID: PMC9895208 DOI: 10.1007/s12070-021-02661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
Diphtheria is an acute infectious upper respiratory tract disease caused by toxigenic strains of Corynebacterium diphtheria and can lead to significant morbidity and mortality in all the age groups. Most of the time diagnosis of diphtheria is clinical. There may be a dirty white patch covering one or both tonsils on examination for which throat swabs are collected for Kleb's-Loeffler's Bacillus (KLB) by direct microscopy and for culture and sensitivity of the organism. To find out the association between clinical diagnosis of diphtheria with smear and culture positivity. 674 cases of Clinical diphtheria were admitted from June 2017 to September 2020 at a tertiary care hospital, Sawai Mansingh Hospital, Jaipur. throat, difficulty in swallowing and swelling in the neck. Out of 674 patients of clinical diphtheria, majority 610 cases (90.5%) were found to have both KLB smear and culture negative. 13 cases (1.9%) were found to have both KLB smear and culture positive. 19 cases (2.8%) were found to have KLB smear positive and culture negative and remaining 32 cases (4.8%) were found to have KLB smear negative and culture positive. Out of 19 patients of KLB smear positive,11 cases (3.5%) were found to have complications. Out of 32 culture positive patients,24 cases (7.7%) were found to have complications. Out of 13 patients of both KLB smear and culture positive,11 cases (3.5%) were found to have complications. Our study concluded that the negative report of KLB smear and culture does not rule out diphtheria and it is evident that percentage of complication is high in patients with either KLB smear or culture or both positive with respect to both being negative. The correlation is found to be significant (p < 0.001).
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Affiliation(s)
- Saket Kumar Jammar
- Department of Otorhinolaryngology, SMS Medical College and Hospitals, Jaipur, Rajasthan India
| | - Tanmaya Kataria
- Department of Otorhinolaryngology, SMS Medical College and Hospitals, Jaipur, Rajasthan India
| | - Sunita Agarwal
- Department of Otorhinolaryngology, SMS Medical College and Hospitals, Jaipur, Rajasthan India
| | - Shraddha Sharma
- Department of Otorhinolaryngology, SMS Medical College and Hospitals, Jaipur, Rajasthan India
| | - Ramlakhan Meena
- Department of Otorhinolaryngology, SMS Medical College and Hospitals, Jaipur, Rajasthan India
| | - Shashank Nath Singh
- Department of Otorhinolaryngology, SMS Medical College and Hospitals, Jaipur, Rajasthan India
| | - Rekha Harshvardhan
- Department of Otorhinolaryngology, SMS Medical College and Hospitals, Jaipur, Rajasthan India
| | - Ajay Gupta
- Department of PSM, SMS Medical College and Hospitals, Jaipur, Rajasthan India
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Jha AK, Padala SRAN, Parida S, Mishra SK. Diphtheritic Myocarditis Patient with an Impending Upper Airway Compromise. Indian J Crit Care Med 2022; 26:1153-1154. [PMID: 36876208 PMCID: PMC9983671 DOI: 10.5005/jp-journals-10071-24333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Jha AK, Padala SRAN, Parida S, Mishra SK. Diphtheritic Myocarditis Patient with an Impending Upper Airway Compromise. Indian J Crit Care Med 2022;26(10):1153-1154.
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Affiliation(s)
- Ajay Kumar Jha
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Satyen Parida
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandeep Kumar Mishra
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Rezaeifard M, Solhi R, Mohammadi M, Abbasi E, Aminian M. Production of IgY polyclonal antibody against diphtheria toxin and evaluation of its neutralization effect by Vero cell assay. BMC Biotechnol 2021; 21:34. [PMID: 33980219 PMCID: PMC8117566 DOI: 10.1186/s12896-021-00694-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diphtheria is a bacterial disease which is caused by Corynebacterium diphtheriae. The symptoms are due to the diphtheria toxin produced by the bacteria. Antibiotic therapy and the use of diphtheria antitoxin is a recommended strategy to control diphtheria. Although mammalian antibodies are used to treat patients, IgY antibody has advantages over mammalian ones, including cost-effectiveness and production through non-invasive means. Moreover, in contrast to mammalian antibodies, IgY does not bind to the rheumatoid factor and does not activate the complement system. The objective of this study was to evaluate the in vitro neutralizing effect of IgY against diphtheria toxin. RESULTS Anti-DT IgY was produced by immunization of the laying white leghorn chickens. Indirect enzyme-linked immunosorbent assay revealed successful immunization of the animals, and the IgY was purified with a purity of 93% via polyethylene glycol precipitation method. The neutralizing activity of the purified IgY was evaluated by Vero cell viability assay. This assay confirmed that 1.95 μg (8.6 μg/ml of culture medium) of anti-DT IgY would neutralize 10 fold of cytotoxic dose 99% of DT, which was 0.3 ng (1.33 ng/ml of culture medium). CONCLUSION This anti-DT IgY may be applicable for diphtheria treatment and quality controls in vaccine production.
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Affiliation(s)
- Morteza Rezaeifard
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, Iran.,Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Roya Solhi
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, Iran.,Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Mohammadi
- Department of Biochemistry, School of Medicine, Hamedan University of Medical Science, Hamedan, Iran
| | - Ebrahim Abbasi
- Department of Bacterial Vaccines, Razi Vaccine and Serum Research Institute, Karaj, Iran
| | - Mahdi Aminian
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Poursina Street, Keshavarz Boulevard, Tehran, Iran. .,Recombinant Vaccine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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7
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Will RC, Ramamurthy T, Sharma NC, Veeraraghavan B, Sangal L, Haldar P, Pragasam AK, Vasudevan K, Kumar D, Das B, Heinz E, Melnikov V, Baker S, Sangal V, Dougan G, Mutreja A. Spatiotemporal persistence of multiple, diverse clades and toxins of Corynebacterium diphtheriae. Nat Commun 2021; 12:1500. [PMID: 33686077 PMCID: PMC7940655 DOI: 10.1038/s41467-021-21870-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/12/2021] [Indexed: 01/22/2023] Open
Abstract
Diphtheria is a respiratory disease caused by the bacterium Corynebacterium diphtheriae. Although the development of a toxin-based vaccine in the 1930s has allowed a high level of control over the disease, cases have increased in recent years. Here, we describe the genomic variation of 502 C. diphtheriae isolates across 16 countries and territories over 122 years. We generate a core gene phylogeny and determine the presence of antimicrobial resistance genes and variation within the tox gene of 291 tox+ isolates. Numerous, highly diverse clusters of C. diphtheriae are observed across the phylogeny, each containing isolates from multiple countries, regions and time of isolation. The number of antimicrobial resistance genes, as well as the breadth of antibiotic resistance, is substantially greater in the last decade than ever before. We identified and analysed 18 tox gene variants, with mutations estimated to be of medium to high structural impact.
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Affiliation(s)
- Robert C Will
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, UK
| | | | | | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Pradeep Haldar
- Ministry of Health and Family Welfare, Govt. of India, New Delhi, India
| | - Agila Kumari Pragasam
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Karthick Vasudevan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhirendra Kumar
- Translational Health Science and Technology Institute, Faridabad, India
- Maharishi Valmiki Infectious Diseases Hospital, Delhi, India
| | - Bhabatosh Das
- Translational Health Science and Technology Institute, Faridabad, India
| | - Eva Heinz
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Vyacheslav Melnikov
- Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - Stephen Baker
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, UK
| | - Vartul Sangal
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Gordon Dougan
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, UK
| | - Ankur Mutreja
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, UK.
- Translational Health Science and Technology Institute, Faridabad, India.
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Sunarno S, Rukminiati Y, Saraswati RD. ST534: the new sequence type of Corynebacterium diphtheriae causing diphtheria in Jakarta and surrounding areas, Indonesia. Turk J Med Sci 2020; 50:267-270. [PMID: 31769641 PMCID: PMC7080344 DOI: 10.3906/sag-1909-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022] Open
Abstract
Background/aim The aim of this study was to find out characteristics and patterns of the spread of Corynebacterium diphtheriae isolated from Jakarta and the surrounding areas, using the whole genome sequencing (WGS) technique and multilocus sequence typing (MLST) approach. Materials and methods The study samples consisted of 86 C. diphtheriae isolates, which were isolated from diphtheria patients and close contacts of patients. The DNA sequencing was carried out using the WGS technique. Data conversion applied the U-gene software. Molecular typing was conducted through the MLST approach, then followed by online data analysis. Results The results showed that as many as 43 (50%) of all samples examined were new types with the same allele profile, namely 9-1-13-4-3-3-4. New sequence type C. diphtheriae is registered in the MLST global database as ST534 based on the allele profile. The tox gene analysis in 43 isolates with ST534 indicated that there were three mutation positions, all of which were silent mutations. Conclusion The main cause of diphtheria in Jakarta and the surrounding areas is a new sequence type of C. diphtheriae registered as ST534.
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Affiliation(s)
- Sunarno Sunarno
- Center for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Yuni Rukminiati
- Center for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Ratih Dian Saraswati
- Center for Research and Development of Biomedical and Basic Health Technology, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
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Solano N, Gutiérrez V, Ramos S, Peraza A, Castrillo A. Diphtheritic angina in the tongue and floor of the mouth: unusual presentation. Br J Oral Maxillofac Surg 2019; 58:358-360. [PMID: 31864859 DOI: 10.1016/j.bjoms.2019.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/27/2019] [Indexed: 11/17/2022]
Abstract
Diphtheria is an infectious disease caused by Corynebacterium diphtheriae, and is generally characterised by proliferation of the bacteria in the upper respiratory tract, formation of a pseudomembrane, and systemic diffusion of the diphtheria toxin throughout the body. We present the case of a young man with pseudomembranous plaques on the tongue and floor of the mouth, who received systemic and locoregional medical treatment, with a satisfactory outcome after 14 days.
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Affiliation(s)
- N Solano
- Oral and Maxillofacial Surgery Unit, University Hospital of Maracaibo, Venezuela; Oral Surgery Post-Graduated Program, School of Dentistry, Universidad del Zulia, Venezuela
| | - V Gutiérrez
- School of Medicine, Universidad del Zulia, Venezuela
| | - S Ramos
- Oral Surgery Post-Graduated Program, School of Dentistry, Universidad del Zulia, Venezuela
| | - A Peraza
- Oral Surgery Post-Graduated Program, School of Dentistry, Universidad del Zulia, Venezuela.
| | - A Castrillo
- Oral Surgery Post-Graduated Program, School of Dentistry, Universidad del Zulia, Venezuela
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10
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Kin FS, Azman M, Yi BQ, Jeing YD. Strangling angel of children- diphtheria: A case series of airway management and disease progress in diphtheria. INT J PEDIAT OTO CAS 2019. [DOI: 10.1016/j.pedeo.2019.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tosepu R, Gunawan J, Effendy DS, Ahmad LOAI, Farzan A. The outbreak of diphtheria in Indonesia. Pan Afr Med J 2019; 31:249. [PMID: 31448005 PMCID: PMC6691314 DOI: 10.11604/pamj.2018.31.249.16629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/05/2018] [Indexed: 11/11/2022] Open
Abstract
Diptheria is commonly caused by the aerobic gram-positive bacteria, corynebacterium diphtheria. We herein report an unusual case of diphtheria outbreak in Indonesia in 2017 and its possible causes and current management.
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Affiliation(s)
- Ramadhan Tosepu
- Faculty of Public Health, University of Halu Oleo, Kendari, Indonesia
| | - Joko Gunawan
- Akademi Keperawatan Pemerintah Kabupaten Belitung Tanjung pandan, Sumatera Selatan, Indonesia
| | | | | | - Amrin Farzan
- Center of Research, Yayasan Cipta Anak Bangsa (YCAB), Sulawesi Tenggara, Indonesia
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Muthuirulandi Sethuvel DP, Subramanian N, Pragasam AK, Inbanathan FY, Gupta P, Johnson J, Sharma NC, Hemvani N, Veeraraghavan B, Anandan S, Sangal L. Insights to the diphtheria toxin encoding prophages amongst clinical isolates of Corynebacterium diphtheriae from India. Indian J Med Microbiol 2019; 37:423-425. [PMID: 32003344 DOI: 10.4103/ijmm.ijmm_19_469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Diphtheria is a dreadful disease caused by Corynebacterium diphtheriae. Lysogenised bacteriophages carrying toxin gene in C. diphtheriae can make the strain toxigenic. However, such phage disseminates the toxin genes to other strains when it undergoes lytic phase. As little is known about the phage diversity in C. diphtheriae in India, the present study was undertaken to investigate the prophages integrated into the genome of 29 clinical isolates of C. diphtheriae using whole-genome shotgun sequencing. Amongst these isolates, 27 were toxigenic, while 2 were non-toxigenic strains. Of the 27 toxigenic strains, all harbored known phages carrying toxin gene and two other phages with unknown function. However, the two non-toxin strains did not harbour any of the phages in the genome. It is imperative to devise prevention strategies that hinder the dissemination of toxin by prophages, as it may increase the complications of diphtheria post-immunisation.
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Affiliation(s)
| | | | | | | | - Prashant Gupta
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | | | - Nanda Hemvani
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | | | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Lucky Sangal
- World Health Organization Country Office, New Delhi, India
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13
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Exavier MM, Paul Hanna M, Muscadin E, Freishstat RJ, Brisma JP, Canarie MF. Diphtheria in Children in Northern Haiti. J Trop Pediatr 2019; 65:183-187. [PMID: 29688558 DOI: 10.1093/tropej/fmy021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Infection with Corynebacterium diphtheriae persists in Haiti. Twenty-six children with clinically severe respiratory diphtheria presented to a hospital in northern Haiti during a 3-year period beginning in early 2015. The mortality rate was 50%. Partial or absent vaccinations as well as delayed and limited care contributed to mortality. This cohort offer insights into the multiple challenges involved in preventing and caring for children with diphtheria in resource-limited settings.
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Affiliation(s)
| | | | | | | | | | - Michael F Canarie
- Department of Pediatric, Yale University School of Medicine, New Haven, CT, USA
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14
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Joob B, Wiwanitkit V. Diphtheritic polyneuropathy. J Pediatr Neurosci 2019; 14:177. [PMID: 31649784 PMCID: PMC6798276 DOI: 10.4103/jpn.jpn_136_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 08/04/2019] [Accepted: 08/12/2019] [Indexed: 11/30/2022] Open
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15
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Rey-Jurado E, Tapia F, Muñoz-Durango N, Lay MK, Carreño LJ, Riedel CA, Bueno SM, Genzel Y, Kalergis AM. Assessing the Importance of Domestic Vaccine Manufacturing Centers: An Overview of Immunization Programs, Vaccine Manufacture, and Distribution. Front Immunol 2018; 9:26. [PMID: 29403503 PMCID: PMC5778105 DOI: 10.3389/fimmu.2018.00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/04/2018] [Indexed: 12/03/2022] Open
Abstract
Vaccines have significantly reduced the detrimental effects of numerous human infectious diseases worldwide, helped to reduce drastically child mortality rates and even achieved eradication of major pathogens, such as smallpox. These achievements have been possible due to a dedicated effort for vaccine research and development, as well as an effective transfer of these vaccines to public health care systems globally. Either public or private institutions have committed to developing and manufacturing vaccines for local or international population supply. However, current vaccine manufacturers worldwide might not be able to guarantee sufficient vaccine supplies for all nations when epidemics or pandemics events could take place. Currently, different countries produce their own vaccine supplies under Good Manufacturing Practices, which include the USA, Canada, China, India, some nations in Europe and South America, such as Germany, the Netherlands, Italy, France, Argentina, and Brazil, respectively. Here, we discuss some of the vaccine programs and manufacturing capacities, comparing the current models of vaccine management between industrialized and developing countries. Because local vaccine production undoubtedly provides significant benefits for the respective population, the manufacture capacity of these prophylactic products should be included in every country as a matter of national safety.
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Affiliation(s)
- Emma Rey-Jurado
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Tapia
- Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Natalia Muñoz-Durango
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margarita K. Lay
- Departamento de Biotecnología, Facultad de Ciencias del Mar y Recursos Biológicos, Universidad de Antofagasta, Antofagasta, Chile
| | - Leandro J. Carreño
- Millennium Institute on Immunology and Immunotherapy, Programa de Inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Claudia A. Riedel
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yvonne Genzel
- Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Samdani S, Jain A, Meena V, Meena CB. Cardiac complications in diphtheria and predictors of outcomes. Int J Pediatr Otorhinolaryngol 2018; 104:76-78. [PMID: 29287886 DOI: 10.1016/j.ijporl.2017.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To study the cardiac complications in diphtheria patients and to study the predictors of outcomes. STUDY DESIGN Single centre prospective analysis of cardiac complications in diphtheria patients. RESULTS In this study, there were 60 patients diagnosed with diphtheria with ECG changes. The ECG changes seen were sinus tachycardia (68.3%), T wave inversion (20%), ST segment depression (13.3%), right bundle branch block (5%), multiple atrial ectopics (3.3%). The case fatality rate in our study was 25% (15 patients). High CPK-MB, myoglobulin and cardiac troponin levels were associated with cardiac mortality. In our study, cardiac troponin T had the highest sensitivity (80%) and CK-MB had the highest specificity (95.56%). CONCLUSION Cardiac involvement is a common complication of infection with C. diphtheria and is associated with high mortality. As diphtheria can be prevented by adequate vaccination, efforts should be maximized for high vaccine coverage with booster doses.
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Affiliation(s)
- Sunil Samdani
- Department of Otorhinolaryngology (ENT), Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
| | - Avani Jain
- MAMC & Attached Lok Nayak Hospital, New Delhi, India.
| | | | - C B Meena
- Department of Cardiology, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India
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Abstract
Aim To study the spectrum of neurological complications of diphtheria, timing of onset with respect to respiratory disease, and pattern of recovery. Settings and Design Prospective, observational, hospital-based study conducted in tertiary care hospital. Materials and Methods Twenty-eight cases of diphtheria with neurological complications were admitted during the period of study. Demographic profile, age, gender, status of immunization, past history stressing on the severity of the respiratory disease, and complaints regarding diverse complications of diphtheria were recorded. Detailed clinical and central nervous system examinations along with relevant investigations were carried out. Results Children were in the age group of 3-18 years. All 28 children presented with bulbar symptoms. Isolated palatal palsy was present in 18 children (64%). Third cranial involvement was present in four children. Three children had unilateral lower motor neuron facial palsy and one child had sixth cranial nerve palsy. Nine children developed symmetric limb weakness. Diaphragmatic palsy was present in three children with the onset from 1-3 weeks after pharyngeal diphtheria. Loss of vasomotor tone was present in two children. Recovery was complete in all 28 children. Conclusion Pediatricians/neurophysicians should have a high index of suspicion to recognize diphtheritic polyneuropathy. It carries good prognosis, hence timely diagnosis and differentiation from other neuropathies is a prerequisite for rational management and contact tracing.
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Affiliation(s)
- Prem L Prasad
- Department of Paediatrics, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Preeti L Rai
- Department of Paediatrics, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
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Rajamani Sekar S, Veeraraghavan B, Anandan S, Devanga Ragupathi N, Sangal L, Joshi S. Strengthening the laboratory diagnosis of pathogenicCorynebacteriumspecies in the Vaccine era. Lett Appl Microbiol 2017; 65:354-365. [DOI: 10.1111/lam.12781] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/06/2017] [Accepted: 07/20/2017] [Indexed: 01/06/2023]
Affiliation(s)
- S.K. Rajamani Sekar
- Department of Clinical Microbiology; Christian Medical College; Vellore India
| | - B. Veeraraghavan
- Department of Clinical Microbiology; Christian Medical College; Vellore India
| | - S. Anandan
- Department of Clinical Microbiology; Christian Medical College; Vellore India
| | | | - L. Sangal
- World Health Organization (WHO) Country Office; New Delhi India
| | - S. Joshi
- World Health Organization (WHO) Country Office; New Delhi India
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Murhekar M. Epidemiology of Diphtheria in India, 1996-2016: Implications for Prevention and Control. Am J Trop Med Hyg 2017; 97:313-318. [PMID: 28722581 PMCID: PMC5544098 DOI: 10.4269/ajtmh.17-0047] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/19/2017] [Indexed: 11/07/2022] Open
Abstract
Diphtheria is an acute disease caused by exotoxin-producing Corynebacterium diphtheriae. Globally, diphtheria has been showing a declining trend due to effective childhood vaccination programs. A substantial proportion of global burden of diphtheria is contributed by India. Hospital-based surveillance studies as well as diphtheria outbreaks published in last 20 years (1996-2016) indicate that diphtheria cases are frequent among school-going children and adolescents. In some Indian states, Muslim children are affected more. As per the national level health surveys, coverage of three doses of diphtheria vaccine was 80% during 2015-2016. Information about coverage of diphtheria boosters is not routinely collected through these surveys, but is expected to be low. Few studies also indicate low diphtheria immunity among school-going children and adults. The strategies for prevention of diphtheria need to focus on improving coverage of primary and booster doses of diphtheria vaccines administered as a part of Universal Immunization Program as well as introducing diphtheria vaccine for school-going children.
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Affiliation(s)
- Manoj Murhekar
- Division of Epidemiology, National Institute of Epidemiology, Chennai, India
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Diphtheria revisited. Indian Pediatr 2017; 54:411-412. [DOI: 10.1007/s13312-017-1115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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