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Nguyen Thi Nguyen T, Parry CM, Campbell JI, Vinh PV, Kneen R, Baker S. Endemic erythromycin resistant Corynebacterium diphtheriae in Vietnam in the 1990s. Microb Genom 2022; 8:mgen000861. [PMID: 36259695 PMCID: PMC9676054 DOI: 10.1099/mgen.0.000861] [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: 12/23/2021] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Diphtheria is a potentially fatal respiratory disease caused by toxigenic forms of the Gram-positive bacterium Corynebacterium diphtheriae. Despite the availability of treatments (antitoxin and antimicrobials) and effective vaccines, the disease still occurs sporadically in low-income countries and in higher income where use of diphtheria vaccine is inconsistent. Diphtheria was highly endemic in Vietnam in the 1990s; here, we aimed to provide some historical context to the circulation of erythromycin resistant organisms in Vietnam during this period. After recovering 54 C. diphtheriae isolated from clinical cases of diphtheria in Ho Chi Minh City between 1992 and 1998 we conducted whole genome sequencing and analysis. Our data outlined substantial genetic diversity among the isolates, illustrated by seven distinct Sequence Types (STs), but punctuated by the sustained circulation of ST67 and ST209. With the exception of one isolate, all sequences contained the tox gene, which was classically located on a corynebacteriophage. All erythromycin resistant isolates, accounting for 13 % of organisms in this study, harboured a novel 18 kb erm(X)-carrying plasmid, which exhibited limited sequence homology to previously described resistance plasmids in C. diphtheriae. Our study provides historic context for the circulation of antimicrobial resistant C. diphtheriae in Vietnam; these data provide a framework for the current trajectory in global antimicrobial resistance trends.
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Affiliation(s)
- To Nguyen Thi Nguyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Microbiology, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Parry
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK
- Alder Hey Children’s Hospital, NHS Foundation Trust, Liverpool, UK
| | - James I. Campbell
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phat Voong Vinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Rachel Kneen
- Alder Hey Children’s Hospital, NHS Foundation Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Stephen Baker
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
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Edwards D, Kent D, Lester C, Brown CS, Murphy ME, Brown NM, Sule O, Itani A, Chand M, Trindall A, Pearson C, Roddick I, Fry NK, Hoffmann J, Iyanger N, Kemp L, White J, Javid B, Ramsay ID, Zenner D, Ahmed A, Amirthalingam G, Salimee S, Litt D, Reacher M. Transmission of toxigenic Corynebacterium diphtheriae by a fully immunised resident returning from a visit to West Africa, United Kingdom, 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 30280689 PMCID: PMC6169202 DOI: 10.2807/1560-7917.es.2018.23.39.1700681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In early 2017, a United Kingdom (UK)-born person in their 20s presented with a skin ulcer on the foot 3 weeks after returning from Ghana. The patient had last received a diphtheria-containing vaccine in 2013, completing the recommended course. MALDI-TOF of a cutaneous swab identified Corynebacterium diphtheriae. Real-time PCR ascertained the species and presence of the diphtheria toxin gene. An Elek test confirmed toxigenicity. The isolate was macrolide sensitive and penicillin resistant. The local Public Health England (PHE) Health Protection Team obtained the patient's clinical history and traced contacts to inform appropriate public health action. One close contact (in their early 80s with uncertain immunisation status who had not recently travelled) had a positive throat swab for toxigenic C. diphtheriae and reported a history of mild coryzal symptoms. Multilocus sequence typing revealed that strains from the index case and contact had Sequence Type 463. Diphtheria is extremely rare in the UK due to high vaccine coverage and this is the first documented transmission in 30 years. Clinicians and laboratory staff should remain highly suspicious of lesions in overseas travellers, even when patients are fully vaccinated. Older individuals who might not have completed a full immunisation course may have higher diphtheria susceptibility.
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Affiliation(s)
- David Edwards
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Dianne Kent
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Caroline Lester
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | | | - Michael E Murphy
- Department of Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Nicholas M Brown
- PHE Public Health Laboratory Cambridge, Public Health England, Cambridge, United Kingdom
| | - Olajumoke Sule
- PHE Public Health Laboratory Cambridge, Public Health England, Cambridge, United Kingdom
| | | | - Meera Chand
- NIHR Health Protection Research Unit in Respiratory Infections, Public Health England, London, United Kingdom
| | - Amy Trindall
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
| | - Callum Pearson
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
| | - Iain Roddick
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
| | - Norman K Fry
- National Infection Service, Public Health England, London, United Kingdom
| | - Jorg Hoffmann
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Nalini Iyanger
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Joanne White
- National Infection Service, Public Health England, London, United Kingdom
| | - Babak Javid
- Department of Medicine, University of Cambridge School of Clinical Medicine, University of Cambridge Hospitals Trust, Cambridge, United Kingdom
| | - Isobel D Ramsay
- Department of Medicine, University of Cambridge School of Clinical Medicine, University of Cambridge Hospitals Trust, Cambridge, United Kingdom
| | - Dominik Zenner
- National Infection Service, Public Health England, London, United Kingdom
| | - Aliko Ahmed
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
| | - Sultan Salimee
- East of England Health Protection Team, Public Health England, Thetford, United Kingdom
| | - David Litt
- National Infection Service, Public Health England, London, United Kingdom
| | - Mark Reacher
- Field Epidemiology Service, Public Health England, Cambridge, United Kingdom
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Seth-Smith HMB, Egli A. Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings. Front Public Health 2019; 7:235. [PMID: 31497588 PMCID: PMC6713046 DOI: 10.3389/fpubh.2019.00235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022] Open
Abstract
Corynebacterium diphtheriae (C. diphtheriae) is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by Corynebacterium ulcerans and Corynebacterium pseudotuberculosis. Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic C. diphtheriae diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of C. diphtheriae and share our own experience with the coordination of a Swiss-German outbreak.
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Affiliation(s)
- Helena M. B. Seth-Smith
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
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Lai Y, Purnima P, Ho M, Ang M, Deepak RN, Chew KL, Vasoo S, Capulong DF, Lee V. Fatal Case of Diphtheria and Risk for Reemergence, Singapore. Emerg Infect Dis 2019; 24:2084-2086. [PMID: 30334727 PMCID: PMC6199979 DOI: 10.3201/eid2411.180198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a fatal autochthonous diphtheria case in a migrant worker in Singapore. This case highlights the risk for individual cases in undervaccinated subpopulations, despite high vaccination coverage in the general population. Prompt implementation of public health measures and maintaining immunization coverage are critical to prevent reemergence of diphtheria.
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Aps LRDMM, Piantola MAF, Pereira SA, de Castro JT, Santos FADO, Ferreira LCDS. Adverse events of vaccines and the consequences of non-vaccination: a critical review. Rev Saude Publica 2018; 52:40. [PMID: 29668817 PMCID: PMC5933943 DOI: 10.11606/s1518-8787.2018052000384] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/28/2017] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To analyze the risks related to vaccines and the impacts of non-vaccination on the world population. METHODS This is a narrative review that has considered information present in the bibliographic databases NCBI-PubMed, Medline, Lilacs, and Scientific Electronic Library Online (SciELO), between November 2015 and November 2016. For the analysis of outbreaks caused by non-vaccination, we considered the work published between 2010 and 2016. RESULTS We have described the main components of the vaccines offered by the Brazilian public health system and the adverse events associated with these elements. Except for local inflammatory reactions and rare events, such as exacerbation of autoimmune diseases and allergies, no causal relationship has been demonstrated between the administration of vaccines and autism, Alzheimer's disease, or narcolepsy. On the other hand, the lack of information and the dissemination of non-scientific information have contributed to the reemergence of infectious diseases in several countries in the world and they jeopardize global plans for the eradication of these diseases. CONCLUSIONS The population should be well informed about the benefits of vaccination and health professionals should assume the role of disseminating truthful information with scientific support on the subject, as an ethical and professional commitment to society.
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Affiliation(s)
| | | | - Sara Araujo Pereira
- Universidade de São Paulo. Instituto de Ciências Biomédicas. Departamento de Microbiologia. São Paulo, SP, Brasil
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Sangal V, Hoskisson PA. Evolution, epidemiology and diversity of Corynebacterium diphtheriae: New perspectives on an old foe. INFECTION GENETICS AND EVOLUTION 2016; 43:364-70. [PMID: 27291708 DOI: 10.1016/j.meegid.2016.06.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/19/2022]
Abstract
Diphtheria is a debilitating disease caused by toxigenic Corynebacterium diphtheriae strains and has been effectively controlled by the toxoid vaccine, yet several recent outbreaks have been reported across the globe. Moreover, non-toxigenic C. diphtheriae strains are emerging as a major global health concern by causing severe pharyngitis and tonsillitis, endocarditis, septic arthritis and osteomyelitis. Molecular epidemiological investigations suggest the existence of outbreak-associated clones with multiple genotypes circulating around the world. Evolution and pathogenesis appears to be driven by recombination as major virulence factors, including the tox gene and pilus gene clusters, are found within genomic islands that appear to be mobile between strains. The number of pilus gene clusters and variation introduced by gain or loss of gene function correlate with the variable adhesive and invasive properties of C. diphtheriae strains. Genomic variation does not support the separation of C. diphtheriae strains into biovars which correlates well with findings of studies based on multilocus sequence typing. Genomic analyses of a relatively small number of strains also revealed a recombination driven diversification of strains within a sequence type and indicate a wider diversity among C. diphtheriae strains than previously appreciated. This suggests that there is a need for increased effort from the scientific community to study C. diphtheriae to help understand the genomic diversity and pathogenicity within the population of this important human pathogen.
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Affiliation(s)
- Vartul Sangal
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Paul A Hoskisson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK.
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Jakovljev A, Steinbakk M, Mengshoel AT, Sagvik E, Brügger-Synnes P, Sakshaug T, Rønning K, Blystad H, Bergh K. Imported toxigenic cutaneous diphtheria in a young male returning from Mozambique to Norway, March 2014. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.24.20835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In March 2014 a 20-year-old man was diagnosed with cutaneous diphtheria at St. Olavs University Hospital in Trondheim, Norway on his return from Africa. The man had been in Mozambique since autumn 2013 and had experienced persistent skin ulcer infections. His was in good general health. Toxin-producing Corynebacterium diphtheriae was grown from a wound specimen. He had completed the national childhood vaccination programme and received a diphtheria vaccine booster dose in 2005. Screening of close contacts revealed an asymptomatic person colonised with non-toxigenic C. diphtheriae.
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Affiliation(s)
- A Jakovljev
- Department of Medical microbiology, St. Olavs University Hospital, Trondheim, Norway
| | - M Steinbakk
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - A T Mengshoel
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - E Sagvik
- Department of Infectious Diseases Control, Municipality of Trondheim, Norway
| | - P Brügger-Synnes
- Department of Infectious Diseases, St. Olavs University Hospital, Trondheim, Norway
| | | | - K Rønning
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - H Blystad
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - K Bergh
- Department of Medical microbiology, St. Olavs University Hospital, Trondheim, Norway
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