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Berger A, Meinel DM, Marosevic D, Konrad R, Egli A, Sing A. Molekulare Epidemiologie toxigener Corynebacterium diphtheriae Infektionen in Deutschland (Epidemiological analysis of toxigenic Corynebacterium diphtheriae infections in Germany using molecular typing methods). Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1601959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Berger
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - DM Meinel
- Universitätsspital Basel, Klinische Mikrobiologie, Basel
| | - D Marosevic
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - R Konrad
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - A Egli
- Universitätsspital Basel, Klinische Mikrobiologie, Basel
| | - A Sing
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
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Meinel DM, Kuehl R, Zbinden R, Boskova V, Garzoni C, Fadini D, Dolina M, Blümel B, Weibel T, Tschudin-Sutter S, Widmer AF, Bielicki JA, Dierig A, Heininger U, Konrad R, Berger A, Hinic V, Goldenberger D, Blaich A, Stadler T, Battegay M, Sing A, Egli A. Outbreak investigation for toxigenic Corynebacterium diphtheriae wound infections in refugees from Northeast Africa and Syria in Switzerland and Germany by whole genome sequencing. Clin Microbiol Infect 2016; 22:1003.e1-1003.e8. [PMID: 27585943 DOI: 10.1016/j.cmi.2016.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/28/2016] [Accepted: 08/19/2016] [Indexed: 01/28/2023]
Abstract
Toxigenic Corynebacterium diphtheriae is an important and potentially fatal threat to patients and public health. During the current dramatic influx of refugees into Europe, our objective was to use whole genome sequencing for the characterization of a suspected outbreak of C. diphtheriae wound infections among refugees. After conventional culture, we identified C. diphtheriae using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and investigated toxigenicity by PCR. Whole genome sequencing was performed on a MiSeq Illumina with >70×coverage, 2×250 bp read length, and mapping against a reference genome. Twenty cases of cutaneous C. diphtheriae in refugees from East African countries and Syria identified between April and August 2015 were included. Patients presented with wound infections shortly after arrival in Switzerland and Germany. Toxin production was detected in 9/20 (45%) isolates. Whole genome sequencing-based typing revealed relatedness between isolates using neighbour-joining algorithms. We detected three separate clusters among epidemiologically related refugees. Although the isolates within a cluster showed strong relatedness, isolates differed by >50 nucleotide polymorphisms. Toxigenic C. diphtheriae associated wound infections are currently observed more frequently in Europe, due to refugees travelling under poor hygienic conditions. Close genetic relatedness of C. diphtheriae isolates from 20 refugees with wound infections indicates likely transmission between patients. However, the diversity within each cluster and phylogenetic time-tree analysis suggest that transmissions happened several months ago, most likely outside Europe. Whole genome sequencing offers the potential to describe outbreaks at very high resolution and is a helpful tool in infection tracking and identification of transmission routes.
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Affiliation(s)
- D M Meinel
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland; Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; Applied Microbiology Research, Department of Biomedicine, University Basel, Basel, Switzerland
| | - R Kuehl
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - R Zbinden
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - V Boskova
- Computational Evolution, D-BSSE, ETH Zurich, Basel, Switzerland
| | - C Garzoni
- Department of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland
| | - D Fadini
- Internal Medicine, Ospedale di Mendrisio, Mendrisio, Switzerland
| | - M Dolina
- Clinical Microbiology, EOLAB, Bellinzona, Switzerland
| | - B Blümel
- Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - T Weibel
- Clinical Microbiology, Labor Team W, Saint Gallen, Switzerland
| | - S Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - A F Widmer
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - J A Bielicki
- Paediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - A Dierig
- Paediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - U Heininger
- Paediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - R Konrad
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; German National Consiliary Laboratory on Diphtheria, Oberschleissheim, Germany
| | - A Berger
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; German National Consiliary Laboratory on Diphtheria, Oberschleissheim, Germany
| | - V Hinic
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - D Goldenberger
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - A Blaich
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - T Stadler
- Computational Evolution, D-BSSE, ETH Zurich, Basel, Switzerland
| | - M Battegay
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - A Sing
- Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany; German National Consiliary Laboratory on Diphtheria, Oberschleissheim, Germany
| | - A Egli
- Clinical Microbiology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University Basel, Basel, Switzerland.
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Castillo-Ramírez S, Fingerle V, Jungnick S, Straubinger RK, Krebs S, Blum H, Meinel DM, Hofmann H, Guertler P, Sing A, Margos G. Trans-Atlantic exchanges have shaped the population structure of the Lyme disease agent Borrelia burgdorferi sensu stricto. Sci Rep 2016; 6:22794. [PMID: 26955886 PMCID: PMC4783777 DOI: 10.1038/srep22794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/18/2016] [Indexed: 12/14/2022] Open
Abstract
The origin and population structure of Borrelia burgdorferi sensu stricto (s.s.), the agent of Lyme disease, remain obscure. This tick-transmitted bacterial species occurs in both North America and Europe. We sequenced 17 European isolates (representing the most frequently found sequence types in Europe) and compared these with 17 North American strains. We show that trans-Atlantic exchanges have occurred in the evolutionary history of this species and that a European origin of B. burgdorferi s.s. is marginally more likely than a USA origin. The data further suggest that some European human patients may have acquired their infection in North America. We found three distinct genetically differentiated groups: i) the outgroup species Borrelia bissettii, ii) two divergent strains from Europe, and iii) a group composed of strains from both the USA and Europe. Phylogenetic analysis indicated that different genotypes were likely to have been introduced several times into the same area. Our results demonstrate that irrespective of whether B. burgdorferi s.s. originated in Europe or the USA, later trans-Atlantic exchange(s) have occurred and have shaped the population structure of this genospecies. This study clearly shows the utility of next generation sequencing to obtain a better understanding of the phylogeography of this bacterial species.
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Affiliation(s)
- S. Castillo-Ramírez
- Programa de Genómica Evolutiva, Centro de Ciencias Genómicas, Universidad Nacional Autónoma de México, Apartado Postal 565-A, CP 62210, Cuernavaca, Morelos, México
| | - V. Fingerle
- National Reference Center for Borreliosis at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - S. Jungnick
- National Reference Center for Borreliosis at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - R. K. Straubinger
- LMU Munich, Department of Infection and Zoonoses, Veterinärstr. 13, 80539 Munich, Germany
| | - S. Krebs
- LMU Munich, Gene Centre, Lafuga, Feodor-Lynen-Strasse 25, 81377 Munich, Germany
| | - H. Blum
- LMU Munich, Gene Centre, Lafuga, Feodor-Lynen-Strasse 25, 81377 Munich, Germany
| | - D. M. Meinel
- National Reference Center for Borreliosis at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - H. Hofmann
- TU Munich, Klinik für Dermatologie and Allergologie, 80802 Munich, Germany
| | - P. Guertler
- National Reference Center for Borreliosis at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - A. Sing
- National Reference Center for Borreliosis at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
| | - G. Margos
- National Reference Center for Borreliosis at the Bavarian Health and Food Safety Authority, Veterinärstr. 2, 85764 Oberschleissheim, Germany
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Berger A, Meinel DM, Schaffer A, Ziegler R, Pitteroff J, Konrad R, Sing A. A case of pharyngeal diphtheria in Germany, June 2015. Infection 2016; 44:673-5. [PMID: 26883545 DOI: 10.1007/s15010-016-0882-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND In June 2015, a 45-year-old man suffering from acute necrotic tonsillitis and throat phlegmon was hospitalized in Nuremberg, Germany. After emergency surgery the patient was initially treated with antibiotics. RESULTS A throat swab grew a toxigenic Corynebacterium diphtheriae biovar mitis strain. The patient's vaccination status was not documented and the patient was tested serologically for anti-diphtheria antibodies showing no protective immunity. Extensive control investigations were performed by the local health department showing no likely source of his infection. CONCLUSION No secondary cases were found and the patient completely recovered.
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Affiliation(s)
- A Berger
- National Consiliary Laboratory for Diphtheria, 85764, Oberschleißheim, Germany.,Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764, Oberschleißheim, Germany
| | - D M Meinel
- Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764, Oberschleißheim, Germany
| | - A Schaffer
- Public Health Authority, City of Nuremberg, Nuremberg, Germany
| | - R Ziegler
- Institute for Clinical Hygiene, Microbiology and Infectiology, Klinikum Nürnberg, Nuremberg, Germany
| | - J Pitteroff
- Otorhinolaryngology Clinic, Klinikum Nürnberg, Nuremberg, Germany
| | - R Konrad
- National Consiliary Laboratory for Diphtheria, 85764, Oberschleißheim, Germany.,Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764, Oberschleißheim, Germany
| | - Andreas Sing
- National Consiliary Laboratory for Diphtheria, 85764, Oberschleißheim, Germany. .,Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764, Oberschleißheim, Germany.
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