#Nontoxigenic Corynebacterium #diphtheriae #Infections, #Europe (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Summary, edited.]

Volume 25, Number 7—July 2019 / Letter

Nontoxigenic Corynebacterium diphtheriae Infections, Europe


To the Editor: We read with interest the article by Dangel et al. analyzing nontoxigenic Corynebacterium diphtheriae infections in northern Germany during 2016–2017 (1). Among the cases, 2 patients originated from Poland; each experienced an invasive disease, 1 endocarditis and 1 sepsis. Poland and Germany are neighboring countries. In Poland, we also observed an accumulation of nontoxigenic C. diphtheriaeinfections during 2016–2017. In both countries, most infections were caused by isolates belonging to sequence type (ST) 8 biotype gravis, which we previously suspected of having increased pathogenic properties (2).


Keywords: Corynebacterium dipththeriae; European Region.


Geographically Diverse #Clusters of Nontoxigenic #Corynebacterium diphtheriae #Infection, #Germany, 2016–2017 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 7—July 2018 / Research

Geographically Diverse Clusters of Nontoxigenic Corynebacterium diphtheriae Infection, Germany, 2016–2017

Alexandra Dangel1  , Anja Berger1, Regina Konrad, Heribert Bischoff, and Andreas Sing

Author affiliations: Bavarian Health and Food Safety Authority, Oberschleissheim, Germany (A. Dangel, A. Berger, R. Konrad, H. Bischoff, A. Sing); German Consiliary Laboratory on Diphtheria, Oberschleissheim (A. Berger, R. Konrad, A. Sing)



From 2016 through the middle of 2017, the German Consiliary Laboratory on Diphtheria noted an increase in nontoxigenic Corynebacterium diphtheriae isolates submitted from cities in northern Germany. Many patients for whom epidemiologic data were available were homeless, alcohol or drug abusers, or both. After performing routine diagnostics and multilocus sequence typing (MLST), we analyzed isolates of sequence type (ST) 8 and previously submitted isolates by whole-genome sequencing. Results were analyzed for phylogenetic relationship by core genome MLST (cg-MLST) and whole-genome single-nucleotide polymorphism profiles. Next-generation sequencing–based cg-MLST revealed several outbreak clusters caused by ST8; the geographic focus was in the metropolitan areas of Hamburg and Berlin. To achieve enhanced analytical depth, we used additional cg-MLST target genes and genome-wide single-nucleotide polymorphisms. We identified patient characteristics and detected transmission events, providing evidence that nontoxigenic C. diphtheriae infection is a potential public health threat in industrialized countries.


Keywords: Diphtheria; Corynebacterium diphtheriae; Germany.


#Molecular Characterization of #Corynebacterium diphtheriae #Outbreak Isolates, #SouthAfrica, March–June 2015 (@CDC_EIDjournal, abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 23, Number 8—August 2017 / Research

Molecular Characterization of Corynebacterium diphtheriae Outbreak Isolates, South Africa, March–June 2015

Mignon du Plessis, Nicole Wolter, Mushal Allam, Linda de Gouveia, Fahima Moosa, Genevie Ntshoe, Lucille Blumberg, Cheryl Cohen, Marshagne Smith, Portia Mutevedzi, Juno Thomas, Valentino Horne, Prashini Moodley, Moherndran Archary, Yesholata Mahabeer, Saajida Mahomed, Warren Kuhn, Koleka Mlisana, Kerrigan McCarthy, and Anne von Gottberg

Author affiliations: National Health Laboratory Service, Johannesburg, South Africa (M. du Plessis, N. Wolter, M. Allam, L. de Gouveia, F. Moosa, G. Ntshoe, L. Blumberg, C. Cohen, M. Smith, P. Mutevedzi, J. Thomas, K. McCarthy, A. von Gottberg); University of the Witwatersrand, Johannesburg (M. du Plessis, N. Wolter, C. Cohen, A. von Gottberg); National Health Laboratory Service, Cape Town, South Africa (V. Horne); University of KwaZulu-Natal, Durban, South Africa (P. Moodley, M. Archary, Y. Mahabeer, S. Mahomed, W. Kuhn, K. Mlisana); National Health Laboratory Service, Durban (Y. Mahabeer, K. Mlisana); National Department of Health, KwaZulu-Natal, South Africa (W. Kuhn)



In 2015, a cluster of respiratory diphtheria cases was reported from KwaZulu-Natal Province in South Africa. By using whole-genome analysis, we characterized 21 Corynebacterium diphtheriae isolates collected from 20 patients and contacts during the outbreak (1 patient was infected with 2 variants of C. diphtheriae). In addition, we included 1 cutaneous isolate, 2 endocarditis isolates, and 2 archived clinical isolates (ca. 1980) for comparison. Two novel lineages were identified, namely, toxigenic sequence type (ST) ST-378 (n = 17) and nontoxigenic ST-395 (n = 3). One archived isolate and the cutaneous isolate were ST-395, suggesting ongoing circulation of this lineage for >30 years. The absence of preexisting molecular sequence data limits drawing conclusions pertaining to the origin of these strains; however, these findings provide baseline genotypic data for future cases and outbreaks. Neither ST has been reported in any other country; this ST appears to be endemic only in South Africa.

Keywords: Diphtheria; Corynebacterium Diphtheriae; South Africa.