1
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Berger A, Badell E, Åhman J, Matuschek E, Zidane N, Kahlmeter G, Sing A, Brisse S. Corynebacterium diphtheriae and Corynebacterium ulcerans: development of EUCAST methods and generation of data on which to determine breakpoints. J Antimicrob Chemother 2024; 79:968-976. [PMID: 38497937 DOI: 10.1093/jac/dkae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Evidence-based clinical susceptibility breakpoints have been lacking for antimicrobial agents used for diphtheria. OBJECTIVES We aimed to evaluate broth microdilution and disc diffusion methods and create a dataset of MIC values and inhibition zone diameters (ZDs) from which breakpoints could be determined. METHODS We included 400 recent clinical isolates equally distributed by species (Corynebacterium diphtheriae and Corynebacterium ulcerans) and by national surveillance programmes (France and Germany). Non-duplicate toxigenic and non-toxigenic isolates were chosen to enable the inclusion of a diversity of susceptibility levels for the 13 agents tested. Broth microdilution and disc diffusion, using EUCAST methodology for fastidious organisms, were used. RESULTS The distributions of MIC and ZD values were largely in agreement among methods and countries. Breakpoints to allow categorization of WT isolates as susceptible, i.e. susceptible (S) or susceptible, increased exposure (I) were determined for 12 agents. The data supported a breakpoint for benzylpenicillin and amoxicillin of resistant (R) > 1 mg/L since WT isolates were inhibited by 1 mg/L or less. WT isolates were categorized as I (S ≤ 0.001 mg/L) for benzylpenicillin, emphasizing the need for increased exposure, and S (S ≤ 1 mg/L) for amoxicillin. Erythromycin breakpoints were set at S ≤ 0.06 mg/L and R > 0.06 mg/L. The corresponding ZD breakpoints were determined for all agents except amoxicillin, for which categorization was based on benzylpenicillin results. CONCLUSIONS This work provided a large set of antimicrobial susceptibility data for C. diphtheriae and C. ulcerans, using a harmonized methodology. The dataset allowed EUCAST and experts in the diphtheria field to develop evidence-based breakpoints in January 2023.
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Affiliation(s)
- Anja Berger
- National Consiliary Laboratory for Diphtheria, Bavarian Food and Health Authority (LGL), Oberschleissheim, Germany
| | - Edgar Badell
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 25-28 rue du Docteur Roux, F-75724, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Jenny Åhman
- EUCAST Development Laboratory (EDL), Växjö, Sweden
| | | | - Nora Zidane
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 25-28 rue du Docteur Roux, F-75724, Paris, France
| | | | - Andreas Sing
- National Consiliary Laboratory for Diphtheria, Bavarian Food and Health Authority (LGL), Oberschleissheim, Germany
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 25-28 rue du Docteur Roux, F-75724, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
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2
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He Q, Wu Y, Hou S, Luo L, Zhang Z. Seroprevalence of Diphtheria and Tetanus Immunoglobulin G among the General Health Population in Guangzhou, China. Vaccines (Basel) 2024; 12:381. [PMID: 38675763 PMCID: PMC11053562 DOI: 10.3390/vaccines12040381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
A seroepidemiological study was conducted in 2018 to assess diphtheria and tetanus antibodies in Guangzhou, China. Diphtheria and tetanus antibody concentrations were measured with an enzyme-linked immunosorbent assay. A total of 715 subjects were enrolled in the study. The overall diphtheria and tetanus toxoid IgG-specific antibody levels were 0.126 IU/mL (95% CI: 0.115, 0.137) and 0.210 IU/mL (95% CI: 0.185, 0.240), respectively; the overall positivity rate was 61.82% (95% CI: 58.14, 65.39) and 71.61% (95% CI: 68.3, 74.92), respectively. The diphtheria and tetanus antibody concentration was decreased by age and increased by doses. The geometric mean concentrations and positivity rate of diphtheria and tetanus antibodies were lowest and below the essential protection level in people over 14 years of age. Compared to children and adolescents, middle-aged people and the aged are at much higher risk of infection with Corynebacterium diphtheriae and Clostridium tetani. The current diphtheria and tetanus immunization schedule does not provide persistent protection after childhood. There is an urgent need to adjust the current immunization schedule.
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Affiliation(s)
- Qing He
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Yejian Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Shuiping Hou
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Lei Luo
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Zhoubin Zhang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
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3
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Simonetti O, Cosimi L, Cigana M, Penco A, DI Bella S, Martini M. Balto and Togo during the cold winter of Alaska (1925): the two canine heroes in the fight against diphtheria. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2024; 65:E98-E104. [PMID: 38706760 PMCID: PMC11066831 DOI: 10.15167/2421-4248/jpmh2024.65.1.3229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/28/2024] [Indexed: 05/07/2024]
Abstract
In recent years, diphtheria has re-emerged in areas with inadequate vaccination coverage, and Europe has not been spared with several cases among migrants. Diphtheria is a potentially fatal infection caused mainly by toxigenic strains of Corynebacterium diphtheriae. Due to the high mortality rate, especially among young children, the fight against diphtheria is considered one of the first conquests of immunization. In the history of medicine, there is a unique case of an unconventional response to a diphtheria outbreak in which sled dogs were used to overcome the supply difficulties of diphtheria antitoxin. The mass media followed the medical response to the outbreak and raised audience awareness of public health issues. The facts of Nome, Alaska, in 1925 can serve as a catalyst to rethink conventional responses to diphtheria outbreaks in low-income countries today and promote mass media awareness of public health importance.
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Affiliation(s)
- Omar Simonetti
- Infectious Diseases Unit, University Hospital of Trieste, Italy
| | - Lavinia Cosimi
- Infectious Diseases Unit, University Hospital of Trieste, Italy
| | - Marco Cigana
- Emergency Department, San Jacopo Hospital, Pistoia, Italy
| | - Arturo Penco
- Department of Pediatrics, Latisana-Palmanova Hospital, ASUFC, Udine, Italy
| | - Stefano DI Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
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4
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Steffen R, Chen LH, Leggat PA. Travel vaccines-priorities determined by incidence and impact. J Travel Med 2023; 30:taad085. [PMID: 37341307 DOI: 10.1093/jtm/taad085] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Infectious disease epidemiology is continuously shifting. While travel has been disrupted by the COVID-19 pandemic and travel-related epidemiological research experienced a pause, further shifts in vaccine-preventable diseases (VPDs) relevant for travellers have occurred. METHODS We conducted a literature search on the epidemiology of travel-related VPD and synthesized data for each disease with a focus on symptomatic cases and on the impact of the respective infection among travellers, considering the hospitalization rate, disease sequela and case fatality rate. We present new data and revised best estimates on the burden of VPD relevant for decisions on priorities in travel vaccines. RESULTS COVID-19 has emerged to be a top travel-related risk and influenza remains high in the ranking with an estimated incidence at 1% per month of travel. Dengue is another commonly encountered infection among international travellers with estimated monthly incidence of 0.5-0.8% among non-immune exposed travellers; the hospitalized proportion was 10 and 22%, respectively, according to two recent publications. With recent yellow fever outbreaks particularly in Brazil, its estimated monthly incidence has risen to >0.1%. Meanwhile, improvements in hygiene and sanitation have led to some decrease in foodborne illnesses; however, hepatitis A monthly incidence remains substantial in most developing regions (0.001-0.01%) and typhoid remains particularly high in South Asia (>0.01%). Mpox, a newly emerged disease that demonstrated worldwide spread through mass gathering and travel, cannot be quantified regarding its travel-related risk. CONCLUSION The data summarized may provide a tool for travel health professionals to prioritize preventive strategies for their clients against VPD. Updated assessments on incidence and impact are ever more important since new vaccines with travel indications (e.g. dengue) have been licensed or are undergoing regulatory review.
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Affiliation(s)
- Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Zurich 8001, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Lin H Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Faculty of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4810, Australia
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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5
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Vusirikala A, Tonge S, Bell A, Linley E, Borrow R, O'Boyle S, de Lusignan S, Charlett A, Balasegaram S, Amirthalingam G. Reassurance of population immunity to diphtheria in England: Results from a 2021 national serosurvey. Vaccine 2023; 41:6878-6883. [PMID: 37821313 DOI: 10.1016/j.vaccine.2023.10.003] [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: 07/19/2023] [Revised: 09/04/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Diphtheria is rare in England because of an effective national immunisation schedule that includes 5 doses of a diphtheria-containing vaccine at 2, 3, 4 months, preschool and adolescent boosters. However, in recent years there has been a notable increase in cases due to Corynebacterium ulcerans among older adults and evidence of endemic transmission of C. diphtheriae (normally associated with travel to endemic countries). We aimed to update 2009 estimates of diphtheria immunity considering the evolving epidemiology. METHODS Residual sera collected from diagnostic laboratories and general practitioners in England in 2021 were randomly selected and tested for diphtheria antibody, to estimate proportions protected per age group. Diphtheria antibody levels were defined as susceptible (<0.01 IU/mL), basic protection (0.01-0.099 IU/mL) and full protection (≥0.1 IU/mL). Immunity estimates were standardised to the England population and compared to 2009. RESULTS Based on 3,745 residual sera tested, 89% (95%CI: 87%-90%) of the 2021 England population had at least basic diphtheria protection (vs. 90% [88%-92%] in 2009) and 50% (48%-52%) full protection (vs. 41% [38%-44%]). Higher antibody levels were observed in those aged 1 and under, 10-11, 12-15, 25-34 and 35-44 years compared to 2009. The largest proportion susceptible were observed in those aged 70+, 26% (21%-31%) vs 12% (7%-18%) in 2009. CONCLUSIONS Basic diphtheria protection is comparable between 2021 and 2009. The increase in immunity in working age adults is likely due to the school leaver booster introduced in 1994. The current vaccination schedule is maintaining sufficient population immunity. However, we recommend clinicians remain vigilant to severe diphtheria outcomes in older adults, because of their observed susceptibility.
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Affiliation(s)
- Amoolya Vusirikala
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; UK Field Epidemiology Training Programme, UK Health Security Agency, London, UK.
| | - Simon Tonge
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Abigail Bell
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Shennae O'Boyle
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon de Lusignan
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Andre Charlett
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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6
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Klapproth H, Klapproth L, Ruegamer T, Uhl F, Jantsch J, Fabri M. [Bacterial infections of the skin in the context of climate change and migration]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:851-857. [PMID: 37812206 DOI: 10.1007/s00105-023-05231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND In the context of climate change and migration, both common and previously less common pathogens are gaining importance as cutaneous bacterial infections. OBJECTIVE To inform medical professionals about challenges to dermatology posed by climate change and migration. MATERIALS AND METHODS Review of the current literature on emerging antimicrobial resistance and emerging pathogens in general and on the epidemiological situation in Germany in particular. RESULTS Climate change has a direct impact on microbiological ecosystems in Germany's warming coastal waters leading to an increase of marine V. vulnificus counts and human infections. Secondary to global warming, transmitting vectors of, for example, Lyme disease, rickettsioses and tularemia are also increasing. In addition, infectious diseases like cutaneous diphtheria and mycobacteriosis have been diagnosed in migrants, mostly likely acquired before migration or on the migration route and first diagnosed in Germany. In this context, antimicrobial resistance (e.g. methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant gram-negative bacteria) is gaining importance. CONCLUSION Due to progressive changes in global climate and ongoing migration, the aforementioned pathogens of infectious skin diseases and changes in antimicrobial resistance patterns have to be expected. Physicians should be aware of these developments in order to offer appropriate diagnostics and treatment. Epidemiological and biogeographic monitoring will be indispensable for managing emerging changes.
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Affiliation(s)
- Henning Klapproth
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland.
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Laurenz Klapproth
- Earth Observation and Modelling, Geographisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Tamara Ruegamer
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
| | - Florian Uhl
- Earth Observation and Modelling, Geographisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Jonathan Jantsch
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
- Center for Molecular Medicine Cologne (CMMC), Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
| | - Mario Fabri
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinik Köln und Universität zu Köln, Köln, Deutschland
- Center for Molecular Medicine Cologne (CMMC), Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
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7
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Jacquinet S, Martini H, Mangion JP, Neusy S, Detollenaere A, Hammami N, Bruggeman L, Hoorelbeke B, Pierard D, Cornelissen L. Outbreak of Corynebacterium diphtheriae among asylum seekers in Belgium in 2022: operational challenges and lessons learnt. Euro Surveill 2023; 28:2300130. [PMID: 37917029 PMCID: PMC10623644 DOI: 10.2807/1560-7917.es.2023.28.44.2300130] [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: 02/20/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023] Open
Abstract
Since 2022, European countries have been facing an outbreak of mainly cutaneous diphtheria caused by toxigenic Corynebacterium diphtheriae among asylum seekers. In Belgium, between 1 March and 31 December 2022, 25 cases of toxigenic C. diphtheriae infection were confirmed among asylum seekers, mostly among young males from Afghanistan. Multi-locus sequence typing showed that most isolates belonged to sequence types 574 or 377, similar to the majority of cases in other European countries. The investigation and management of the outbreak, with many asylum seekers without shelter, required adjustments to case finding, contact tracing and treatment procedures. A test-and-treat centre was organised by non-governmental organisations, the duration of the antimicrobial treatment was shortened to increase compliance, and isolation and contact tracing of cases was not possible. A vaccination centre was opened, and mobile vaccination campaigns were organised to vaccinate a maximum of asylum seekers. No more cases were detected between end December 2022 and May 2023. Unfortunately, though, three cases of respiratory diphtheria, including one death, were reported at the end of June 2023. To prevent future outbreaks, specific attention and sufficient resources should be allocated to this vulnerable population, in Belgium and at international level.
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Affiliation(s)
- Stéphanie Jacquinet
- Epidemiology of infectious diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Helena Martini
- Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - Sarah Neusy
- Preventive Medecine, Commission Communautaire Commune, Brussels, Belgium
| | | | - Naïma Hammami
- Agency for Care and Health, Team Infection control and prevention, Brussels, Belgium
| | - Lien Bruggeman
- National Medical Coordinator, Fedasil, Brussels, Belgium
| | - Bart Hoorelbeke
- Public Health Emergencies department, Federal Public Service - Health, Food Chain Safety and Environment, Brussels, Belgium
| | - Denis Pierard
- Department of Microbiology, National Reference Centre for toxigenic corynebacteria, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Laura Cornelissen
- Epidemiology of infectious diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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8
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Galfo V, Riccardi N, Leonildi A, Falcone M, Barnini S. Pharyngeal and cutaneous diphtheria: a tail of a refugee. Infection 2023; 51:1599-1600. [PMID: 36719633 DOI: 10.1007/s15010-023-01990-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Valentina Galfo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Niccolò Riccardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | | | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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9
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Taccari F, Frondizi F, Salvati F, Giovannenze F, Del Giacomo P, Damiano F, Spanu T, Graffeo R, Menchinelli G, Mariotti M, Sanguinetti M, Castri F, Neumayr A, Brunetti E, Errico G, Murri R, Cauda R, Scoppettuolo G. Cutaneous diphtheria most likely due to exposure in a detention camp in Libya. J Travel Med 2023; 30:taad073. [PMID: 37225240 DOI: 10.1093/jtm/taad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
A 24-year-old male Bangladeshi asylum seeker presented to the emergency department of Policlinico A. Gemelli of Rome, Italy with multiple nodular, pruritic lesions on both lower limbs and both elbows. We present a skin disease typical for persons living in crowded conditions.
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Affiliation(s)
- Francesco Taccari
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Federico Frondizi
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Salvati
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Giovannenze
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Paola Del Giacomo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Fernando Damiano
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Teresa Spanu
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosalia Graffeo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Giulia Menchinelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Melinda Mariotti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Castri
- Dipartimento di Scienze della salute della donna, del bambino e di sanità pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Douglas, Australia
| | - Enrico Brunetti
- Division of Infectious and Tropical Diseases, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia Errico
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Rita Murri
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Cauda
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarlo Scoppettuolo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Sing* A, Badenschier* F, Dangel A, Sprenger A, Hobmaier B, Külper-Schiek W, Prins H, Martin-Sanchez M, Wagner-Wiening C, Berger A. Clustering of Diphtheria Cases in Refugees That Arrived in Germany in 2022. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:557-558. [PMID: 37732594 PMCID: PMC10546880 DOI: 10.3238/arztebl.m2023.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Andreas Sing*
- German National Consiliary Laboratory on Diphtheria (NCLD), Bavarian State Office for Health and Food Safety, Oberschleißheim, Germany,
- Ludwig-Maximilians University of Munich (LMU), Munich, Germany
- *These two authors are co-first authors
| | - Franziska Badenschier*
- Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- ECDC Fellowship Programme, EPIET Associated Programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- *These two authors are co-first authors
| | - Alexandra Dangel
- NGS Core Unit, Bavarian State Office for Health and Food Safety, Oberschleißheim, Germany
| | - Annika Sprenger
- NGS Core Unit, Bavarian State Office for Health and Food Safety, Oberschleißheim, Germany
| | - Bernhard Hobmaier
- Department of Bacteriology, Bavarian State Office for Health and Food Safety, Oberschleißheim, Germany
| | - Wiebe Külper-Schiek
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Henrieke Prins
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Mario Martin-Sanchez
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Christiane Wagner-Wiening
- Ministry for Social Affairs, Health and Integration Baden-Württemberg, State Health Department, Stuttgart, Germany
| | - Anja Berger
- German National Consiliary Laboratory on Diphtheria (NCLD), Bavarian State Office for Health and Food Safety, Oberschleißheim, Germany,
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Garrigos T, Grimal A, Badell E, Traversier N, Picot S, Lignereux A, Ramiandrisoa M, Ben Cimon C, Jaffar-Bandjee MC, Gbaguidi-Haore H, Toubiana J, Brisse S, Miltgen G, Belmonte O. Emerging Corynebacterium diphtheriae Species Complex Infections, Réunion Island, France, 2015-2020. Emerg Infect Dis 2023; 29:1630-1633. [PMID: 37486209 PMCID: PMC10370861 DOI: 10.3201/eid2908.230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Clinical, epidemiologic, and microbiologic analyses revealed emergence of 26 cases of Corynebacterium diphtheriae species complex infections on Réunion Island, France, during 2015-2020. Isolates were genetically diverse, indicating circulation and local transmission of several diphtheria sublineages. Clinicians should remain aware of the risk for diphtheria and improve diagnostic methods and patient management.
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12
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Melnikov VG, Berger A, Dangel A, Sing A. Lateral flow immunoassay-based laboratory algorithm for rapid diagnosis of diphtheria. OPEN RESEARCH EUROPE 2023; 3:62. [PMID: 37645492 PMCID: PMC10445807 DOI: 10.12688/openreseurope.15038.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 08/31/2023]
Abstract
Background: In industrialised countries diphtheria is a rare but still life-threatening disease with a recent increase in cases due to migration and zoonotic aspects. Due to the rarity of the disease, laboratory diagnosis of diphtheria is often carried out in central reference laboratories and involves the use of sophisticated equipment and specially trained personnel. The result of the diphtheria agent detection can usually be obtained after 5-6 days or more. Authors suggest a Lateral Flow Immunoassay (LFIA)-based laboratory algorithm for the diagnosis of diphtheria, which may render less time in issuing a result and could promote the testing be performed in laboratories closer to the patient. Methods: LFIA for diphtheria toxin (DT) detection was designed using a pair of monoclonal antibodies to receptor-binding subunit B of the DT, and validated with 322 corynebacterial cultures as well as 360 simulated diphtheria specimens. Simulated diphtheria specimens were obtained by spiking of human pharyngeal samples with test strains of corynebacteria. The simulated specimens were plated on selective tellurite agar and after 18-24 hours of incubation, grey/black colonies characteristic of the diphtheria corynebacteria were examined for the DT using LFIA. Results: The diagnostic sensitivity of the LFIA for DT detection on bacterial cultures was 99.35%, and the specificity was 100%. Also, the LFIA was positive for all pharyngeal samples with toxigenic strains and negative for all samples with non-toxigenic strains. For setting LFIA, a 6-hour culture on Elek broth was used; thus, under routine conditions, the causative agent of diphtheria could be detected within two working days after plating of the clinical specimen on the tellurite medium of primary inoculation. Conclusions: The availability of such a simple and reliable methodology will speed up and increase the accuracy of diphtheria diagnosis globally.
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Affiliation(s)
- Vyacheslav G. Melnikov
- National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
| | - Anja Berger
- Public Health Microbiology, National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
| | - Alexandra Dangel
- Public Health Microbiology, National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
| | - Andreas Sing
- Public Health Microbiology, National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
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