Diphtheria outbreak in Maranhão, Brazil: microbiological, clinical and epidemiological aspects

• Published in: Epidemiology and infection Vol. 143; no. 4; pp. 791 - 798
• Main Authors: SANTOS, L. S., SANT'ANNA, L. O., RAMOS, J. N., LADEIRA, E. M., STAVRACAKIS-PEIXOTO, R., BORGES, L. L. G., SANTOS, C. S., NAPOLEÃO, F., CAMELLO, T. C. F., PEREIRA, G. A., HIRATA, R., VIEIRA, V. V., COSME, L. M. S. S., SABBADINI, P. S., MATTOS-GUARALDI, A. L.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.03.2015
• Subjects: Adolescent; Adult; Antimicrobial agents; Brazil - epidemiology; Child; Corynebacterium diphtheriae; Corynebacterium diphtheriae - drug effects; Developing countries; Diphtheria; Diphtheria - drug therapy; Diphtheria - epidemiology; Diphtheria - microbiology; Diphtheria - pathology; Disease; Disease Outbreaks; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Epidemics; Epidemiology; Female; Health care; Humans; Laboratories; LDCs; Male; Microbial Sensitivity Tests; Original Papers; Penicillin; Public health; Respiratory infections; Vaccines; Young Adult; Brazil; England; Haiti; United Kingdom > UK; United States > US; Brazil; Corynebacterium diphtheriae biovar intermedius; diphtheria outbreak
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268814001241

We describe microbiological, clinical and epidemiological aspects of a diphtheria outbreak that occurred in Maranhão, Brazil. The majority of the 27 confirmed cases occurred in partially (n = 16) or completely (n = 10) immunized children (n = 26). Clinical signs and characteristic symptoms of diphtheria such as cervical lymphadenopathy and pseudomembrane formation were absent in 48% and 7% of the cases, respectively. Complications such as paralysis of lower limbs were observed. Three cases resulted in death, two of them in completely immunized children. Microbiological analysis identified the isolates as Corynebacterium diphtheriae biovar intermedius with a predominant PFGE type. Most of them were toxigenic and some showed a decrease in penicillin G susceptibility. In conclusion, diphtheria remains endemic in Brazil. Health professionals need to be aware of the possibility of atypical cases of C. diphtheriae infection, including pharyngitis without pseudomembrane formation.