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Geographically Diverse Clusters of Nontoxigenic Corynebacterium diphtheriae
Infection, Germany, 2016-2017
#MMPMID29912709
Dangel A
; Berger A
; Konrad R
; Bischoff H
; Sing A
Emerg Infect Dis
2018[Jul]; 24
(7
): 1239-1245
PMID29912709
show ga
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.
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