title: Molecular and epidemiological review of toxigenic diphtheria infections in England between 2007 and 2013.
abstract: Human infections caused by toxigenic corynebacteria occur sporadically across Europe. In this report, we undertook the epidemiological and molecular characterization of all toxigenic corynebacterium strains isolated in England between January 2007 and December 2013. Epidemiological aspects include case demographics, risk factors, clinical presentation, treatment, and outcome. Molecular characterization was performed using multilocus sequence typing (MLST) alongside traditional phenotypic methods. In total, there were 20 cases of toxigenic corynebacteria; 12 (60.0%) were caused by Corynebacterium ulcerans, where animal contact was the predominant risk factor. The remaining eight (40.0%) were caused by Corynebacterium diphtheriae strains; six were biovar mitis, which were associated with recent travel abroad. Adults 45 years and older were particularly affected (55.0%; 11/20), and typical symptoms included sore throat and fever. Respiratory diphtheria with the absence of a pharyngeal membrane was the most common presentation (50.0%; 10/20). None of the eight C. diphtheriae cases were fully immunized. Diphtheria antitoxin was issued in two (9.5%) cases; both survived. Two (9.5%) cases died, one due to a C. diphtheriae infection and one due to C. ulcerans. MLST demonstrated that the majority (87.5%; 7/8) of C. diphtheriae strains represented new sequence types (STs). By adapting several primer sequences, the MLST genes in C. ulcerans were also amplified, thereby providing the basis for extension of the MLST scheme, which is currently restricted to C. diphtheriae. Despite high population immunity, occasional toxigenic corynebacterium strains are identified in England and continued surveillance is required.
authors.affiliation: WHO Global Reference Centre for Diphtheria and Streptococcal Infections, Public Health England (PHE), London, United Kingdom.
authors.forename: Leonard
authors.initials: L
authors.lastname: Both
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Collins
authors.affiliation: WHO Global Reference Centre for Diphtheria and Streptococcal Infections, Public Health England (PHE), London, United Kingdom.
authors.forename: Aruni
authors.initials: A
authors.lastname: de Zoysa
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), London, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: White
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), London, United Kingdom.
authors.forename: Sema
authors.initials: S
authors.lastname: Mandal
authors.affiliation: WHO Global Reference Centre for Diphtheria and Streptococcal Infections, Public Health England (PHE), London, United Kingdom Androulla.Efstratiou@phe.gov.uk.
authors.forename: Androulla
authors.initials: A
authors.lastname: Efstratiou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D003352:Corynebacterium / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D003354:Corynebacterium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D003710:Demography; D004167:Diphtheria Toxin / Q000378:metabolism*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004167:Diphtheria Toxin