title: Diphtheria outbreak in Maranhão, Brazil: microbiological, clinical and epidemiological aspects.
abstract: 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.
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: L S
authors.initials: LS
authors.lastname: Santos
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: L O
authors.initials: LO
authors.lastname: Sant'anna
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: J N
authors.initials: JN
authors.lastname: Ramos
authors.affiliation: National Institute of Quality Control in Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ,Brazil.
authors.forename: E M
authors.initials: EM
authors.lastname: Ladeira
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Stavracakis-Peixoto
authors.affiliation: Laboratory of Bacterial Respiratory and Systemic Diseases,Ceuma University - UNICEUMA,São Luís, MA - Brazil.
authors.forename: L L G
authors.initials: LL
authors.lastname: Borges
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: C S
authors.initials: CS
authors.lastname: Santos
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Napoleão
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: T C F
authors.initials: TC
authors.lastname: Camello
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: G A
authors.initials: GA
authors.lastname: Pereira
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: R
authors.initials: R
authors.lastname: Hirata
authors.affiliation: National Institute of Quality Control in Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ,Brazil.
authors.forename: V V
authors.initials: VV
authors.lastname: Vieira
authors.affiliation: Central Laboratory of Public Health,Oswaldo Cruz Institute - LACEN,São Luís, MA,Brazil.
authors.forename: L M S S
authors.initials: LM
authors.lastname: Cosme
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: P S
authors.initials: PS
authors.lastname: Sabbadini
authors.affiliation: Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculty of Medical Sciences,Rio de Janeiro State University,UERJ, Rio de Janeiro, RJ - LDCIC/FCM/UERJ; The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health - FNS/MS,Brazil.
authors.forename: A L
authors.initials: AL
authors.lastname: Mattos-Guaraldi
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003353:Corynebacterium diphtheriae / Q000187:drug effects; D004165:Diphtheria / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D055815:Young Adult
keywords: diphtheria outbreak