Journal
EPIDEMIOLOGY AND INFECTION
Volume 143, Issue 4, Pages 791-798Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0950268814001241
Keywords
Brazil; Corynebacterium diphtheriae biovar intermedius; diphtheria outbreak
Funding
- FAPEMA
- FAPERJ
- CNPq
- CAPES
- SR-2/UERJ
- Programa de Nucleo de Excelencia (PRONEX)
- Programa Nacional de Pos-Doutorado PNPD (CAPES/MEC)
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We describe microbiological, clinical and epidemiological aspects of a diphtheria outbreak that occurred in Maranhao, 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.
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