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Volume 23, Number 8—August 2017
Research

Molecular Characterization of Corynebacterium diphtheriae Outbreak Isolates, South Africa, March–June 2015

Mignon du PlessisComments to Author , Nicole Wolter, Mushal Allam, Linda de Gouveia, Fahima Moosa, Genevie Ntshoe, Lucille Blumberg, Cheryl Cohen, Marshagne Smith, Portia Mutevedzi, Juno Thomas, Valentino Horne, Prashini Moodley, Moherndran Archary, Yesholata Mahabeer, Saajida Mahomed, Warren Kuhn, Koleka Mlisana, Kerrigan McCarthy, and Anne von Gottberg
Author affiliations: National Health Laboratory Service, Johannesburg, South Africa (M. du Plessis, N. Wolter, M. Allam, L. de Gouveia, F. Moosa, G. Ntshoe, L. Blumberg, C. Cohen, M. Smith, P. Mutevedzi, J. Thomas, K. McCarthy, A. von Gottberg); University of the Witwatersrand, Johannesburg (M. du Plessis, N. Wolter, C. Cohen, A. von Gottberg); National Health Laboratory Service, Cape Town, South Africa (V. Horne); University of KwaZulu-Natal, Durban, South Africa (P. Moodley, M. Archary, Y. Mahabeer, S. Mahomed, W. Kuhn, K. Mlisana); National Health Laboratory Service, Durban (Y. Mahabeer, K. Mlisana); National Department of Health, KwaZulu-Natal, South Africa (W. Kuhn)

Main Article

Table 2

Characteristics of patients and carriers who were Corynebacterium diphtheriae culture-positive, KwaZulu-Natal Province, South Africa, March–June 2015*

No. Age, y Isolate no. Diagnosis Vaccination status† Outcome Specimen type Biotype Elek tox gene PCR ST CRISPR-Cas system (no. spacers)
1
8
45903
Respiratory diphtheria
Incomplete (missed 18 mo and 6 y boosters)
Died
Tonsillar swab
mitis
Pos
Pos
378
I-E-a (33)
2
8
45236
Respiratory diphtheria
Incomplete (missed 18 mo and 6 y boosters)
Survived
Throat swab
mitis
Pos
Pos
378
I-E-a (33)
3‡
9
45237 Respiratory diphtheria
Incomplete (missed 6 y booster)
Survived
Throat and nasal swabs
gravis Neg Neg 395 I-E-a (41), I-E-b (22)
45238
mitis
Pos
Pos
378
I-E-a (37)
4
31
45262
Cutaneous diphtheria
Unknown
Survived
Groin swab
gravis
Neg
Neg
395
I-E-a (28), I-E-b (21)
5
9
45902
Respiratory diphtheria§
Unknown
Survived
Tracheal aspirate
mitis
Pos
Pos
378
I-E-a (37)
6
5
45463
Respiratory diphtheria§
Unknown
Survived
Tracheal aspirate
gravis
Pos
Pos
378
I-E-a (37)
7
8
45461
Carrier§
Unknown
Survived
Throat swab
gravis
Pos
Pos
378
I-E-a (37)
8
1
45462
Carrier§
Unknown
Survived
Throat swab
mitis
Pos
Pos
378
I-E-a (37)
9
41
45464
Respiratory diphtheria
Unknown
Died
Throat swab
mitis
Pos
Pos
378
I-E-a (33)
10
17
45465
Respiratory diphtheria
Incomplete (missed 12 y booster)
Survived
Throat swab
mitis
Pos
Pos
378
I-E-a (37)
11
13
45466
Respiratory diphtheria
Incomplete (missed 18 mo, 6 y, and 12 y boosters)
Died
Tonsillar swab
mitis
Pos
Pos
378
I-E-a (37)
12
21
45785
Respiratory diphtheria
Unknown
Survived
Throat and nasal swabs
mitis
Pos
Pos
378
I-E-a (34)
13
6
45786
Carrier¶
Unknown
Survived
Throat and nasal swabs
mitis
Pos
Pos
378
I-E-a (33)
14
11
45784
Probable diphtheria
Up-to-date
Survived
Throat and nasal swabs
intermedius
Neg
Neg
395
I-E-a (38), I-E-b (21)
15
11
45789
Carrier#
Unknown
Survived
Throat and nasal swabs
mitis
Pos
Pos
378
I-E-a (31)
16
9
45790
Carrier#
Unknown
Survived
Throat and nasal swabs
mitis
Pos
Pos
378
I-E-a (31)
17
11
45791
Carrier#
Unknown
Survived
Throat and nasal swabs
mitis
Pos
Pos
378
I-E-a (31)
18
10
45792
Carrier#
Unknown
Survived
Throat and nasal swabs
gravis
Neg
Neg
395
I-E-a (42), I-E-b (22)
19
13
45787
Respiratory diphtheria**
Incomplete (missed 14 wk,18 mo, and 6 y boosters)
Survived
Throat swab
intermedius
Pos
Pos
378
I-E-a (35)
20 4 45788 Respiratory diphtheria** Up-to-date Survived Throat swab intermedius Pos Pos 378 I-E-a (35)

*CRISPR, clustered, regularly interspaced, short palindromic repeats; DTaP, diphtheria, tetanus, and pertussis; neg, negative; pos, positive; ST, sequence type.
†The Expanded Programme on Immunization in South Africa recommends DTaP vaccination at 6 weeks, 10 weeks, and 14 weeks with a booster at 18 months, and a tetanus-diphtheria booster at 6 years and 12 years (https://www.health-e.org.za/wp-content/uploads/2014/02/South-Africa-EPI-vaccines-revised-Oct-2010.pdf).
‡Two different genotypes were isolated from 1 patient during the same disease episode.
§Members of the same family.
¶Family member of a person who had respiratory diphtheria symptoms and died. The postmortem throat swab from this person was culture negative.
#Contact of patient 14.
**Members of the same family.

Main Article

Page created: July 17, 2017
Page updated: July 17, 2017
Page reviewed: July 17, 2017
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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