TY - JOUR AU - Dangel, Alexandra AU - Berger, Anja AU - Konrad, Regina AU - Bischoff, Heribert AU - Sing, Andreas T1 - Geographically Diverse Clusters of Nontoxigenic Corynebacterium diphtheriae Infection, Germany, 2016–2017 T2 - Emerging Infectious Disease journal PY - 2018 VL - 24 IS - 7 SP - 1239 SN - 1080-6059 AB - 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. KW - bacterial infections KW - bacteria KW - diphtheria KW - drug users KW - disease outbreaks KW - molecular typing KW - epidemiology KW - DNA sequencing KW - public health KW - Germany KW - homeless DO - 10.3201/eid2407.172026 UR - https://wwwnc.cdc.gov/eid/article/24/7/17-2026_article ER - End of Reference