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Diphtheria outbreak in Maranhão, Brazil: microbiological, clinical and epidemiological aspects

2014; Cambridge University Press; Volume: 143; Issue: 4 Linguagem: Inglês

10.1017/s0950268814001241

1469-4409

Louisy Sanches dos Santos, Lincoln de Oliveira Sant’Anna, Juliana Nunes Ramos, Elisa Martins Ladeira, Renata Stavracakis Peixoto, Lucas Lourencio Borges, Cíntia Silva Santos, Fátima Napoleão, T.C.F. Camello, G.A. Pereira, Raphael Hirata, Verônica Viana Vieira, Lécia Maria Sousa Santos Cosme, Priscila Soares Sabbadini, Ana Luíza Mattos‐Guaraldi,

Toxin Mechanisms and Immunotoxins

SUMMARY 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.