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Epidemiol Infect. 2015 Mar;143(4):791-8. doi: 10.1017/S0950268814001241.

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

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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.
National Institute of Quality Control in Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ,Brazil.
Laboratory of Bacterial Respiratory and Systemic Diseases,Ceuma University - UNICEUMA,São Luís, MA - Brazil.
Central Laboratory of Public Health,Oswaldo Cruz Institute - LACEN,São Luís, MA,Brazil.


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.


diphtheria outbreak

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