{"doi":"10.1093/infdis/jiaa729","title":"Investigation of a Large Diphtheria Outbreak and Cocirculation of <i>Corynebacterium pseudodiphtheriticum</i> Among Forcibly Displaced Myanmar Nationals, 2017–2019","abstract":"BACKGROUND: Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh. METHODS: Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation. RESULTS: Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum. CONCLUSIONS: We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.","journal":"The Journal of Infectious Diseases","year":2020,"id":81623,"datarank":0.40620753016533157,"base_score":2.70805020110221,"endowment":2.70805020110221,"self_citation_contribution":0.40620753016533157,"citation_network_contribution":0.0,"self_endowment_contribution":0.40620753016533157,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":14,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9585,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":422013,"name":"Margaret M. 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Cassiday","orcid":"0000-0002-5845-676X","position":8,"is_corresponding":false},{"id":422020,"name":"David Lonsway","orcid":"0000-0002-7359-7587","position":9,"is_corresponding":false},{"id":423087,"name":"Mirza Farrque","orcid":null,"position":10,"is_corresponding":false},{"id":423088,"name":"Tanvir Hossen","orcid":null,"position":11,"is_corresponding":false},{"id":106003,"name":"Leora R. Feldstein","orcid":"0000-0002-4430-6760","position":12,"is_corresponding":false},{"id":422021,"name":"Nicholas Cook","orcid":"0000-0002-2886-8202","position":13,"is_corresponding":false},{"id":423089,"name":"Gladys Maldonado-Quiles","orcid":null,"position":14,"is_corresponding":false},{"id":422022,"name":"Ahmed Nawsher Alam","orcid":"0000-0002-7962-0725","position":15,"is_corresponding":false},{"id":422023,"name":"A. K. M. Muraduzzaman","orcid":"0000-0002-3757-3027","position":16,"is_corresponding":false},{"id":422024,"name":"Arifa Akram","orcid":"0000-0001-8829-9817","position":17,"is_corresponding":false},{"id":78474,"name":"Laura Conklin","orcid":"0000-0001-8416-9724","position":18,"is_corresponding":false},{"id":361923,"name":"Stephanie Doan","orcid":"0000-0002-7424-9234","position":19,"is_corresponding":false},{"id":422025,"name":"Michael S. Friedman","orcid":"0000-0003-1531-8620","position":20,"is_corresponding":false},{"id":422026,"name":"Anna M. Acosta","orcid":"0000-0001-9234-9493","position":21,"is_corresponding":false},{"id":422027,"name":"Susan Hariri","orcid":"0000-0002-5977-0259","position":22,"is_corresponding":false},{"id":24136,"name":"LeAnne M. Fox","orcid":null,"position":23,"is_corresponding":false},{"id":423090,"name":"Tejpratap Tiwari","orcid":null,"position":24,"is_corresponding":false},{"id":328824,"name":"Meerjady Sabrina Flora","orcid":"0000-0001-5172-1295","position":25,"is_corresponding":false},{"id":423085,"name":"Lauren M. Weil","orcid":null,"position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T21:52:58.921847Z","pmid":"33245764","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}