Seth-Smith Helena M B, Egli Adrian
Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
Front Public Health. 2019 Aug 21;7:235. doi: 10.3389/fpubh.2019.00235. eCollection 2019.
() is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by and . Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of and share our own experience with the coordination of a Swiss-German outbreak.
（）在大多数西方国家是一种相对罕见的病原体。虽然产毒素菌株可导致咽白喉，有潜在致命后果，但更常见的表现是伤口感染。白喉毒素由噬菌体编码，也可由 和 携带。目前在欧洲，感染主要在来自白喉更流行地区的旅行者和难民、卫生条件差的城市地区患者以及静脉吸毒者中被诊断出来。大约一半的病例是不产毒素的分离株。快速鉴定细菌病原体和毒素产生是患者及疫情管理的关键要素。除了对患者进行即时临床管理外，应尽快将产毒素 的诊断告知公共卫生机构。由于语言障碍和社会环境，从患者收集与病例相关的流行病学数据往往具有挑战性。然而，关于患者接触情况、疫苗接种状况以及适当情况下的旅行/难民路线的信息至关重要，应予以记录。此外，应使用高分辨率分型对分离株进行特征分析，以识别传播情况和疫情。近年来，全基因组测序（WGS）已成为高分辨率分型方法的金标准，可对病原体传播进行详细调查。具有测序能力冗余的分散式测序策略，随后进行数据交换可能是未来一个有价值的选择，特别是因为WGS变得更易于获得和便携。在这种情况下，使用公共可用平台共享序列数据至关重要。微生物实验室、治疗医生、难民中心、社会工作者和公共卫生官员之间的密切互动是成功管理疑似疫情的关键要素。在参考中心分析细菌分离株可能进一步有助于提供更专业的微生物技术并使信息标准化，但在疫情期间这也更耗时。公共卫生机构和实验室之间的集中式沟通策略在建立和协调有效的监测及感染控制方面有很大帮助。我们回顾了关于 高分辨率分型的当前文献，并分享我们在协调瑞士 - 德国疫情方面的经验。
