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Volume 31, Number 3—March 2025
Synopsis

Corynebacterium diphtheriae Infections, South Africa, 2015–2023

Mignon du PlessisComments to Author , Rito Mikhari, Linda de Gouveia, Noluthando Duma, Tamsin Lovelock, Charlene Lawrence, Prasha Mahabeer, Yesholata Mahabeer, Nevashan Govender, Susan Nzenze, Jonathan Featherston, Mishalan Moodley, Jocelyn Moyes, Sibongile Walaza, Cheryl Cohen, and Anne von Gottberg
Author affiliation: National Health Laboratory Service, Johannesburg, South Africa (M. du Plessis, R. Mikhari, L. de Gouveia, N. Duma, N. Govender, S. Nzenze, J. Featherston, M. Moodley, J. Moyes, S. Walaza, C. Cohen, A. von Gottberg); University of the Witwatersrand, Johannesburg (M. du Plessis, R. Mikhari, S. Walaza, C. Cohen, A. von Gottberg); Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa (T. Lovelock); Western Cape Department of Health, Cape Town (C. Lawrence); National Health Laboratory Service, Durban, South Africa (P. Mahabeer, Y. Mahabeer); University of Kwazulu-Natal, Durban (P. Mahabeer, Y. Mahabeer); University of Cape Town, Cape Town (A. von Gottberg)

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Table 2

Clinical characteristics of Corynebacterium diphtheriae isolates, South Africa, 2015–2023*

Clinical category No. isolates/total (%) Sequence type/sublineage†
Total no. isolates
 84
 NA
Respiratory diphtheria 27/84 (32) NA
Toxin positive 26/27 (96) ST378/SL265, n = 20; ST905/SL393, n = 1; ST906/SL394, n = 5
Toxin negative‡
 1/27 (4)
 ST395/SL31, n = 1
Endocarditis 14/84 (17) NA
Toxin positive 0 NA
Toxin negative
 14/14 (100)
 ST391/SL52, n = 1; ST395/SL31, n = 2; ST743/SL31, n = 1; ST885/SL31, n = 8; ST887/SL31, n = 1; ST924/SL396, n = 1
Cutaneous diphtheria 22/84 (26) NA
Toxin positive 2/22 (9) ST378/SL265, n = 2
Toxin negative
 20/22 (91)
 ST395/SL31, n = 5; ST608/SL259, n = 2§; ST885/SL31, n = 2; ST886/SL389, n = 3; ST888/SL31, n = 2; ST890/SL390, n = 1; ST891/SL391, n = 2; ST894/SL392, n = 1; ST896/SL31, n = 1; ST964/SL397, n = 1
Nonspecific respiratory illness 5/84 (6) NA
Toxin positive 0 NA
Toxin negative
 5/5 (100)
 ST395/SL31, n = 1; ST886/SL389, n = 1; ST888/SL31, n = 1; ST904/SL31, n = 2
Asymptomatic carrier¶ 16/84 (19) NA
Toxin positive 14/16 (88) ST378/SL265, n = 7; ST906/SL394, n = 7
Toxin negative 2/16 (13) ST395/SL31, n = 1; ST885/SL31, n = 1

*Total number of isolates was 84 from 83 patients. NA, not applicable; SL, sublineage; ST, sequence type. †Sublineage identified by using core genome multilocus sequence typing (26). ‡One patient with respiratory diphtheria harbored toxigenic ST378 and nontoxigenic ST395 in their throat. §Sublineage not assigned for 1 isolate. ¶Contacts of symptomatic patients (did not develop respiratory symptoms).

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