Clinical profile and outcome of diphtheria in central India: a retrospective observational study

Abstract

Background: Although, diphtheria is eliminated by many developed countries by effective immunization, still diphtheria continues to be endemic in India and leading cause of morbidity and mortality, especially in areas in the border of the two states. The objective of the present study was to recognize the clinical profile, morbidity and mortality pattern of diphtheria and to study their immunization status as a retrospective observational study performed in pediatric wards and paediatric intensive care unit.Methods: The medical records were recovered from the case files, searching for cases diagnosed as diphtheria from the Medical Record Section and Statistical Service of the institute. A pre-established protocol was formed after approval from institutional ethical committee. Case study included suspected, probable and confirmed cases of diphtheria as per the WHO definition guidelines. All the relevant data and information regarding age, gender, residence, socioeconomic status, immunization status, clinical details, laboratory investigation, complications, and treatment provided, and outcome were recorded.Results: Amongst 47 patients, 55.32% were >5years and mean age was 6.46±3.08 years with no difference in sex distribution. 2(4.25%) patients were completely immunized, 27(57.45%) were partially immunized and 18(38.30%) were not immunized. An immunization rate was less in females as compared to males. All patients presented with fever and membrane in throat followed by throat pain 95.74%, enlarged/congested tonsils 80.85%, respiratory difficulty 68.08%, dysphagia 59.57% bull neck 48.94% and voice change 36.17%. Myocarditis was the commonest (42.55%) complication followed by palatal palsy (14.89%), polyneuropathy (8.51%), acute renal failure (4.25%) and DIC & shock (4.25%) were observed. Case fatality rate was 21.28%. Maximum numbers of cases were noted during the rainy season.Conclusions: Shifting of occurrence of diphtheria in the age group of 5-15 years suggest the need to improve and strengthen the immunization activity specially booster doses in the border districts as most of the cases were from areas at the border of two states.

Resurgence of diphtheria and its outcome among children in western Uttar Pradesh: a battle to conquer

“…Of 29 cases with myocarditis, 14(77.7%) succumbed due to underlying ventricular tachycardia and cardiogenic shock. Jayashree et al, reported 32 patients with myocarditis of which 25(78.1%) died, similar results were obtained by Meshram et al 13,9 In this study, it was observed that inadequate immunity and prolonged illness had significant association with development of myocarditis. Thus, re-emphasizing the role of early diagnosis and prompt management of this dreadful disease, which may further ameliorate the subsequent development of such devastating complication in these patients.…”

“…similar to reports from different centres (32-56.3%) in north India. 9,17 Late presentation when complications had already been set in, delayed ADS administration, financial constraints by care givers attributed to high case fatality rate in this series. This study made an important observation with regards to immunization status and disease related morbidity and fatality, as complete survival was observed in fully immunized group.…”

“…Similar finding was observed by other authors. 9,13,18 Of total 53 diphtheria cases, 18 expired resulting in case fatality rate of 33.9%. similar to reports from different centres (32-56.3%) in north India.…”

Resurgence of Diphtheria – A case report

“…The clinical manifestations can vary from mild to severe to the life threatening depending on immune status of host and severity of infection [12]. In the present study, 6 year old boy had fever, throat pain, neck swelling, difficulty in breathing and membrane over tonsil.…”

Diphtheria or Streptococcal Pharyngitis: A Case Report Highlighting the Diagnostic Dilemma in the Post-vaccination Era

“…There have been several recent reports of outbreaks and newspaper articles highlighting the seriousness of the present situation, which emphasizes the role of the public, healthcare workers, and governments in order to control and prevent the spread of diphtheria [19][20]. A local newspaper published (in the Telegu language) a picture of parents and relatives carrying and transporting a pediatric patient to a better medical facility whose condition worsened with suspected diphtheria, as shown in Figure 7.…”