Clinical spectrum and outcomes of pediatric diphtheria

Abstract

Background Although vaccination programs have succeeded in reducing the incidence of diphtheria, it remains a health problem in Asia, including Indonesia.
 Objective To investigate the clinical spectrum and outcomes of pediatric diphtheria in Wahidin Sudirohusodo Hospital.
 Methods This study was a retrospective review of childhood diphtheria medical records from January 2011 to December 2017 in Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi. Recorded data consisted of age, gender, nutritional and immunization statuses, signs and symptoms, throat swab culture results, complications, and outcomes. 
 Results Of 28 subjects aged 9 months to 17.10 years, the majority were >5 years (57.1%) and male (60.7%). Subjects’ mean age was 6.15 years and 82.1% of cases were well nourished. Overall, 85.7% had received complete immunizations, while 14.3% were not immunized, having received neither basic nor booster vaccines. The presenting manifestations were fever, pseudomembranes, and sore throat in all subjects, enlarged tonsils (78.57%), dysphagia (67.86%), cough (57.14%), headache (57.14%), hoarseness (67.86%), bull neck (25%), and myocarditis (14.3%). Most subjects had hospital stays of >10 days (67.9%). Mortality was 14.3%, usually in those admitted with a late, deteriorating condition and dying before getting optimal treatment. Poor outcome was significantly associated with the lack of basic or booster immunizations, poor nourishment, bull neck, myocarditis, and hospital stays < 5 days (P<0.05 for all). 
 Conclusion The clinical spectrum and outcomes of pediatric diphtheria in this study are relatively similar to reports from other hospitals. Mortality was mostly in patients who lack basic or booster immunizations, are poorly nourished, or have bull neck, myocarditis, or hospital stays < 5 days.

Clinical Manifestation of Childhood Diphtheria

“…We observed that children who had completed their vaccination were more prone to get infected than children who were unvaccinated or partially vaccinated. In agreement to our results, (Alfiansyah, 2015) and (Nawing et al, 2019) reported children with completed vaccination had the highest incident of diphtheriae. These studies also observed more children with completed vaccination experienced the disease (Arifin & Prasasti, 2017).…”

“…Similar results stated myocarditis was the most common complications done by (Arya et al, 2022;Dyah Nugroho et al, 2019;Liansyah et al, 2020;Nawing et al, 2019). Sign of myocarditis wasn't met clinically.…”

“…A study by (Arya et al, 2022) described all diphtheria cases in children experienced sore throat and fever while bullneck and airway obstruction were less common. (Nawing et al, 2019) found most common symptoms were fever, sore throat and dysphagia. In diphtheria, fever is not usually high so that patient doesn't usually complaint about it.…”

Microbiological and Clinical Aspects of Diphtheria-Confirmed Cases from Capital City of Indonesia, Jakarta, and Surrounding Areas in 2017

“…A study in India revealed that most diphtheria cases were non-vaccination (79%) or incomplete vaccination (18%), with CFR in 48% and tracheostomy in approximately 50% of the cases (22). Nawing et al also described fatal cases that had not received a vaccination or had received it partially (23). Furthermore, three-quarters of the cases had unidentified contact.…”

Prevalence of Risk Factors for Diphtheria: CLTS and DPT-HB-HIB3 Immunization Coverage in East Java (Periode 2018-2020)

“…The excessive population in an area may cause a slum environment that may become breeding site for Corynebacterium diphtheria. Others include low vaccination coverage, crowding, migration or population movement, environmental factors, nutritional status, parental behavior, and personal hygiene of children (15). Research conducted in Yemen, diphtheria cases were mostly found in areas with massive population displacement, non-functioning services, lack of food, poor clean water, and poor sanitation (16).…”