Historical assessment of diphtheritic myocarditis from a hospital in northeastern Thailand

Abstract

Background:Although there have been many descriptive studies of diphtheria from resource limited countries, descriptions of the natural history of diphtheritic myocarditis in patients from these countries are scarce. Objective: To present the natural history of diphtheritic myocarditis from a hospital in northeastern Thailand. Methods: The clinical features of 38 patients with diphtheria admitted to the Khon Kaen University Hospital in northeastern Thailand between 1983 and 1996 were reviewed. Results: Of the 38 cases of diphtheria, 10 progressed to diphtheritic myocarditis (26%). Electrocardiographic findings of the 10 patients with myocarditis were myocardial and conduction abnormalities. The presence of a clinically severe (toxic) type (P < 0.001) or a swollen neck (bull neck) (P = 0.001) was a predictor of the occurrence of myocarditis. Five (50%) of the 10 patients with myocarditis had conduction abnormalities (third-degree atrioventricular block 3, left bundle branch block 1, and right bundle branch block 1). Four patients with severe symptomatic bradyarrhythmia (third-degree atrioventricular block 3, and left bundle branch block 1) received ventricular pacing, and 3 patients died after this pacing. Echocardiographic abnormalities of left ventricular dilatation and myocardial hypertrophy were found in all 5 patients with conduction abnormalities. All 6 of 7 survivors of diphtheritic myocarditis had normal 12-lead electrocardiographic results at 1-month follow-up. A patient who was the survivor of third-degree AV block had an electrocardiographic finding of flat T waves, and with a complete echocardiographic normalization of left ventricular dilatation and myocardial hypertrophy. Conclusion:The present study confirms that increasing diphtheria immunization coverage in the population remains the most important strategy for the control of diphtheria. In resource limited countries, clinical findings, electrocardiography, and sometimes where available, echocardiography are helpful in assessing the severity of diphtheritic myocarditis, decision making of acute management, and predicting fatal outcome.

Rheumatic and congenital heart diseases among school children of Khon Kaen, Thailand: declining prevalence of rheumatic heart disease

“…Khon Kaen city is located at the center of Khon Kaen province. Khon Kaen University's Srinagarind Hospital is a large 1,100 bed referral facility located within Khon Kaen city [11]. This study targeted urban school children to study impact of changes in SES on the prevalence of RF/ RHD and CHD and compare findings with a previous study in 1986 (Table 1) [4].…”

The prevalence of rheumatic heart disease in northeastern Thailand is declining

“…As for other infectious diseases, such as smallpox, poliomyelitis, measles, diphtheria, and tetanus, the development of vaccines and implementation of wide immunization programmes has the potential for controlling group A streptococcal infections [17]. Currently, there are group A streptococcal vaccines in very early clinical trials, a suitable preparation for widespread use will not be available for a number of decades.…”

Original article. Childhood infective endocarditis in Khon Kaen University Hospital from 1992 to 2011

“…The population of the northeastern Thailand was approximately 20.9 million in 2002. KKU hospital, having approximately 1,100 beds, is located in the central area of Khon Kaen province in northeastern Thailand and is a teaching and tertiary referral center in this region [10,11]. According to the 2002 census, the population of Khon Kaen province was approximately 1.7 million.…”