Post-diphtheritic neuropathy: a clinical study in paediatric intensive care unit of a developing country

Kanwal, Sandeep Kumar; Yadav, Dinesh Kumar; Chhapola, Viswas; Kumar, Virendra

doi:10.1258/td.2012.120293

Cited by 13 publications

(10 citation statements)

References 4 publications

(6 reference statements)

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“…We could not find any study in which NCV was done in diphtheritic children without polyneuropathy for comparison. Kanwal et al (2012) 4 measured NCV in 12 children with post-DP, three of whom had decreased amplitude and five of whom had decreased conduction velocity.…”

Section: Discussionmentioning

confidence: 99%

Post-diphtheritic Polyneuropathy in Children with Diphtheria: A Prospective Observational Study

Barla,

Kumar,

Verma

et al. 2023

Indian Journal of Clinical Medicine

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This study aimed to determine the proportion of diphtheria patients who develop post-diphtheritic polyneuropathy (DP) later on and also to study the clinical features and outcomes of children with post-DP. This prospective observational study was conducted at the Department of Pediatrics, King George’s Medical University, Lucknow, Uttar Pradesh, India. Children under 14 hospitalized with clinically diagnosed diphtheria and post-DP were recruited (n = 81). Detailed clinical examination with appropriate investigations was conducted, including throat swabs for staining and culture for Corynebacterium diphtheria, nerve conduction studies, electrocardiography, and echocardiography. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0. Seventy-four cases of diphtheria and seven cases of post-DP were enrolled, 56.8% were male, and the most prevalent age group afflicted was two to five years. Fifty-three children (65.4%) were partially immunized for diphtheria. Neck swelling, voice change, difficulty breathing, noisy breathing, respiratory involvement, and stridor were significantly more common in the unimmunized group. Voice change, heart rate irregularity, and hypotension were substantially more common in patients who developed clinical neuropathy than those who did not. Early administration of antibiotics in children with diphtheria before hospital admission was found to be significant in those children who did not develop clinical polyneuropathy, 38.5% of diphtheria survivors had abnormal nerve conduction study at six weeks of illness. Neck swelling and change in voice were significantly more common in patients with abnormal nerve conduction velocity (NCV) than in normal nerve conduction studies, 87.5% of children who had taken antibiotics before hospital admission had no clinical neuropathy, and NCV was also normal. Clinical neuropathy developed in just 20% of diphtheria patients with impaired NCV. Any child diagnosed with diphtheria should be followed for three to six months in anticipation of neurological complications. DP carries a good prognosis; hence, timely diagnosis and differentiation from other neuropathies is a prerequisite for rational management.

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Section: Discussionmentioning

confidence: 99%

Post-diphtheritic Polyneuropathy in Children with Diphtheria: A Prospective Observational Study

Barla,

Kumar,

Verma

et al. 2023

Indian Journal of Clinical Medicine

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“…Three patients in this study presented with DP and two required mechanical ventilation in contrast to the study from Delhi where respiratory muscles were involved in 85.4% cases and 60.4% required mechanical ventilation. [ 5 ] Respiratory embarrassment was managed by timely tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of diphtheria for neurological complications

Prasad

Lata

2018

J Pediatr Neurosci

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Aim:To study the spectrum of neurological complications of diphtheria, timing of onset with respect to respiratory disease, and pattern of recovery.Settings and Design:Prospective, observational, hospital-based study conducted in tertiary care hospital.Materials and Methods:Twenty-eight cases of diphtheria with neurological complications were admitted during the period of study. Demographic profile, age, gender, status of immunization, past history stressing on the severity of the respiratory disease, and complaints regarding diverse complications of diphtheria were recorded. Detailed clinical and central nervous system examinations along with relevant investigations were carried out.Results:Children were in the age group of 3–18 years. All 28 children presented with bulbar symptoms. Isolated palatal palsy was present in 18 children (64%). Third cranial involvement was present in four children. Three children had unilateral lower motor neuron facial palsy and one child had sixth cranial nerve palsy. Nine children developed symmetric limb weakness. Diaphragmatic palsy was present in three children with the onset from 1–3 weeks after pharyngeal diphtheria. Loss of vasomotor tone was present in two children. Recovery was complete in all 28 children.Conclusion:Pediatricians/neurophysicians should have a high index of suspicion to recognize diphtheritic polyneuropathy. It carries good prognosis, hence timely diagnosis and differentiation from other neuropathies is a prerequisite for rational management and contact tracing.

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“…Acute onset bulbar symptoms with respiratory failure and descending paralysis, as in our patient, may occur in several neuromuscular disorders including variants of Guillain-Barre syndrome (GBS), diphtaria, botulism and toxins. [ 2 3 4 5 ] Familial occurrence, EDX findings and lack of cytoalbuminemic dissociation in CSF are against the diagnosis of GBS. The absence of demylinating features in EDX and lack of previous history of pharyngitis exclude diagnosis of diphtheria.…”

Section: Discussionmentioning

confidence: 99%

Clinical and electrodiagnostic findings in cyhalothrine poisoning

et al. 2016

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Acute onset bulbar symptoms with respiratory failure and descending paralysis may occur in several neuromuscular disorders including variants of Guillain-Barre syndrome (GBS), diphtheria, botulism and toxins. We present a 51-year-old man who presented with complains of ptosis and dyspnea following pyrethroids spraying in an enclosed area for eradication of flea. Within 5-6 days of admission limb weakness, dysphagia, dysarthria, blurred vision, diplopia, tremor and respiratory distress added to previous symptoms. Temporal profile of events after exposure, development of similar symptoms in patient's son, electrodiagnostic findings and exclusion of other etiologies confirms intoxication etiology. We reviewed the literature and provide an extensive electrodiagnostic overview.

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Post-diphtheritic neuropathy: a clinical study in paediatric intensive care unit of a developing country

Cited by 13 publications

References 4 publications

Post-diphtheritic Polyneuropathy in Children with Diphtheria: A Prospective Observational Study

Post-diphtheritic Polyneuropathy in Children with Diphtheria: A Prospective Observational Study

Prospective study of diphtheria for neurological complications

Clinical and electrodiagnostic findings in cyhalothrine poisoning

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