Prognostic Significance of Electrocardiographic Changes in Diphtheria Myocarditis: A Cross-Sectional Study

Abstract

Background: Diphtheria is still endemic in India due to inadequate immunization. The incidence of myocarditis is higher in these patients. Objectives: The objective of this study was to study clinical profile, clinical outcomes as well as immunization status of the patients diagnosed with diphtheria myocarditis in Indian scenario. Methodology: This prospective observational study was carried out in one of the tertiary care hospital of south India from August 2011 to December 2012. A total of 33 cases with clinically confirmed diagnosis of diphtheria myocarditis were enrolled depending upon the inclusion and exclusion criteria of the study. Electrocardiography and 2-dimensional echocardiography was done at the time of admission and repeated when required. Results: The most common age group affected is 5 -10 years, with no sex difference in occurrence. Only 1 patient, out of 33 patients, was adequately immunized. Asymptomatic myocardial involvement (with only changes in electrocardiogram) was seen in 21 patients whereas 12 patients were symptomatic. The average duration of resolution of electrocardiographic changes was 4 -6 weeks. It should be noted that out of 28 patients who developed conduction abnormalities, 24 patients died. Temporary pacemaker support was given for 8 patients, of whom only one patient recovered. The patient was followed till hospital discharge. Conclusion: The mortality associated with diphtheria myocarditis is higher in Indian population. As diphtheria can be prevented by adequate vaccination, efforts should be maximized for 90% coverage with three doses of diphtheria toxoid in children below one year of age and immunity towards it should be maintained by booster doses.

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

“…In India, incidence of diphtheric myocarditis varies from 16 to 66%. [22][23][24] Palatal palsy characterized by a nasal quality of voice, nasal regurgitation commonly occurring in second and third week and earliest neurological complication which may occur alone or in association with other types of paralysis. In present series, 7 (14.89%) patients had palatal palsy and 4 (8.51%) had polyneuropathy with or without cranial nerve involvement.…”

Clinical spectrum and outcomes of pediatric diphtheria

“…Ratageri et al reported that the most common clinical presentation in their patients were pseudomembranes (100%), fever (92.8%), cervical lymphadenopathy (92.8%), followed by sore throat (64.2%), neck swelling (42.8%), dysphagia (35.7%), bull neck (28.5%), and halitosis 24 In our study, myocarditis was found in 4/28 of patients, as the only complication observed, but Meshram et al found myocarditis in 42.55% of patients 24 and various studies in India found incidences of diphtheria myocarditis from 16 to 66%. [33][34][35] Basavaraja et al showed that out of 45.16% patients with bull neck, 71.4% died; and out of 41.9% patients with myocarditis, 76.9% died. 26 However, in our study out of 25% patients with bull neck, 57.1% died, whereas all patients with myocarditis died.…”

Diphtheria-Associated Myocarditis: Clinical Profiles and Mortality Trends in a Tertiary Care Hospital in Pakistan

“…Extension of the PR interval, alterations in the ST-segment, disappearance of anterior R waves, bundle branch block, total heart block, and arrhythmias of the supraventricular and ventricular regions are common among the ECG findings. Elevated cardiac enzymes and ECG alterations can identify asymptomatic myocardial involvement [ 11 ]. According to the findings of our research, the most prevalent cardiac ECG findings were rhythm abnormalities.…”