Prospective study of diphtheria for neurological complications

Abstract

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.

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

“…10 In Prasad et al (2018) study palatal palsy was present in 18 children (64%). 12 Bulbar symptoms in the form of nasal twang, regurgitation, and dysphagia were observed in all children. Nine children had symmetric limb weakness.…”

“…In our study, children with palatal palsy recovered within three to five weeks while children with limb weakness recovered within four to six weeks. 12 Bulbar symptoms in the form of nasal twang, regurgitation, and dysphagia were observed in all children. Nine children had symmetric limb weakness.…”

Locally acquired respiratory diphtheria in Australia

“…Cardiac toxicity may occur acutely but often occurs seven to 14 days after respiratory symptom onset; neurological involvement, particularly bulbar weakness and other cranial neuropathies, may not appear for weeks to months 2 . Neurological manifestations of diphtheria usually resolve completely 3 but require supportive, multidisciplinary care.…”

Infections of the Peripheral Nervous System

“…No specific treatment exists for the neuropathy itself, and the benefit of giving the antitoxin after the development of neuropathy is unclear 63 . Diphtheritic neuropathy usually has a good prognosis with recovery of neurologic function; however, death occurs in a small percentage because of disease complications 62,69 …”

“…63 Diphtheritic neuropathy usually has a good prognosis with recovery of neurologic function; however, death occurs in a small percentage because of disease complications. 62,69 Autonomic Dysfunction Several infections have been associated with peripheral autonomic dysfunction and even more associated with central autonomic dysfunction. Chagas disease, caused by the parasite Trypanosoma cruzi, can cause autonomic neuropathy, particularly affecting cardiac and gastrointestinal function.…”