The clinical picture and diagnosis of diphtheritic carditis in children

Loukoushkina, E F; Bobko, Philip; Колбасова, Е. В.; Казакова, Л. В.; Краснов, В. В.; Shipova, L. G.; Лазарева, Татьяна Станиславовна; Vlasova, I. N.; Schmaltz, A. A.

doi:10.1007/s004310050871

Cited by 26 publications

(15 citation statements)

References 5 publications

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“…An echocardiographic finding of left ventricular systolic dysfunction was found in all 3 fatal cases in contrast with a survivor of third-degree AV block who had a normal left ventricular systolic function. These findings confirm that cardiac involvement of severe diphtheria is characterized by severe impairment of the myocardium and the conduction system [5,7].…”

Section: Discussionsupporting

confidence: 82%

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Historical assessment of diphtheritic myocarditis from a hospital in northeastern Thailand

Panamonta

2014

Asian Biomedicine

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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.

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Section: Discussionsupporting

confidence: 82%

“…with diphtheritic myocarditis, but these data are limited [7]. Although there have been many descriptive studies of diphtheria in resource limited countries including Thailand, data on clinical outcomes of myocarditis in patients with diphtheria are scarce [3,4,6,[8][9][10][11].…”

mentioning

confidence: 99%

Historical assessment of diphtheritic myocarditis from a hospital in northeastern Thailand

Panamonta

2014

Asian Biomedicine

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“…It does not occur with cutaneous diphtheria and therefore probably results from local toxin spread in the oropharyngeal tissues. 17,18 This results in a nasal voice and regurgitation of ingested fluids through the nose. Later, blurred vision may occur because of paralysis of the muscles of accommodation together with paralysis of the pharynx, larynx and respiratory muscles.…”

Section: Neuropathymentioning

confidence: 98%

“…Electrocardiographic (ECG) abnormalities are more common than clinical signs of myocarditis and include frequent supraventricular and ventricular ectopics, bursts of tachyarrhythmia, broadening of the QRS complex, ST and T wave changes, varying degrees of heart block, and bradyarrhythmias. [18][19][20] The loss of anterior R waves or the development of complete heart block is an ominous sign. Patients with bundle branch block and complete heart block of more than 48 hours' duration, or laryngeal infection; 80 000-100 000 units for malignant diphtheria (bull neck, toxic state).…”

Section: Myocarditismentioning

confidence: 98%