DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20184257

Clinical profile and predictors of outcome of patients with diphtheria in tertiary care pediatric centre from Southern India

Vinayaka H. S., Manoj D., Basavaraj G. V.

Abstract


Background: Diphtheria is still a fatal infectious disease even in this era of universal immunization. The disease has been completely eradicated in most of the developed countries. On the contrary, in developing countries, although the incidence has drastically declined, still account for 80-90% of global burden. The objectives of this study is to study the clinical profile and predictors of outcome of patients with diphtheria.

Methods: All children between the age group of 0 to 15 years admitted with signs and symptoms of diphtheria during January to August 2017 formed the study group. Throat swab for Albert’s stain and culture sensitivity were sent in all patients at the time of admission. All children were started on parenteral crystalline penicillin and Anti Diphtheritic Serum as recommended. All details that is demographic data, clinical features, immunization status, complications and outcome were entered in a proforma and analysed. Several variables were compared among the survivors and non-survivors to determine the predictors of outcome. Outcome is defined as either recovered or died.

Results: A total of 42 patients were included in the study group. Among 42 patients, 21 (50 %) were between 5-10 years, 12 (28 %) were between 0-5 years and 9 patients (22 %) were more than 10 years. Most common symptoms were fever followed by throat pain, difficulty in swallowing and bull neck. Alberts stain was positive in 83% of cases and culture positivity in 30% of cases. Myocarditis (47%) was the most common complication followed by acute kidney injury (40%), airway compromise (59%) and thrombocytopenia (42%). A total number of 19 patients died.

Conclusions: Diphtheria is highly fatal disease with increased mortality. Myocarditis was the commonest and most serious complication. Presence of myocarditis, AKI, thrombocytopenia, airway compromise and inadequate immunization are important predictors of outcome.


Keywords


Diphtheria, Myocarditis, Outcomes

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References


Vitek CR, Wharton M. Diphtheria in the former Soviet Union: Reemergence of a pandemic disease. Emerging Infectious Diseases 1998;4:539-50.

Galazka AM, Robertson SE. Diphtheria: changing patterns in the developing world and the industrialized world. Eu J Epidemiol. 1995;11(1):107-17.

WHO. Reported cases of selected VPD’s. Data for cases reported in 2016; based on incidence data as reported in Joint Reporting Form (JRF). Available at http://www.who.int/immunization/monitoring_surveillanc e/routine/reporting/en/

Nath B, Mahanta TG. Investigation of an outbreak of diphtheria in Borborooah block of Dibrugarh district, Assam. Indian J Community Med. 2010;35(3):436.

Parande MV, Parande AM, Lakkannavar SL, Kholkute SD, Roy S. Diphtheria outbreak in rural north Karnataka, India. JMM Case Rep. 2014;1(3).

Meera M, Rajarao M. Diphtheria in Andhra Pradesh: a clinical-epidemiological study. Int J Inf Dis. 2014;19:74-8.

European Centre for Disease Prevention and Control. Communicable disease threats report, 13-19 March 2016, week 11. ECDC. 2016. Available at http://ecdc.europa.eu/en/publications/Publications/communicable-disease-threats-report-13-19-mar-2016.pdf

Efstratiou A, Engler KH, Mazurova IK, Glushkevich T, Vuopio-Varkila J, Popovic T. Current approaches to the laboratory diagnosis of diphtheria. J Inf Dis. 2000;181(1):S138-45.

Bhagat S, Grover SS, Gupta N, Roy RD, Khare S. Persistence of Corynebacterium diphtheriae in Delhi and National Capital Region (NCR). The Indian J Med Res. 2015;142(4):459.

Kole AK, Roy R, Kar SS, Chanda D. Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital. Indian J Med Sci. 2010;64(8).

Basavaraja GV, Chebbi PG, Joshi S. Resurgence of diphtheria: clinical profile and outcome-a retrospective observational study. Int J Contemp Pediatr. 2016;3(1):60-3.

Jayashree M, Shruthi N, Singhi S. Predictors of outcome in patients with diphtheria receiving intensive care. Indian Pediatr. 2006;43:155-60

Singh SN, Singh A, Chandra S. Clinical profile and predictors of poor outcome of hospitalized diphtheria cases in children from Lucknow region of North India. Clin Epidemiol Global Health. 2014;2(2):75-9.