Citation Information :
Gampa M, Karna PN, Reddy KV, Priyadarshini T. Study of Diphtheria and Its Complications: A Retrospective Study from a Tertiary Care Hospital. Pediatr Inf Dis 2021; 3 (4):140-142.
Aim and objective: To study clinical presentation and complication in diphtheria in pediatric age-group.
Materials and methods: Retrospectively 33 clinical diphtheria cases who got admitted to the isolation unit of Niloufer hospital from August 2019 to July 2020 were taken for this study. The epidemiological details, vaccination status, clinical profile, routine blood investigations along with SGOT, ECG, treatment given, and interventions done with outcome were studied.
Results: The common symptoms observed were throat pain seen in 26 cases (79%), fever seen in 25 cases (76%), dysphagia seen in 24 cases (75%), bull neck seen in 18 cases (55%), and palpitations seen in 06 cases (18%). Of the 33 patients, 4 (12%) patients had completed vaccination, 29 (88%) cases were either unimmunized or partially immunized as per their age. The complications observed were cardiac involvement evident through elevated serum transaminase and ECG changes seen in 06 cases (18%), neurological involvement seen in 05 cases (15%), renal failure seen in 04 cases (12%), thrombocytopenia seen in 02 cases (6%), and bleeding seen in 01 case (3%). Tracheostomy due to airway compromise required in six cases. A total number of nine (29%) patients died with complications.
Conclusion: Diphtheria incidence is relatively more in the age-group >5 years. The common symptoms are throat pain followed by fever, dysphagia, and bull neck. Common complications observed are myocarditis associated with high mortality, palatal palsy, renal failure, and thrombocytopenia. An increase in vaccination coverage is an effective preventive measure to reduce the incidence of diphtheria.
Ventola CL. Immunization in the United States: Recommendations, barriers, and measures to improve compliance: Part 1: childhood vaccinations. P T. 2016;41(7):426-436. PMID: 27408519; PMCID: PMC4927017.
Prabhakaran Nair TN, Varughese E. Immunization coverage of infants—rural-urban difference in Kerala. Indian Pediatr 1994;31(2):139–143.
Park textbook of social and preventive medicine 25th edition.
Mathur SB, Mukherjee SB, Indian paediatrics diptheria revisited. From the Department of Pediatrics, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
Murhekar M. Epidemiology of diphtheria in India, 1996–2016: implications for prevention and control. Am J Trop Med Hyg 2017;97(2):313–318. DOI: 10.4269/ajtmh.17-0047.
Basavaraja GV, Chebbi PG, Joshi S. Esurgence of diphtheria: clinical profile and outcome - a retrospective observational study. Int J Clin Pract 2016;3(1):60–63. DOI: 10.18203/2349-3291.ijcp20160058.
Singhal T, Lodha R, Kapil A, et al. Diphtheria-down but not out. Indian Pediatr 2000;37(7):728–738.
Ray SK, Das Gupta S, Saha I. A report of diphtheria surveillance from a rural medical college hospital. J Indian Med Assoc 1998;96(8): 236–238.
Berger S, Infectious Diseases of India, 2019. 620 pages, 109 graphs, 6,807 references. Gideon e-books, https://www.gideononline.com/ebooks/country/infectious-diseases-of-india/.
Sharma NC, Banavaliker JN, Ranjan R, et al. Bacteriological and epidemiological characteristics of diphtheria cases in and around Delhi - A retrospective study. Indian J Med Res 2007;126(6):545–552. DOI: 10.4103/ijmr.IJMR_403_17.
Meshram RM, Patil A. Clinical profile and outcome of diphtheria in central India: a retrospective observational study. Int J Clin Pract 2018;5(4):1600–1605. DOI: 10.18203/2349-3291.ijcp20182572.
Kole AK, Roy R, Kar SS, Cardiac involvement in diphtheria: Study from a tertiary referral infectious disease hospital. Department of Medicine, ID and BG Hospital, Kolkata, India.
Piradov MA, Pirogov VN, Popova LM, et al. Diphtheritic polyneuropathy: clinical analysis of severe forms. Arch Neurol 2001;58(9):1438–1442. DOI: 10.1001/archneur.58.9.1438.
McAuley JH, Fearnley J, Laurence A, et al. Diphtheritic polyneuropathy. J Neurol Neurosurg Psychiatry 1999;67(6):825–826. DOI: 10.1136/jnnp.67.6.825.
Manikyamba D, Satyavani A, Deepa P. Diphtheritic polyneuropathy in the wake of resurgence of diphtheria. J Pediatr Neurosci. 2015;10(4):331–334. DOI: 10.4103/1817-1745.174441.