DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20200695

Resurgence of diphtheria: clinical profile and outcome in a tertiary care hospital of South India

Ananya U. Shetty, Vinod Chavan, Mahantesh Matti, Vijay Kulkarni

Abstract


Background: Diphtheria is a potentially fatal acute disease caused by Corynebacterium diphtheria. It was one of the leading causes of mortality in the pre vaccination era. This study is an attempt to highlight the clinical profile, outcome and demographic characteristics, immunization status of pediatric diphtheria cases in South India. Objective of the study was to analyze the clinical profile, immunization status and outcome in children with diphtheria admitted to the PICU in a tertiary care hospital.

Methods: This retrospective study was conducted in a tertiary care hospital in South India. The case records of all children admitted to the hospital between January 1st, 2014 to December 31st, 2018 with clinically suspected diphtheria were analyzed. The data was analyzed with respect to clinical features, demographic characteristics, immunization status, complications and outcome using appropriate statistical methods.

Results: 18 cases were clinically suspected to have diphtheria. The average age of children presenting with diphtheria was 9 years. Out of the 18 cases, 11 were male, 7 were female. 16 out of 18 cases were from rural areas, whereas only 2 cases were from urban areas. Fever, sore throat and dysphagia were the presenting complaints in all cases. Neck swelling, white patch over tonsil and tender cervical lymphadenopathy were the other findings noted. Out of 18 cases, 7 were completely immunized, 8 were incompletely immunized and 3 were not immunized. Antidiphtheritic serum was given in 14 cases. Myocarditis, airway compromise and neurological deficits were the complications noted. Case fatality rate was 50%.

Conclusions: Diphtheria still remains a major public health problem in developing countries like India. Mortality and morbidity due to diphtheria continues to be high despite ready availability of vaccines and antitoxin. Childhood immunization program, especially follow up and administration of booster doses must be prioritized.


Keywords


Diphtheria, Immunization, Myocarditis, Neurological deficits, Outcome

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References


WHO Vaccine-Preventable Diseases: Monitoring System 2013 Global Summary. Available at: http://apps.who.int/ immunization_monitoring/ globalsummary/countries?countrycriteria%5Bcountry%5D%5B%5D=IND& commit=OK. Accessed 27 October 2013.

2009 Coverage Evaluation Survey: All India Report. New Delhi: The United Nations Children's Fund; 2010. Available at: http://www.unicef.org/india/ health_5578.htm. Accessed 27 October 2013.

International Institute of Population Sciences (IIPS). District Level Household and Facility Survey (DLHS-3) 2007–08: India. Mumbai: IIPS; 2010. Available at: http://www.rchiips.org/pdf/ INDIA_REPORT_DLHS-3.pdf. Accessed 27 October 2013.

Goel S, Dogra V, Gupta SK, Lakshmi PV, Varkey S, Pradhan N, et al. Effectiveness of Muskaan Ek Abhiyan (the smile campaign) for strengthening routine immunization in Bihar, India. Indian Pediatr. 2012; 49:103-8.

National Vaccine Policy. New Delhi: Ministry of Health and Family Welfare, Government of India; 2011.Available at: https://mohfw.gov.in/sites/default/files/108481119000.pdf. Accessed 27 October 2013.

Global Action Plan 2011–2020. Geneva: World Health Organization; 2013.Available at: http://www.who.int/immunization/ global_vaccine_action_ plan/ GVAP_doc_2011_2020/en/index.html. Accessed 27 October 2013.

World Health Organization. Fact Sheet WHO/288, March 2005. Available at: http://whqlibdoc.who.int/fact_sheet/ 2005/ FS_288.pdf. Accessed 27 October 2013.

Vashishtha VM, Kumar P. 50 years of immunization in India: Progress and future. Indian Pediatr. 2013;50:111-8.

UNICEF Coverage Evaluation survey, 2009 National Fact Sheet. Available at: http://www.unicef.org /India / National_Fact_Sheet_CES_2009.pdf. Accessed 18 Dec 2010.

Singhal T, Lodha R, Kapil A, Jain Y, Kabra SK. Diphtheria—down but not out. Indian Pediatr. 2000; 37:728-37.

Patel UV, Patel BH, Bhavsar BS, Dabhi HM, Doshi SK. A retrospective study of diphtheria cases, Rajkot, Gujarat. Indian J Commu Med. 2004 Oct 1;24:161-3.

Khan N, Shastri J, Aigal U, Doctor B. Resurgence of diphtheria in the vaccination era. Indian J Med Microbiol. 2007;25:434-7.

WHO Vaccine-Preventable Diseases: Monitoring System 2013 Global Summary. Available at: http://apps.who.int/immunization_monitoring/globalsummary/countrie. Accessed 10 Dec 2019.

National Health Profile (NHP) of India – 2011, Government of India, Central Bureau of Health Intelligence, DGHS. Ministry of Health and Family Welfare. Available at: http://cbhidghs.nic.in/writereaddata/mainlinkFile/08%20 Health%20Status%20%20Indicators%20%202011.pdf. Accessed 27 April 2018.

Vashishtha VM, Bansal CP, Gupta SG. Pertussis Vaccines: Position Paper of Indian Academy of Pediatrics (IAP). Indian Pediatr 2013;50:1001-9.

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

Mandel GL, Bennett JE, Dolin R. In: Mandell, Douglas, eds. Bennett’s Principles and Practice of Infectious Disease. 7th Edn. Philadelphia: Elsevier; 2009: 2687-2694.

World Health Organisation. Diphtheria vaccine: WHO position paper. Weekly Epidemiol Rec. 2006;81:24-32.

Central Bureau of Health Intelligence, Directorate General of Health Services, Government of India. National Health Profiles; 2011. Available from: http://www.cbhidghs.nic.in/index1.asp?linkid=267. Accessed 31 Dec 2016.

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

Centre for disease control and prevention. Diphtheria. CDC website. Available at: https://www.cdc.gov/diphtheria/index.html. Accessed 21 Sep 2016.

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.

Vinayaka HS, Manoj D, Basavaraj GV. Clinical profile and predictors of outcome of patients with diphtheria in tertiary care pediatric centre from Southern, India. Int J Contemp Pediatr. 2018;5:2138-41.

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.