Clinical Profile, Immunization Status And Antitoxin Administration Of Diphtheria Cases During An Outbreak In Rural North India

Introduction: Diphtheria is an acute potentially fatal infectious disease caused by the toxigenic strains of Corynebacterium diphtheriae. Acute respiratory obstruction, toxic myocarditis and neurologic weakness are the most important complications of diphtheria. The clinical presentation and severity of diphtheria vary in immunised and non immunised children. Early diagnosis and prompt treatment including administration of diphtheria antitoxin and antibiotics minimise mortality. Methods: Records of 215 children admitted with the diagnosis of clinical diphtheria in a tertiary care teaching hospital in Nuh, Haryana, from January, 2019 to December, 2019 were analysed with respect to clinical features, immunization status, complications and mortality. Patients were divided into survivors and non-survivors and variables were compared between the two groups. Results: Data of 215 children was obtained. Young children (median age 5 year) were predominantly affected, and only 5(2.3%) children were fully immunized. Pseudo membrane was present in 113 (52.5%) cases. Albert staining and culture were positive in 57.2% (123) and 8.8% (19) cases, respectively. Complications developed in 38.1% (n=82) cases and included: airway compromise 15.3% (n=33), palatal palsy 4.7% (n=10), symmetric polyneuropathy 0.9% (n=2), diphtheritic cardiomyopathy 8.8% (n=19), acute kidney injury 2.3% (n=5), thrombocytopenia 6.6% (n=12) and hepatitis 0.4% (n=1) cases. Anti-diphtheritic serum(ADS) was administered to all admitted patients. Tracheostomy was done in (n=33)(15.3%) children. Case fatality rate was 12.1%. Conclusion: Diphtheria mostly affected young unvaccinated or partially vaccinated children. Complications and mortality was high in unimmunized or partially immunized young children and those with bull neck, pseudo membrane, delayed (≥5days) administration of ADS, acute kidney injury, thrombocytopenia and leucocytosis. Regular monitoring helped to detect asymptomatic myocarditis. The outbreak highlighted the need to improve awareness about diphtheria and better vaccination coverage. Administration of diphtheria antitoxin within 72 hours of presentation decreases the development of neurological complications.