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Diphtheritic myocarditis: clinical and laboratory parameters of prognosis and fatal outcome
P V Havaldar1, M N Sankpal, R P Doddannavar
1Department of Pediatrics, District Hospital, Belgaum, India. pvhavaldar@usa.net
Abstract:
Of the 97 throat smear-positive cases of diphtheria treated, 16 developed evidence of myocarditis (16.5%). Age, duration of illness prior to admission, anatomical extent of membrane formation, total leukocyte count and serum glutamic oxalo-acetic transaminase (SGOT) levels were analysed in fatal and non-fatal cases and the differences between the two groups found to be statistically significant with regard to anatomical extent of membrane formation, total leukocyte count and SGOT levels. The extension of membrane formation to two or more sites was a highly sensitive predictor of mortality. A total leukocyte count > 25,000 cells/mm3 had a high specificity and positive predictive value while SGOT levels of > 80 IU/l had high sensitivity and a negative predictive value.
Insights
Myocarditis affects 16.5% of diphtheria patients. Membrane extension to multiple sites, high leukocyte counts, and elevated SGOT levels predict mortality in diphtheria patients.
Area of Science:
- Infectious Diseases
- Cardiology
- Clinical Pathology
Background:
- Diphtheria remains a significant public health concern, particularly in regions with suboptimal vaccination rates.
- Myocarditis is a serious complication of diphtheria, leading to increased morbidity and mortality.
- Early identification of risk factors for severe outcomes is crucial for timely intervention.
Purpose of the Study:
- To investigate the incidence of myocarditis in diphtheria patients.
- To identify clinical and laboratory predictors of mortality in diphtheria.
- To evaluate the prognostic value of membrane extent, leukocyte count, and SGOT levels.
Main Methods:
- Retrospective analysis of 97 throat smear-positive diphtheria cases.
- Comparison of demographic, clinical, and laboratory data between fatal and non-fatal cases.
- Statistical analysis to determine significant predictors of mortality.
Main Results:
- Myocarditis developed in 16.5% of treated diphtheria cases.
- Significant differences between fatal and non-fatal cases included anatomical extent of membrane formation, total leukocyte count, and SGOT levels.
- Extension of membrane to two or more sites strongly predicted mortality.
- Leukocyte count > 25,000 cells/mm3 and SGOT > 80 IU/l showed high predictive values for mortality.
Conclusions:
- Myocarditis is a common complication of diphtheria.
- Anatomical extent of membrane, leukocyte count, and SGOT levels are valuable prognostic indicators.
- These factors can aid in risk stratification and management of diphtheria patients.