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Diphtheria in Afghanistan--review of 155 cases
Abstract:
During the 3-year study period, 155 culture-positive cases of diphtheria were reviewed at the Institute of Child Health, Kabul. They comprised 0.6% of hospital admissions due to medical disorders in our institute. About 80% of patients belonged to an age group of 1-10 years and only two patients were less than 1 year old. The male to female ratio was 1.3:1. There was no history of previous vaccination against diphtheria in 96.7% of patients. In the majority of patients faucial diphtheria was diagnosed (77.4%), followed by laryngeal (16.1%) an combined pharyngolaryngeal (6.5%). Clinical presentation was with a mild to moderate degree of fever, sore throat, cervical lymphadenopathy, toxaemia, tachycardia and a characteristic thick greyish-white membrane. The main early complications were laryngeal obstruction (35), myocarditis (18), shock (3), polyneuritis (3) and renal failure (2). The overall case fatality rate was 19.3%. Prognosis was unfavourable in patients with laryngeal diphtheria when there was a delay of more than 4 days before reaching the hospital and if there was a delay in relieving laryngeal obstruction by tracheostomy. Outcome was unrelated to the age of the patient.
Insights
Diphtheria remains a significant threat, particularly affecting children aged 1-10 years. High fatality rates underscore the urgent need for vaccination and prompt medical intervention for diphtheria cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diphtheria poses a significant public health challenge, especially in regions with low vaccination rates.
- Understanding the epidemiology and clinical characteristics of diphtheria is crucial for effective disease control.
Purpose of the Study:
- To analyze the clinical features, complications, and outcomes of culture-positive diphtheria cases.
- To identify risk factors associated with unfavorable prognosis in diphtheria patients.
Main Methods:
- Retrospective review of 155 culture-positive diphtheria cases admitted to the Institute of Child Health, Kabul over a 3-year period.
- Data collection included patient demographics, clinical presentation, vaccination history, complications, and treatment outcomes.
Main Results:
- Diphtheria accounted for 0.6% of medical admissions, predominantly affecting children aged 1-10 years (80%).
- A high proportion of patients (96.7%) lacked diphtheria vaccination history.
- Faucial diphtheria was most common (77.4%), with significant complications including laryngeal obstruction (35 cases) and myocarditis (18 cases).
- The overall case fatality rate was 19.3%, with unfavorable prognosis linked to delayed hospital admission and treatment of laryngeal obstruction.
Conclusions:
- Diphtheria remains a prevalent and severe disease in unvaccinated populations, particularly impacting children.
- Prompt diagnosis, management of complications like laryngeal obstruction, and widespread vaccination are critical to reduce diphtheria morbidity and mortality.