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Published on: May 31, 2017
Diphtheritic Myocarditis in an Unvaccinated Child
Roger Esmel-Vilomara1, Marc Figueras-Coll2, Ferran Rosés-Noguer3
1Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Pediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain; Pediatric Cardiology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR Sant Pau), Barcelona, Spain.
Insights
Diphtheria can cause severe myocarditis in unvaccinated children, requiring advanced life support like extracorporeal membrane oxygenation. Early treatment with diphtheria antitoxin (DAT) is vital but global access remains a challenge.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- Diphtheria remains a threat to unvaccinated children despite widespread vaccination.
- Myocarditis is a primary cause of mortality in diphtheria cases.
Background:
Diphtheria, a preventable yet potentially fatal childhood disease, remains a significant threat to unimmunized children, despite its decreased prevalence due to widespread vaccination.
Case Summary:
A 6-year-old unvaccinated Spanish boy presented with diphtheritic myocarditis. His condition rapidly deteriorated, leading to cardiogenic shock and ventricular tachycardia, necessitating the use of venoarterial extracorporeal membrane oxygenation and the international procurement of diphtheritic antitoxin (DAT).
Discussion:
Myocarditis stands as the primary cause of mortality in diphtheria. Early DAT administration is crucial, but its effectiveness diminishes once the diphtheria toxin binds to tissues, and global accessibility may be challenging due to limited production. In scenarios of refractory cardiogenic shock, the employment of mechanical circulatory support, specifically with left cavity drainage systems, can be vital.
Take Home Messages:
Timely vaccination is crucial in preventing diphtheria-related fatalities. Global access to essential treatments like DAT remains a significant challenge.
