Clinico-Epidemiological Profile of Pediatric Diphtheria Cases in a Tertiary Care Hospital in Western India: A...

Diphtheria is an acute, fatal, bacterial toxin-induced disease and a significant health problem in developing countries. It remains endemic in India, including the state of Rajasthan.

The present study was a cross-sectional observational study conducted in a tertiary care center of Western India (Jodhpur, Rajasthan) over a period of one year (January to December 2019). All patients in the pediatric age group (up to 18 years of age) who presented with clinical features of suspected diphtheria per the WHO case definition and a positive throat swab for Klebs-Löffler bacillus (KLB) stain were enrolled in the study.

A total of 21,146 patients in the pediatric age group were admitted during the study period, out of which 66 fulfilled the inclusion criteria. The proportion of diphtheria was 3.121 per 1,000 admissions, with the highest number of cases admitted in the winter season from November to February 2019 (42, 63.64%). The male-to-female ratio was 1.87:1, and most cases were from lower socioeconomic strata (43, 65.15%), resided in rural areas (57, 86.36%), were partially immunized (42, 63.64%), and belonged to the 6-14 years age group (49, 74.24%). Most cases presented with pseudomembrane (64, 96.97%), followed by fever (60, 90.91%), dysphagia (57, 86.36%), and neck oedema (51, 77.27%). The most common complications were myocarditis (23, 34.85%), followed by polyneuropathy (17, 25.76%), acute kidney injury (16, 24.24%), bleeding diathesis (15, 22.73%), and multiple organ dysfunction syndrome (MODS) (11, 16.67%). Thrombocytopenia, high levels of blood urea, serum sodium and potassium, and creatine kinase-myocardial band (CK-MB) were significantly associated with poor outcomes, and 23 cases (34.84%) had abnormal ECG findings suggestive of myocarditis. The case fatality rate (CFR) was 18.18% (12/66), ranging from 11.90% among partially immunized cases to 33.33% among unimmunized children.

High immunization coverage for diphtheria among children under five years of age has shifted the age group to 6-14-year-old children who are less immune to the disease. Biochemical parameters such as low platelets, high blood urea, serum sodium and potassium, and raised serum CK-MB are associated with poor outcomes. Myocarditis also carries a poor prognosis.