Prognostic value of electrocardiographic monitoring of patients with severe diphtheria

Area of Science:

• Pediatrics
• Cardiology
• Infectious Diseases

Background:

• Diphtheria can lead to severe complications, including myocarditis and cardiac dysfunction.
• Clinical presentation of diphtheritic myocarditis can be subtle, making early detection challenging.

Purpose of the Study:

• To document electrocardiographic findings in Vietnamese children with severe diphtheria.
• To assess the relationship between electrocardiographic abnormalities and clinical outcomes, including mortality.

Main Methods:

• Prospective study of 15 Vietnamese children with severe diphtheria.
• Comprehensive electrocardiographic monitoring, including 24-hour Holter monitoring.
• Correlation of electrocardiographic findings with clinical status and patient outcomes.

Main Results:

• All 15 children exhibited electrocardiographic abnormalities on 24-hour monitoring, irrespective of clinical signs of myocarditis.
• Elevated rates of supraventricular and ventricular ectopy were common and persisted post-acute illness.
• More than two ventricular ectopic beats at presentation predicted fatal outcome with 100% sensitivity and specificity.
• Fatal outcomes occurred due to respiratory arrest and cardiogenic shock, with one case requiring pacemaker insertion for complete heart block.

Conclusions:

• Continuous electrocardiographic monitoring is crucial for detecting subclinical diphtheritic myocarditis in children.
• Ventricular ectopy is a significant predictor of mortality in severe diphtheria.
• Recovery from diphtheritic myocarditis may be prolonged, necessitating extended cardiac surveillance.