Resurgence of diphtheria in rural north Karnataka: Clinical profile and outcome

Introduction: Although, diphtheria is eliminated in many developed countries by effective immunization, diphtheria still continues to be endemic in India and is the leading cause of morbidity and mortality, especially in rural parts of North Karnataka. The objective of the present study is to recognize the clinical profile, morbidity and mortality pattern of diphtheria and to study their immunization status as a hospital based observational study performed in paediatric intensive care unit. Materials and Methods: This study is a hospital based observational study from April 2018 to August 2018 at a tertiary care referral PICU, S.Nijalingappa Medical College and HSK hospital, Bagalkot, Karnataka. The cases were analysed with respect to demographic details, clinical features, immunization status, complications and mortality. Results: The study consisted of 22 children who presented with features suggestive of diphtheria, 90% were >5years of age with male to female ratio of 1.2:1. Of the 22 children 4 (18.2%) children were completely immunized, and 18(81.8%) were partially immunized/not immunized. All patients presented with fever, membrane in throat and throat pain (100%) followed by bull neck 54.5%, dysphagia 36.36%, epistaxis 9% and Airway obstruction 4.54%. Alberts stain was positive in 18 cases (81.8%) and throat swab culture positive in 16 cases (72.7%). Myocarditis was the commonest complication (63.6%) followed by palatal palsy (13.63%), shock (4.5%) and stroke (4.5%). Case fatality rate was 18.18%. Conclusion: Shifting of occurrence of diphtheria in the age group of >5 years suggest the need to improve and strengthen the immunization program specially the booster doses.