A cross sectional study on clinical profile and complications associated with diphtheria in Sir Ronald Ross Institute of Tropical and Communicable diseases, Hyderabad, Telangana state (original) (raw)
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A Case Series of Diphtheria in Western India: Time to Revisit Vaccination Coverage and Policy?
2021
INTRODUCTION: Diphtheria is a significant child health problem in countries with low immunization coverage. Reports of diphtheria in the adult population are also increasing. Here we describe case series of diphtheria in western India for 6 months. OBJECTIVE: To identify and isolate Corynebacterium species, demonstrate the isolates for toxigenicity and examine the immune status of the patients by estimating antibody titers in sera (antidiphtheria toxoid IgG). METHODS: Twelve patients admitted with clinical suspicion of oropharyngeal diphtheria for six months. In each case, two throat swabs were collected and primary identification of Corynebacterium diphtheriae was done by direct microscopy (Gram's and Albert's stains), bacteriological culture and biochemical tests as per the standard procedure. Culture isolates were tested for toxigenicity by Elek's gel precipitation and were sent to a reference laboratory for tox A gene detection by polymerase chain reaction. Anti-diphtheria toxoid IgG antibody levels were determined in patient's sera using a commercial Anti-Diphtheria Toxoid IgG Enzyme-Linked Immunosorbent Assay (EUROIMMUN, Germany) at a reference laboratory. RESULTS: All 12 patients presented with oropharyngeal diphtheria with the formation of pseudomembrane in the oropharynx. Eleven patients were of the pediatric age group and one was an adult. The microbiological diagnosis was achieved for 11 patients and one was diagnosed clinically. Based on vaccination history, microbiological findings and distribution of anti-diphtheria toxoid IgG antibodies titers, the results showed persistence of toxigenic strain of Corynebacterium diphtheriae circulating in our region. CONCLUSIONS: The present study demonstrated that toxigenic strains of C. diphtheriae are circulating in this geographical location which indicates the need for constant epidemiological surveillance ensuring early detection of diphtheria and review the efficacy of the immunization programme.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: Diphtheria is an infectious disease caused by a gram-positive facultatively anaerobic bacilli, Corynebacterium (C.) diphtheriae. The present health statistics and data from the few studies that have been carried out suggest that our war with this disease is still going on and is far from being over in spite of the vaccine that’s freely available. Aim: To study clinical profile, complications, and outcome of diphtheria in karnataka population and to correlate with immunisation status. Materials and Methods: This was a hospital-based prospective cross-sectional observational study done in the Department of Paediatrics, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India, from January 2018 to November 2018. Patients admitted with history suggestive of diphtheria were enrolled and categorised into probable and confirmed cases. The age, sex, area of residence, religion, immunisation status, mean time of presentation to hospital from onset of illness, use of ...
Resurgence of diphtheria: clinical profile and outcome in a tertiary care hospital of South India
International Journal of Contemporary Pediatrics
Background: Diphtheria is a potentially fatal acute disease caused by Corynebacterium diphtheria. It was one of the leading causes of mortality in the pre vaccination era. This study is an attempt to highlight the clinical profile, outcome and demographic characteristics, immunization status of pediatric diphtheria cases in South India. Objective of the study was to analyze the clinical profile, immunization status and outcome in children with diphtheria admitted to the PICU in a tertiary care hospital.Methods: This retrospective study was conducted in a tertiary care hospital in South India. The case records of all children admitted to the hospital between January 1st, 2014 to December 31st, 2018 with clinically suspected diphtheria were analyzed. The data was analyzed with respect to clinical features, demographic characteristics, immunization status, complications and outcome using appropriate statistical methods.Results: 18 cases were clinically suspected to have diphtheria. The...
Diphtheria: A case series from West Maharashtra, India
Journal of Medical Sciences and Health
Diphtheria is an acute infectious toxin mediated disease caused by Corynebacterium diphtheriae. Effective vaccination has decreased the incidence of disease globally. However, despite of a full-fledged Universal Immunization Programme, the cases are still seen in children and adolescents in many states in India. Here, we report three recent cases of diphtheria from Solapur district of Maharashtra to flag the awareness of the disease and importance of vaccination. Keywords: Corynebacterium diphtheria, immunization, Diphtheria antitoxin
2013
Diphtheria is a communicable disease of global significance, and its outbreaks have to be reported to the world community under the International Health Regulations (IHR). A pilot seroepidemiological survey was conducted to assess immunity status of diphtheria among healthy individuals of Rawalpindi/Islamabad (Pakistan), who had been administered at least one dose of the vaccine against the disease, as part of childhood vaccination. The study group comprised of 128 healthy subjects, grouped according to the decade representing their age. Antidiphtheria IgG levels were measured by Enzyme Linked Immunosorbent Assay (ELISA) method. The studied sample showed 100% prevalence of diphtheria antitoxin, confirming prior vaccination; however 49.2% exhibited only minimal protection against diphtheria. Full protection was observed in a significantly higher (p=0.013) percentage of males (54.45%) as compared to female subjects (33.33%). Maximum level of serum antibodies were seen in 1-10 year age...
Clinico-epidemiological Profile of Children with Diphtheria in Tertiary Care Hospital of Nepal
Journal of Nepal Paediatric Society
Introduction: This study was conducted with the aim to describe the clinical presentation of diphtheria in children, relationship between clinical disease and immunization status, complications of the disease and adverse events due to anti diphtheria serum (ADS). Methods: All patients admitted at Tribhuvan University Teaching Hospital, Kathmandu from July 2016 to November 2018 with clinical diagnosis of diphtheria were included in this study. Results: There were total 12 children and age ranged from five to 15 years, out of which seven (58%) were males and five (42%) were females. All of them were immunized except one whose immunization status was unknown. All of them had tonsillopharyngeal diphtheria. Four patients (33%) also had nasal and five (42%) patients had additional laryngotracheal diphtheria. Seven patients had bull neck on presentation. Four patients had airway obstruction due to laryngotracheal diphtheria requiring tracheostomy. Throat swab for Corynebacterium Diphtheria...
Sporadic Outbreaks of Diphtheria: A Three Year Study from a Tertiary Care Centre of Northeast India
Diphtheria is an acute toxin mediated contagious febrile illness, predominantly in children, caused by the locally invasive Gram positive bacillus Corynebacterium diphtheriae. In developing countries, with increasing coverage of immunization, the incidence of the disease has declined. This study was carried out to know the incidence of diphtheria among 99 patients from suspected sporadic diphtheria outbreaks, admitted in a tertiary care centre of Assam in Northeast India, over a period of three years from January, 2013 to December, 2015. Throat swabs were collected and subjected to direct smear microscopy by Gram's and Albert stains, and culture on Blood agar, Loeffler's seum and Tellurite Blood agar media. C. diphtheriae was isolated in 26 cases. The highest culture positivity of 40% each was in age groups 5-9 and 10-14 years. Culture positivity was highest (62.5%) in non-immunized patients, and surprisingly, it was 31.57% in fully immunized patients. The study signifies re-emergence of diphtheria in this State calling for intensive monitoring and review of Universal Immunization Programme, and quality, storage and transport conditions of vaccines in the State.
Recent Cases of Diphtheria in a Metropolitan City
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2020
Introduction: Diphtheria is an acute, highly infectious and previously endemic disease. Due to the vaccine preventable nature of the disease and initial steady decline, not much attention had been given towards this disease. Recent increase in the number of clinically suspected and laboratory confirmed cases of diphtheria have been observed in our laboratory. Aims and objectives: To study the status of resurgence of the disease in a tertiary care hospital of Mumbai. Materials and methods: 76 throat swabs and 1 slough material from 57 clinically suspected cases of diphtheria over a period of one and a half year from July 2018 to December 2019 were obtained and were processed for microscopy and culture for Corynebacterium species by standard microbiological techniques. Results: Eighteen (23.37%) out of 77 samples yielded Corynebacterium species on culture. Out of 57 suspected patients, 11 were culture confirmed diphtheria (19.29%). None of the patients were less than 5 years of age, 5...
Diphtheria is a re-emerging disease with a changing epidemiology. It is thus essential to recognize diphtheria's clinical profile, patterns of morbidity and mortality, and the level of immunization. This study aimed to analyze the clinical-epidemiological profile of patients with diphtheria at the Infectious Disease Hospital, New Delhi, India. The present study was a cross-sectional investigation conducted on 94 patients diagnosed with diphtheria. The data collection tool was a questionnaire that had questions eliciting details such as socio-demographic characteristics, clinical history, examination findings, and vaccination history. The case fatality rate was calculated. Means and proportions were also measured, and the significance level was set at P <0.05. The meanSD age of the participants was 94.4 years. Laryngeal involvement was found in 10 (11%) participants. Complete diphtheria vaccination doses were taken by 6 (6.4%) participants. The case fatality rate was 13%, and complications such as neuropathy were found in 21 (22%) cases, cardiac problems in 12 (13%), and respiratory problems in 13 (14%). Longer duration of the illness, delayed presentation, and complications were associated with poor clinical outcomes (P<0.05). The majority of diphtheria cases were 6-10 years old and had a low socioeconomic status. Most of them had a partial vaccination against diphtheria. Around one-third of the patients had complications related to diphtheria, and the case fatality rate was also high. Key preventive measures for controlling the deadly diphtheria disease include specialized immunization programs for areas with poor immunization coverage, as well as the early detection and treatment of suspected cases.
Diphtheria remains a threat to health in the developing world: an overview
Memórias do Instituto Oswaldo Cruz, 2003
Changes in the epidemiology of diphtheria are occurring worldwide. A large proportion of adults in many industrialized and developing countries are now susceptible to diphtheria. Vaccine-induced immunity wanes over time unless periodic booster is given or exposure to toxigenic Corynebacterium diphtheriae occurs. Immunity gap in adults coupled with large numbers of susceptible children creates the potential for new extensive epidemics. Epidemic emergencies may not be long in coming in countries experiencing rapid industrialization or undergoing sociopolitical instability where many of the factors thought to be important in producing epidemic such as mass population movements and difficult hygienic and economic conditions are present. The continuous circulation of toxigenic C. diphtheriae emphasizes the need to be aware of epidemiological features, clinical signs, and symptoms of diphtheria in vaccine era so that cases can be promptly diagnosed and treated, and further public health measures can be taken to contain this serious disease. This overview focused on worldwide data obtained from diphtheria with particular emphasis to main factors leading to recent epidemics, new clinical forms of C. diphtheriae infections, expression of virulence factors, other than toxin production, control strategies, and laboratory diagnosis procedures.