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Clinico-Epidemiological Profile and Predictors of Poor Outcome Among Children During a Diphtheria Outbreak in Haryana

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Abstract

Objective

To study the clinico-epidemiological profile and predictors of poor outcome in an outbreak of diphtheria.

Methods

Records of 390 children admitted with the diagnosis of clinical diphtheria in a tertiary care teaching hospital in Nuh, Haryana, from January, 2018 to December, 2020 were analysed with respect to demographic details, immunization status, clinical features, complications and mortality. Patients were divided into survivors and non-survivors, and various variables were compared between the two groups to identify the factors associated with poor outcome.

Results

Out of 390 cases, data of 318 (81.5%) was included. Young children (median age 5 year) were predominantly affected, and only 8 (2.5%) children were fully immunized. Pseudomembrane was present in 245 (77%) cases. Albert staining and culture were positive in 84.6% (269) and 12.9% (41) cases, respectively. Complications developed in 48.4% (n=154) cases and included: airway compromise 22.6% (n=72), diphtheritic cardiomyopathy 12.9% (n=41), acute kidney injury 3.7% (n=12), thrombocytopenia 8.5% (n=27) and hepatitis 0.6% (n=2) cases. Anti-diphtheritic serum (ADS) was administered to all admitted patients. Tracheostomy was done in (n=57) (17.9%) children. Case fatality rate was 17.9%.

Conclusion

Diphtheria mostly affected young unvaccinated or partially vaccinated children. Mortality was high in unimmunized or partially immunized young children and those with bull neck, pseudomembrane, delayed (≥5 days) administration of ADS, acute kidney injury, thrombocytopenia and leukocytosis. Myocarditis was strongly associated with high mortality.

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Authors and Affiliations

  1. Department of Pediatrics, Shaheed Hasan Khan Mewati, Government Medical College, MC, Nuh, Haryana, 122107, India

    Ayaz Ahmed, Maha Singh, Priyanka Tank & Meetu Yadav

Authors
  1. Ayaz Ahmed
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  2. Maha Singh
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  3. Priyanka Tank
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  4. Meetu Yadav
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Corresponding author

Correspondence to Meetu Yadav.

Additional information

Ethics clearance

Institutional Ethical Committee, SHKM GMC; No. SHKM/IEC/2020/149, dated Dec 07, 2020.

Contributors

AA, MY: conceptualized the study, collected and interpreted the data and prepared the initial manuscript; MS, PT: supervised the study, revived literature and revised the initial manuscript. All authors approved the final version of the manuscript and are accountable for all aspects related to study.

Funding

None

Competing interests

None stated.

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Ahmed, A., Singh, M., Tank, P. et al. Clinico-Epidemiological Profile and Predictors of Poor Outcome Among Children During a Diphtheria Outbreak in Haryana. Indian Pediatr 60, 280–284 (2023). https://doi.org/10.1007/s13312-023-2859-1

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  • DOI: https://doi.org/10.1007/s13312-023-2859-1

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