A diphtheria outbreak in Buri Ram, Thailand.

In May 1996 there was an outbreak of diphtheria in Buri Ram, Thailand which infected 31 patients, 8 males and 23 females. The mean age of the patients was 8 +/- 5 years. Seventy-four percent had a history of childhood vaccinations. Common signs and symptoms included fever (100%) which was low grade in 61%, sore throat (90%), upper airway obstruction (3%), and hoarseness (10%). Pseudomembranes (seen in 100%) were located on the tonsils (71%), pharynx (22%), larynx (9.6%), and uvula (6%). The mean duration of symptoms prior to admission was 2 days with a range of 1 to 5 days. Complications included upper airway obstruction (10%) and cardiac complications (10%). There were no neurological complication or deaths. There were negative associations between cardiac complications, severity of disease and previous diphtheria vaccination. The ages varied from children to adults. Early recognition and prompt treatment decreased complications and mortality in this group of patients when compared with Chiang Mai and Queen Sirikit National Institute of Child Health (QSNICH) studies.

Potency assay of diphtheria antitoxin in vero cell micro-cultures

Se establecieron condiciones para llevar a cabo la titulación de antitoxina diftérica en células Vero (TCC), y comparar los resultados con la prueba intradérmica (TID) tradicionalmente empleada en todo el mundo para determinación de potencia de toxoide diftérico y de antitoxina de uso terapéutico. Los resultados de titulaciones en pruebas intradérmicas y en cultivos celulares mostraron gran repetibilidad y detectabilidad a concentraciones muy bajas de toxina en la prueba de cultivos celulares, así como una correlación satisfactoria en la titulación de antitoxinas preparadas por inmunización con Patrón Internacional de OMS y con antitoxina de uso terapéutico, pero en los sueros de cobayo se observó un título aproximadamente 10 veces menor al de la prueba intradérmica. Se discuten las posibles causas de estas diferencias de títulos. Esta prueba se podrá adoptar en la forma propuesta para determinar potencia de antitoxina diftérica. En la prueba de potencia del toxoide diftérico, se podría usar si el límite de título en los cobayos se ajusta a 0.2 UIAD en lugar de 2.0 UIAD/ml que se emplea actualmente, considerando la equivalencia obtenida entre las dos pruebas y tomando en cuenta una relación 1:10 entre las pruebas TCC y TID

Diphtheria in the eighties: experience in a south Indian district hospital.

Epidemiological and clinical analysis of 228 cases of diphtheria treated during a 10-year period from 1980-1989 is presented. No statistically significant change in the incidence over a decade was noticed. A high percentage of cases (44.74%) were noted in the age group of 5 years and above. Bilateral tonsillar and pharyngeal membranes together were seen in 60% cases. All patients were treated with diphtheria antitoxin and benzyl penicillin. Severe myocarditis (9 cases), fulminant haemorrhagic complications (2 cases), palatal palsies (11 cases) and polyneuritis and cranial nerve paralysis (2 cases) were the significant complications. Case fatality rate was 13.21%. Statistically significant increase in the mortality (p less than 0.05) was noticed in the year 1987 and onwards. In this period, myocarditis (8 out of 16 deaths) is gradually replacing laryngeal obstruction, the major cause of death in early eighties or post-tracheostomy complications (6 out of 16 deaths). Only 2 patients died of haemorrhagic diphtheria in this period.

Hemorrhagic diphtheria.

Two cases of hemorrhagic diphtheria, a rare entity and severest form are reported. Both of them have been mildly ill for more than 3 days and did not seek medical attention, suddenly developed bleeding episodes with clinical evidence of diphtheria in association with severe thrombocytopenia. Inspite of antitoxin, antibiotics therapy and supportive care one died on the third day. The second case was given additional steroid therapy to the regimen and survived with diphtheria myocarditis.