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.

Fulminant diptheretic myocarditis.

Five cases of fulminant diphtheritic myocarditis are described. Among them, three had extensive faucial diphtheria. Two had minor ECG abnormalities like low voltage QRS complexes. One of the three cases of severe diphtheria had atrioventricular dissociation, one developed LBBB leading to complete heart block, and the last one had ventricular tachycardia. Three of the five children died; all of them had major ECG abnormalities. Prognosis was also related to SGOT levels.