Diphtheria natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2], Aysha Anwar, M.B.B.S[3]
Overview
Diphtheria is a vaccine-preventable disease that can lead to such severe complications as respiratory failure, myocarditis, polyneuropathies, and death.[1][2][3][4][5][6] The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among patients younger than 5 and older than 40 years of age.[7]
Natural History, Complications, and Prognosis
Natural History
The symptoms of diphtheria usually develop following an incubation period of 2-4 days. Early symptoms typically include sore throat, high-grade fever, myalgias, lymphadenopathy, hoarseness of voice, dyspnea, rhinorrhea, and difficulty swallowing. Without treatment, diphtheria may progress to cause airway obstruction, neuropathies, myocarditis, septicemia, shock, and death.[1][2]
Complications
Complications that may develop as a result of diphtheria are:[2][8][9][10][3][4][5][6]
- Respiratory failure
- Myocarditis
- Heart failure
- Polyneuropathies
- 10th cranial nerve disorder
- 9th cranial nerve disorder
- Peripheral motor neuropathy
- Diaphragm paralysis
- Neurogenic bladder dysfunction
- Acute renal failure
- Septicemia
- Death
Prognosis
The overall case-fatality rate for diphtheria is 5–10%, with higher death rates (up to 20%) among patients younger than 5 and older than 40 years of age.[7] Prognosis of diphtheria varies based on following factors:[11][12][13][6]
Good prognostic factors
- Early diagnosis and treatment
- Age >15 years
- Absence of cardiac involvement
Poor prognostic factors
- Delayed diagnosis and treatment
- Age <15 years
- Presence of cardiac involvement
- Presence of complications
- Immunocompromised status
References
- ↑ 1.0 1.1 Dobie RA, Tobey DN (1979). "Clinical features of diphtheria in the respiratory tract". JAMA. 242 (20): 2197–201. PMID 490806.
- ↑ 2.0 2.1 2.2 MORGAN BC (1963). "CARDIAC COMPLICATIONS OF DIPHTHERIA". Pediatrics. 32: 549–57. PMID 14069096.
- ↑ 3.0 3.1 Sanghi V (2014). "Neurologic manifestations of diphtheria and pertussis". Handb Clin Neurol. 121: 1355–9. doi:10.1016/B978-0-7020-4088-7.00092-4. PMID 24365424.
- ↑ 4.0 4.1 Jain A, Samdani S, Meena V, Sharma MP (2016). "Diphtheria: It is still prevalent!!!". Int J Pediatr Otorhinolaryngol. 86: 68–71. doi:10.1016/j.ijporl.2016.04.024. PMID 27260583.
- ↑ 5.0 5.1 http://www.who.int/immunization/topics/diphtheria/en/index1.html Accessed on October 7, 2016
- ↑ 6.0 6.1 6.2 Jayashree M, Shruthi N, Singhi S (2006). "Predictors of outcome in patients with diphtheria receiving intensive care". Indian Pediatr. 43 (2): 155–60. PMID 16528112.
- ↑ 7.0 7.1 http://www.cdc.gov/diphtheria/clinicians.html Accessed on October 7, 2016
- ↑ http://www.cdc.gov/diphtheria/about/complications.html Accessed on October 7, 2016
- ↑ Anima H, Malay M, Santanu H, Rajashree R, Sita C, Baran SA (2008). "A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID & BG Hospital of Kolkata". J Commun Dis. 40 (1): 53–8. PMID 19127670.
- ↑ Reidermann MI (1996). "[Cardiac complications in adult diphtheria: analysis of 212 cases]". Praxis (Bern 1994). 85 (51–52): 1647–51. PMID 9026877.
- ↑ Kadirova R, Kartoglu HU, Strebel PM (2000). "Clinical characteristics and management of 676 hospitalized diphtheria cases, Kyrgyz Republic, 1995". J Infect Dis. 181 Suppl 1: S110–5. doi:10.1086/315549. PMID 10657201.
- ↑ Logina I, Donaghy M (1999). "Diphtheritic polyneuropathy: a clinical study and comparison with Guillain-Barré syndrome". J Neurol Neurosurg Psychiatry. 67 (4): 433–8. PMC 1736572. PMID 10486387.
- ↑ Kneen R, Nguyen MD, Solomon T, Pham NG, Parry CM, Nguyen TT; et al. (2004). "Clinical features and predictors of diphtheritic cardiomyopathy in Vietnamese children". Clin Infect Dis. 39 (11): 1591–8. doi:10.1086/425305. PMID 15578357.