Complications of diphtheria seen during the 1978 outbreak in Khartoum

Abstract

Twenty-nine cases of complicated diphtheria infection occurring during an epidemic in Khartoum are reviewed. The organism was a Corynebacterium diphtheriae subsp. gravis with an unusual property of fermenting sucrose. Eighteen patients were detected during prospective follow-up, where as 11 presented initially with a complication. Complications were mostly seen among pre-school children (65.5%). A routine immunization course had been completed in only two of the patients. Neurological complications were the commonest, lasting for more than two weeks, and five of the six deaths were due to cardiovascular complications.

PIP: The clinical presentation and outcome in 29 children admitted to 2 Khartoum, Sudan, hospitals with complications of diphtheria are described. The patients ranged from 10 months to 11 years, and 66% were in the 2-5-year age group. The organism implicated was Corynebacterium diphtheriae subspecies gravis with an unusual property of fermenting sucrose. Only 2 of the 29 children had received immunizations against diphtheria. The most common complications were neurological. Palatal palsy was present in 21 children (72%) and 8 patients (28%) developed weakness of neck extensors. Bronchopneumonia was seen in 13 children (45%), while cardiovascular complications occurred in 6 children (21%). There were 6 deaths in this group, for a case fatality rate of 21%. 5 of these deaths were attributable to cardiovascular complications and the other followed tracheostomy. Analysis of the number of days from the onset of pharyngeal symptoms to the appearance of complications followed a set pattern. Cardiovascular symptoms were the 1st to appear, followed by palatal palsy, peripheral weakness or paralysis, pharyngeal paralysis, weakness of neck flexors, and 6th and 7th nerve palsies. Although 4 doses of DPT vaccine are not an absolute guarantee diphtheria will not occur, there are significant differences between vaccinated and unvaccinated children in the relative incidence, morbidity, and mortality from the disease. This suggests a justification for mass immunization programs in regions such as the Sudan where diphtheria is common.