When no cases are reported in usa and China in last 10 years hundreds of cases are reported in single Indian state per year with 50 percent mortality

1. DIPHTHERIA MYOCARDITIS:
CASE SERIES IN OSMANIA
GENERAL HOSPITAL
Bhageerath Atthe , KMK REDDY .P. ,Y.V.Subba Reddy,
O. Adikesava Naidu, Ravi Srinivas, Marakkagari
vamsi krishna

2. INTRODUCTION
•The name of the disease is derived from the Greek
word diphthera, meaning leather hide. The disease
was described in the 5th century BC by
Hippocrates,
•The bacterium was first observed in diphtheritic
membranes by Klebs in 1883 and cultivated by
Loffler in 1884, hence it is also called Klebs Loffler
bacillus.
•Culture of the organism requires selective
media containing tellurite.

3. Antitoxin
 The first nobel prize in
medicine was awarded in
1901 to the German
physiologist, Emil Adolf von
Behring for his discovery of
serum therapy in the
development of the diphtheria
and tetanus.

4.  Diphtheria is still endemic in India due to
inadequate immunization.
 The incidence of myocarditis is higher in these
patients.
 The objective of this study was to study clinical
profile, clinical outcomes as well as
immunization status of the patients diagnosed
with diphtheria myocarditis in Indian scenario.

6. Methods
 This was a prospective, single-center and
observational study
 An analysis of 46 cases of diphtheria
myocarditis, observed during year 2016 , 2017
reported in Osmania General Hospital,
Hyderabad.
 All patients were closely monitored for a
minimum period of 4-6 weeks from the onset of
respiratory symptoms.
 Continuous ECG monitoring including blood
biochemistry were done in each case

7. Throat swab for Albert's stain and culture were
done in all cases.
All patients with a clinical diagnosis of diphtheria
were treated with intravenous benzyl penicillin and
antidiphtheritic serum (ADS) .
Each patient was monitored closely for any
development of shortness of breath, palpitation,
chest discomfort, and hypotension

8. Results
 Out of the 46cases reported
 28 were male children,
 18 were female.
31 children were below 10 years of age.
22 children were between 5 and 10 years age
including one Holt- Oram syndrome and one
Down syndrome case.
 Out of the 46 cases, 28 died.
 The case fatality rate in this series was 60 per
cent.

9. SEX DISTRIBUTION
NO OF CASES
MALES
FEMALES

10. 0
5
10
15
20
25
30
MALES FEMALES
DEATH
SURVIVED

11. 0
2
4
6
8
10
12
14
0 TO 5 6 TO 10 11 TO 15 >15
SURVIVED
DEATH

12. Contd..
 None of the 46 patients was adequately
immunized.
 16 children didn’t even receive primary doses
 30 children had not received booster doses .

13. 0
5
10
15
20
25
30
immunized partially
immunized
unvaccinted
death
survived

18. characteristic No of patients=28 No of deaths
Age in years
<5 years 9 8
5– 10 years 22 13
10 – 15 years 13 6
>15 years 2 1
Gender
Males 28 18
Females 18 10
Clinical features
Fever 27 14
Throat pain and cough 27 14
Neurological manifestation 5 3
Bull neck 6 5
White patch 18 8
Immunization status
Non immunized 16 12
Partially immunized 30 16

19. Lbbb

20. ABNORML
CONDUCTION

21. MIMICKING MI

22. CHB WITH JUNCTIONAL ESCAPE

23. ECG abnormality No of patients
ST changes 11
T wave inversion 16
Abnormal conduction 8
LBBB 9
RBBB 11
Complete heart block 8
RBBB + LBBB 6
RBBB + complete heart
block
5
LBBB + complete heart
block
5
RBBB + LBBB + complete
heart block
3

24. Echo findings

25.  Diphtheria antitoxin does not neutralize toxin
that is already fixed to tissues, but it will
neutralize circulating (unbound) toxin and
prevent progression of disease.
 For close contacts, especially household
contacts, a diphtheria booster, appropriate for
age, should be given. Contacts should also
receive antibiotics—benzathine penicillin G
(600,000 units for persons younger than 6
years old and 1,200,000 units for those 6 years
old and older) or a 7- to 10-day course of oral
erythromycin (40 mg/kg/ day for children and 1

26. Temporary Pacemaker
 12 patients were kept on tpi out of which 2
survived after 10 and 12 days duration

28. In this study clustering of diphtheria cases
was seen in the age group of 5-10 years
predominantly due to lack of booster doses
(DT), unidentified and untreated diphtheria
carriers
patients below 5 years of age had diphtheria
possibly due to modifying effect of passively
acquired maternal antibodies in young infants
which could suppress the development of
active immunity following early administration
of DPT vaccine, diminished efficacy of
Discussion

29. Conclusion
When no cases are reported in usa and China
in last 10 years hundreds of cases are reported in
single Indian state per year with 50 percent
mortality
In India, diphtheria still remains endemic with
fulminant complications and mortality especially in
children above 5 years
As diphtheria and its consequences can be
prevented by adequate immunization in children,
necessary steps must be taken for the

30. Many parents are not aware that adolescents
need a number of vaccinations.
Others may question whether their children will
benefit from the recommended immunization
At all visits, review the patient’s immunization
status, regardless of the reason for the visit.
Maintain a comprehensive immunization record in
the patient’s chart and update it regularly, as well
as send the information to the immunization
registry and a smart health card for all

31. Several factors like
 inadequate vaccine coverage,
 poor socio-economic status,
 delayed reporting, and
 non availability/delayed administration of diphtheria
antitoxin further contribute to high mortality.

35. WHAT MORE WE CAN DO
All hospitals should give free consultation
for vaccination
Public health officials and professional
organizations should respond swiftly
Immunization rates among adults should be
given importance considerably like in children

36. As if the celebrities post their voting pics, they
should post their children vaccination pics in USE
social media
The Community Preventive Services Task
Force recommends home visits based on strong
evidence of their effectiveness in increasing
vaccination rates
Immunize at every opportunity
Use a reminder and recall system

39. References
 CDC journal
 IAP journal
 Nelson textbook
 Harrison textbook
 Braunwald textbook

40. THANK YOU
EVERY
VACCINATION IS A
VICTORY