Resurgence of Diphtheria : Are We ready to treat ?

Objectives: To create awareness amongst the medical faculty about a forgotten fatal disease (diphtheria). To determine the age distribution, immunization status, presenting features, prognosis with respect to duration after which they took medication and effect of ADS on recovery in cases of faucial and laryngeal diphtheria. To stress on the importance of DTP immunization to control diphtheria. Study method: In this study, 15 patients who presented to the Government general hospital between July and September 2013 with membranous tonsillitis were enrolled. In every diphtheriaproven case, we administrated antidiphtheric serum (ADS) as early as possible along with injection crystalline penicillin (CP) and oral erythromycin. Tracheostomy was done in two cases who presented with stridor. Patient variables and their correlation with recovery were studied. Results: Out of 15 cases of membranous tonsillitis, nine tested positive for diphtheria; eight, smear positive and one, culture positive. Of these nine cases, eight were between 9 and 13 years old and one was a 50-year-old man. While tracing immunization status, it was found that three children (33%) were not immunized, four children (22%) had not taken booster doses, and in one child and the adult, immunization history was unknown. Clinical presentation of two of the unimmunized cases was late (on 8th day of fever), with stridor due to laryngeal diphtheria. The third child presented with bull neck, and developed myocarditis. These three cases proved fatal. Six cases which presented early and were managed in time recovered fully. Conclusion: Unimmunized children as well as adults are susceptible to diphtheria. High immunization coverage is the only tool to control this infection. Booster doses are needed to control disease in adults. It was found that early diagnosis with high index of suspicion and early administration of ADS along with good supportive therapy carried good prognosis. Every otolaryngologist, pediatrician as well as general practitioner should be ready to manage the cases of diphtheria. Government should be prepared to manage and control epidemics effectively.