TITLE:
Prognostic Significance of Electrocardiographic Changes in Diphtheria Myocarditis: A Cross-Sectional Study
AUTHORS:
Karnakar Rapolu, Krishna Malakonda Reddy Parvathareddy, Suneetha Karumuri, Srinivasa Polasa, Ashok Thakkar
KEYWORDS:
Diphtheria Myocarditis, Clinical Outcomes, Epidemiology
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.5 No.15,
August
7,
2014
ABSTRACT: Background:
Diphtheria is still endemic in India due to inadequate immunization. The
incidence of myocarditis is higher in these patients. Objectives: 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. Methodology: This prospective observational study was carried
out in one of the tertiary care hospital of south India from August 2011 to
December 2012. A total of 33 cases with clinically confirmed diagnosis of
diphtheria myocarditis were enrolled depending upon the inclusion and exclusion
criteria of the study. Electrocardiography and 2-dimensional echocardiography
was done at the time of admission and repeated when required. Results: The most
common age group affected is 5 - 10 years, with no sex difference in
occurrence. Only 1 patient, out of 33 patients, was adequately immunized.
Asymptomatic myocardial involvement (with only changes in electrocardiogram)
was seen in 21 patients whereas 12 patients were symptomatic. The average duration
of resolution of electrocardiographic changes was 4 - 6 weeks. It should be
noted that out of 28 patients who developed conduction abnormalities, 24
patients died. Temporary pacemaker support was given for 8 patients, of whom only
one patient recovered. The patient was followed till hospital discharge.
Conclusion: The mortality associated with diphtheria myocarditis is higher in
Indian population. As diphtheria can be prevented by adequate vaccination,
efforts should be maximized for 90% coverage with three doses of diphtheria
toxoid in children below one year of age and immunity towards it should be
maintained by booster doses.