Diphtheria: A Case Series From Central India
DOI:
https://doi.org/10.52783/jns.v14.2569Keywords:
Diphtheria, Central India, Universal ImmunizationAbstract
Background: Diphtheria continues to be a public health problem in India as it is re-emerging in several regions of the country. In recent times, apart from preschool-aged children, diphtheria outbreaks are seen to affect older children and adults. Recent emergence of cases highlights the risk diphtheria poses when civil unrest interrupts vaccination and healthcare access. An improved understanding of the nature of each outbreak is therefore essential to generate a pool of evidence regarding the current disease status in India. Here we describe the case series of diphtheria from Central part of India so as to better understand the natural history of disease, key epidemiological factors, the role of asymptomatic carriers in transmission and effectiveness of control measures so as to improve clinical practices and support alternative strategies for response to future diphtheria outbreaks.
Results: Among the 10 patients admitted with clinical suspicion of oropharyngeal diphtheria. Microbiological diagnosis was achieved in 3 cases and one was diagnosed clinically. All the 3 bacteriological positive cases were of pediatric age group with incomplete immunization. All the positive cases were found to be originated from inmates of boarding school inhabiting the same residential area. Of the 10 patients, eight (80%) recovered, one (10%) succumbed to death while one took discharge against medical advice. Clinical presentations, vaccination history and microbiologic findings points towards the persistence of toxigenic strain of C. diphtheriae (gravis type) along with other rare corynebacterium spp. that clinically mimic as oropharyngeal diphtheria in the community and their role in disease transmission with potential for future outbreaks.
Conclusion: Awareness among people, widespread universal immunization coverage especially in cohorts of children, availability of modern microbiological support, and rapid early diagnosis are the cardinal steps to control diphtheria resurgence.
Downloads
Metrics
References
Boghani S,Shah H D,Fancy M,et al. A study on the Characteristics and Outcomes of Reported Diphtheria Patients in a Western state in India. Cureus.2023,15(3): e35769. DOI 10.7759/cureus.35769
Das, P. P., Patgiri, S. J., Saikia, L., & PauL, D.Recent outbreaks of diphtheria in Dibrugarh district, Assam, J Clin Diagn Res.2016;10(7):DR01–DR03
De Zoysa A, Hawkey PM, Engler K, George R, Mann G, Reilly W et al. Characterization of toxigenic Corynebacterium ulcerans strains isolated from humans and domestic cats in the United Kingdom. J Clin Microbiol. 2005 Sep;43(9):4377-81. doi: 10.1128/JCM.43.9.4377-4381.2005. PMID: 16145080; PMCID: PMC1234052.
Sharma, N.C., Efstratiou, A., Mokrousov, I. et al. Diphtheria. Nat Rev Dis Primers 2019;5:81. https://doi.org/10.1038/s41572-019-0131-y
Murhekar M, Epidemiology of diphtheria in India, 1996-2016: Implications for Prevention and control Am J Trop med Hyg 2017;97(2):313-18.10.4269/ajtmh.17-004728722581
Linda Quick, Roland W. Sutter, Ketevan Kobaidze, Naile Malakmadze, Revaz Nakashidze, Sophia Murvanidze et al. Risk Factors for Diphtheria: A Prospective Case-Control Study in the Republic of Georgia.The Journal of Infectious Diseases.2000;181(1):121–9.
Truelove SA, Keegan LT, Moss WJ, Chaisson LH, Macher E, Azman AS et al. Clinical and Epidemiological Aspects of Diphtheria: A Systematic Review and Pooled Analysis. Clin Infect Dis. 2020 Jun 24; 71(1):89-97.
Gary W, Procop. Aerobic and Facultative Gram-Positive Bacilli, Chapter 14 Koneman’s Color atlas & textbook of Diagnostic Microbiology 2017 7th edition Philadelphia Wolters Kluwer Health:845-960.
Elek, S. D. 1948. The recognition of toxicogenic bacterial strains in vitro. Br. Med. J. 1:493
Dandinarasaiah, M., Vikram, B.K., Krishnamurthy, N. et al. Diphtheria Re-emergence: Problems Faced by Developing Countries. Indian J Otolaryngol Head Neck Surg.2013, 65: 314–8
Madhulika Mistry & Arpita Bhattacharya. Emergence of Diphtheria in Western Part of Gujarat - A Microbiological Case Series from a Tertiary Care Hospital of Rajkot. Saudi J Pathol Microbiol.2021;6(7):246-9.
Dikid, T., Jain, S. K., Sharma, A., Kumar, A., & Narain, J. P.Emerging & re-emerging infections in India: an overview. The Indian journal of medical research.2013; 138(1):19.
Simmons LE, Abbot JD, Macaulay ME. Diphtheria carriers in Manchester: simultaneous infection with toxigenic and non-toxigenic mitis strains. Lancet 1980; 2:304-5.
Tiley SM, Kociuba KR, Heron LG, Munro R. Infective endocarditis due to nontoxigenic Corynebacterium diphtheriae: a report of seven cases and review. Clin Infect Dis 1993; 16:271-5.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
