Diphtheria natural history, complications and prognosis: Difference between revisions

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{{Diphtheria}}
{{Diphtheria}}


{{CMG}} {{AE}} {{KD}} {{AA}}
{{CMG}}; {{AE}} {{KD}}, {{AA}}
==Overview==
==Overview==
Diphtheria is a vaccine preventable disease which can lead to severe complications like  respiratory failure, myocarditis, polyneuropathies and death once the disease sets in.  
Diphtheria is a vaccine-preventable disease that can lead to such severe complications as [[respiratory failure]], [[myocarditis]], polyneuropathies, and death.<ref name="pmid490806">{{cite journal| author=Dobie RA, Tobey DN| title=Clinical features of diphtheria in the respiratory tract. | journal=JAMA | year= 1979 | volume= 242 | issue= 20 | pages= 2197-201 | pmid=490806 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=490806  }} </ref><ref name="pmid14069096">{{cite journal| author=MORGAN BC| title=CARDIAC COMPLICATIONS OF DIPHTHERIA. | journal=Pediatrics | year= 1963 | volume= 32 | issue=  | pages= 549-57 | pmid=14069096 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14069096  }} </ref><ref name="pmid24365424">{{cite journal| author=Sanghi V| title=Neurologic manifestations of diphtheria and pertussis. | journal=Handb Clin Neurol | year= 2014 | volume= 121 | issue=  | pages= 1355-9 | pmid=24365424 | doi=10.1016/B978-0-7020-4088-7.00092-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24365424  }} </ref><ref name="pmid27260583">{{cite journal| author=Jain A, Samdani S, Meena V, Sharma MP| title=Diphtheria: It is still prevalent!!! | journal=Int J Pediatr Otorhinolaryngol | year= 2016 | volume= 86 | issue=  | pages= 68-71 | pmid=27260583 | doi=10.1016/j.ijporl.2016.04.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27260583  }} </ref><ref name=WHOD>http://www.who.int/immunization/topics/diphtheria/en/index1.html Accessed on October 7, 2016</ref><ref name="pmid16528112">{{cite journal| author=Jayashree M, Shruthi N, Singhi S| title=Predictors of outcome in patients with diphtheria receiving intensive care. | journal=Indian Pediatr | year= 2006 | volume= 43 | issue= 2 | pages= 155-60 | pmid=16528112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16528112  }} </ref> The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among patients younger than 5 and older than 40 years of age.<ref name=CDCD>http://www.cdc.gov/diphtheria/clinicians.html Accessed on October 7, 2016</ref>
==Natural history==


==Complications==
==Natural History, Complications, and Prognosis==
Complications that can develop as a result of diphtheria are:<ref name=CDCdiphtheria>http://www.cdc.gov/diphtheria/about/complications.html Accessed on October 7, 2016</ref><ref name="pmid14069096">{{cite journal| author=MORGAN BC| title=CARDIAC COMPLICATIONS OF DIPHTHERIA. | journal=Pediatrics | year= 1963 | volume= 32 | issue=  | pages= 549-57 | pmid=14069096 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14069096  }} </ref><ref name="pmid19127670">{{cite journal| author=Anima H, Malay M, Santanu H, Rajashree R, Sita C, Baran SA| title=A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID & BG Hospital of Kolkata. | journal=J Commun Dis | year= 2008 | volume= 40 | issue= 1 | pages= 53-8 | pmid=19127670 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19127670  }} </ref><ref name="pmid9026877">{{cite journal| author=Reidermann MI| title=[Cardiac complications in adult diphtheria: analysis of 212 cases]. | journal=Praxis (Bern 1994) | year= 1996 | volume= 85 | issue= 51-52 | pages= 1647-51 | pmid=9026877 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9026877  }} </ref><ref name="pmid24365424">{{cite journal| author=Sanghi V| title=Neurologic manifestations of diphtheria and pertussis. | journal=Handb Clin Neurol | year= 2014 | volume= 121 | issue=  | pages= 1355-9 | pmid=24365424 | doi=10.1016/B978-0-7020-4088-7.00092-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24365424  }} </ref><ref name="pmid27260583">{{cite journal| author=Jain A, Samdani S, Meena V, Sharma MP| title=Diphtheria: It is still prevalent!!! | journal=Int J Pediatr Otorhinolaryngol | year= 2016 | volume= 86 | issue=  | pages= 68-71 | pmid=27260583 | doi=10.1016/j.ijporl.2016.04.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27260583  }} </ref><ref name=WHOD>http://www.who.int/immunization/topics/diphtheria/en/index1.html Accessed on October 7, 2016</ref>
===Natural History===
The symptoms of diphtheria usually develop following an incubation period of 2-4 days. Early symptoms typically include [[sore throat]], high-grade [[fever]], [[myalgias]], [[lymphadenopathy]], hoarseness of voice, [[dyspnea]], [[rhinorrhea]], and difficulty swallowing. Without treatment, diphtheria may progress to cause airway obstruction, neuropathies, [[myocarditis]], [[septicemia]], [[shock]], and death.<ref name="pmid490806">{{cite journal| author=Dobie RA, Tobey DN| title=Clinical features of diphtheria in the respiratory tract. | journal=JAMA | year= 1979 | volume= 242 | issue= 20 | pages= 2197-201 | pmid=490806 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=490806  }} </ref><ref name="pmid14069096">{{cite journal| author=MORGAN BC| title=CARDIAC COMPLICATIONS OF DIPHTHERIA. | journal=Pediatrics | year= 1963 | volume= 32 | issue=  | pages= 549-57 | pmid=14069096 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14069096  }} </ref>
 
===Complications===
Complications that may develop as a result of diphtheria are:<ref name="pmid14069096">{{cite journal| author=MORGAN BC| title=CARDIAC COMPLICATIONS OF DIPHTHERIA. | journal=Pediatrics | year= 1963 | volume= 32 | issue=  | pages= 549-57 | pmid=14069096 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14069096  }} </ref><ref name=CDCdiphtheria>http://www.cdc.gov/diphtheria/about/complications.html Accessed on October 7, 2016</ref><ref name="pmid19127670">{{cite journal| author=Anima H, Malay M, Santanu H, Rajashree R, Sita C, Baran SA| title=A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID & BG Hospital of Kolkata. | journal=J Commun Dis | year= 2008 | volume= 40 | issue= 1 | pages= 53-8 | pmid=19127670 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19127670  }} </ref><ref name="pmid9026877">{{cite journal| author=Reidermann MI| title=[Cardiac complications in adult diphtheria: analysis of 212 cases]. | journal=Praxis (Bern 1994) | year= 1996 | volume= 85 | issue= 51-52 | pages= 1647-51 | pmid=9026877 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9026877  }} </ref><ref name="pmid24365424">{{cite journal| author=Sanghi V| title=Neurologic manifestations of diphtheria and pertussis. | journal=Handb Clin Neurol | year= 2014 | volume= 121 | issue=  | pages= 1355-9 | pmid=24365424 | doi=10.1016/B978-0-7020-4088-7.00092-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24365424  }} </ref><ref name="pmid27260583">{{cite journal| author=Jain A, Samdani S, Meena V, Sharma MP| title=Diphtheria: It is still prevalent!!! | journal=Int J Pediatr Otorhinolaryngol | year= 2016 | volume= 86 | issue=  | pages= 68-71 | pmid=27260583 | doi=10.1016/j.ijporl.2016.04.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27260583  }} </ref><ref name=WHOD>http://www.who.int/immunization/topics/diphtheria/en/index1.html Accessed on October 7, 2016</ref><ref name="pmid16528112">{{cite journal| author=Jayashree M, Shruthi N, Singhi S| title=Predictors of outcome in patients with diphtheria receiving intensive care. | journal=Indian Pediatr | year= 2006 | volume= 43 | issue= 2 | pages= 155-60 | pmid=16528112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16528112  }} </ref>
* [[Respiratory failure]]  
* [[Respiratory failure]]  
* [[Myocarditis]]
* [[Myocarditis]]
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** 9th cranial nerve disorder
** 9th cranial nerve disorder
** [[Peripheral motor neuropathy]]  
** [[Peripheral motor neuropathy]]  
* Diaphragm paralysis
* Neurogenic bladder dysfunction
* [[Acute renal failure ]]
* [[Acute renal failure ]]
* [[Death]]
* [[Septicemia]]
* Death
 
===Prognosis===
The overall case-fatality rate for diphtheria is 5–10%, with higher death rates (up to 20%) among patients younger than 5 and older than 40 years of age.<ref name=CDCD>http://www.cdc.gov/diphtheria/clinicians.html Accessed on October 7, 2016</ref> Prognosis of diphtheria varies based on following factors:<ref name="pmid10657201">{{cite journal| author=Kadirova R, Kartoglu HU, Strebel PM| title=Clinical characteristics and management of 676 hospitalized diphtheria cases, Kyrgyz Republic, 1995. | journal=J Infect Dis | year= 2000 | volume= 181 Suppl 1 | issue=  | pages= S110-5 | pmid=10657201 | doi=10.1086/315549 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10657201  }} </ref><ref name="pmid10486387">{{cite journal| author=Logina I, Donaghy M| title=Diphtheritic polyneuropathy: a clinical study and comparison with Guillain-Barré syndrome. | journal=J Neurol Neurosurg Psychiatry | year= 1999 | volume= 67 | issue= 4 | pages= 433-8 | pmid=10486387 | doi= | pmc=1736572 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10486387  }} </ref><ref name="pmid15578357">{{cite journal| author=Kneen R, Nguyen MD, Solomon T, Pham NG, Parry CM, Nguyen TT et al.| title=Clinical features and predictors of diphtheritic cardiomyopathy in Vietnamese children. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 11 | pages= 1591-8 | pmid=15578357 | doi=10.1086/425305 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15578357  }} </ref><ref name="pmid16528112">{{cite journal| author=Jayashree M, Shruthi N, Singhi S| title=Predictors of outcome in patients with diphtheria receiving intensive care. | journal=Indian Pediatr | year= 2006 | volume= 43 | issue= 2 | pages= 155-60 | pmid=16528112 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16528112  }} </ref>


==Prognosis==
'''Good prognostic factors'''
*The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among persons younger than 5 and older than 40 years of age. The case-fatality rate for diphtheria has changed very little during the last 50 years.
*Early diagnosis and treatment
*Age >15 years
*Absence of cardiac involvement
'''Poor prognostic factors'''
*Delayed diagnosis and treatment
*Age <15 years
*Presence of cardiac involvement
*Presence of complications
*Immunocompromised status


* The disease can be prevented by vaccines. However, the prognosis is not good once the disease sets in.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Gastroenterology]]
[[Category:Infectious disease]]


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2], Aysha Anwar, M.B.B.S[3]

Overview

Diphtheria is a vaccine-preventable disease that can lead to such severe complications as respiratory failure, myocarditis, polyneuropathies, and death.[1][2][3][4][5][6] The overall case-fatality rate for diphtheria is 5%–10%, with higher death rates (up to 20%) among patients younger than 5 and older than 40 years of age.[7]

Natural History, Complications, and Prognosis

Natural History

The symptoms of diphtheria usually develop following an incubation period of 2-4 days. Early symptoms typically include sore throat, high-grade fever, myalgias, lymphadenopathy, hoarseness of voice, dyspnea, rhinorrhea, and difficulty swallowing. Without treatment, diphtheria may progress to cause airway obstruction, neuropathies, myocarditis, septicemia, shock, and death.[1][2]

Complications

Complications that may develop as a result of diphtheria are:[2][8][9][10][3][4][5][6]

Prognosis

The overall case-fatality rate for diphtheria is 5–10%, with higher death rates (up to 20%) among patients younger than 5 and older than 40 years of age.[7] Prognosis of diphtheria varies based on following factors:[11][12][13][6]

Good prognostic factors

  • Early diagnosis and treatment
  • Age >15 years
  • Absence of cardiac involvement

Poor prognostic factors

  • Delayed diagnosis and treatment
  • Age <15 years
  • Presence of cardiac involvement
  • Presence of complications
  • Immunocompromised status

References

  1. ↑ 1.0 1.1 Dobie RA, Tobey DN (1979). "Clinical features of diphtheria in the respiratory tract". JAMA. 242 (20): 2197–201. PMID 490806.
  2. ↑ 2.0 2.1 2.2 MORGAN BC (1963). "CARDIAC COMPLICATIONS OF DIPHTHERIA". Pediatrics. 32: 549–57. PMID 14069096.
  3. ↑ 3.0 3.1 Sanghi V (2014). "Neurologic manifestations of diphtheria and pertussis". Handb Clin Neurol. 121: 1355–9. doi:10.1016/B978-0-7020-4088-7.00092-4. PMID 24365424.
  4. ↑ 4.0 4.1 Jain A, Samdani S, Meena V, Sharma MP (2016). "Diphtheria: It is still prevalent!!!". Int J Pediatr Otorhinolaryngol. 86: 68–71. doi:10.1016/j.ijporl.2016.04.024. PMID 27260583.
  5. ↑ 5.0 5.1 http://www.who.int/immunization/topics/diphtheria/en/index1.html Accessed on October 7, 2016
  6. ↑ 6.0 6.1 6.2 Jayashree M, Shruthi N, Singhi S (2006). "Predictors of outcome in patients with diphtheria receiving intensive care". Indian Pediatr. 43 (2): 155–60. PMID 16528112.
  7. ↑ 7.0 7.1 http://www.cdc.gov/diphtheria/clinicians.html Accessed on October 7, 2016
  8. ↑ http://www.cdc.gov/diphtheria/about/complications.html Accessed on October 7, 2016
  9. ↑ Anima H, Malay M, Santanu H, Rajashree R, Sita C, Baran SA (2008). "A study on determinants of occurrence of complications and fatality among diphtheria cases admitted to ID & BG Hospital of Kolkata". J Commun Dis. 40 (1): 53–8. PMID 19127670.
  10. ↑ Reidermann MI (1996). "[Cardiac complications in adult diphtheria: analysis of 212 cases]". Praxis (Bern 1994). 85 (51–52): 1647–51. PMID 9026877.
  11. ↑ Kadirova R, Kartoglu HU, Strebel PM (2000). "Clinical characteristics and management of 676 hospitalized diphtheria cases, Kyrgyz Republic, 1995". J Infect Dis. 181 Suppl 1: S110–5. doi:10.1086/315549. PMID 10657201.
  12. ↑ Logina I, Donaghy M (1999). "Diphtheritic polyneuropathy: a clinical study and comparison with Guillain-Barré syndrome". J Neurol Neurosurg Psychiatry. 67 (4): 433–8. PMC 1736572. PMID 10486387.
  13. ↑ Kneen R, Nguyen MD, Solomon T, Pham NG, Parry CM, Nguyen TT; et al. (2004). "Clinical features and predictors of diphtheritic cardiomyopathy in Vietnamese children". Clin Infect Dis. 39 (11): 1591–8. doi:10.1086/425305. PMID 15578357.


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