Clinical profile and predictors of poor outcome of hospitalized diphtheria cases in children from Lucknow region of North India

ObjectivesDiphtheria is a re-emerging disease with changing epidemiology. We aimed to identify clinical and demographic characteristics of diphtheria cases and predictors of mortality, reported scarcely.MethodsThis was a retrospective study of 279 diphtheria cases admitted at tertiary care hospital over 2 years. Demographic, clinical details & outcome were recorded. Clinical diagnosis was based on presence of typical membrane or palatal palsy with febrile illness. Microbiologic confirmation could be established in 34 of 111 cases investigated. Categorical variables were analysed by Chi-square test and continuous variables by independent t-test or Mann–Whitney U test. Complications found significant on univariate analysis were analysed by logistic regression to find predictors of mortality.ResultsThe 1–5 yr age group represented 49.5% of the cases & 5–10 yr represented another 43%. Most cases were either unimmunized (79.6%) or partially immunized (18.3%). Majority (83.9%) presented with illness of less than 14 days. The overall case fatality was 48%. Airway obstruction (adjusted OR = 21.7), respiratory paralysis (adjusted OR = 57.7), bradyarrythmia (adjusted OR = 7.0), renal failure (adjusted OR = 5.5) and shock at admission (adjusted OR = 2.9) were independent predictors of mortality.ConclusionDiphtheria among children reflects poor immunization coverage. Airway obstruction, respiratory paralysis, bradyarrythmia, renal failure and shock at admission predicted mortality.