Case Report of an Unvaccinated Child with Diphtheria Associated With Myocarditis and Polyneuropathy

Abstract

Diphtheria is an infection caused by members of Corynebacterium genus which are club shaped gram positive rods. Most infections of diphtheria are due to toxigenic strains of Corynebacterium diphtheriae while C.ulcerans and  C.pseudo tuberculosis  rarely cause the disease. Before the development of vaccine diphtheria had been a major cause of childhood morbidity and mortality(1). According to World Health Organisation,extensive immunisations has greatly  reduced the number of cases from 100,000 cases in 1950 to 8000 cases in 2009 and then 4530 cases were reported worldwide in 2015(2). The prevention against diphtheria includes vaccination of children and chemoprophylaxis of people in close contact with confirmed cases of diphtheria.The globally accepted vaccine is DTP which is a combination of vaccines against Diphtheria,Tetanus and Pertussis(1). Although it has become a disease of past in many countries but it is still a major concern for many other countries due to low vaccine coverage and progressively decreasing vaccine immunity in adults(3). Diphtheria is primarily of three types i.e Respiratory, Cutaneous and Ocular.However diphtheria toxin  can disseminate into blood and affects myocardium and peripheral  nerves.This leads to serious complications such as Myocarditis, Peripheral neuropathy and Polyneuropathy(1). It has been estimated that myocarditis and/or peripheral neuropathy is present in 10-20% of people presenting with diphtheria. Myocarditis is associated with 60-70%  of death in acute phase of Diphtheria(1). Completely unvaccinated children are more likely to develop myocarditis than partially immunized children(4). Unvaccinated population affected with diphtheria has a high fatality count of 5-17%(1).

Severe diphtheria with myocardial and neurological involvement in a swedish patient is presented in a case report by Sten Skogmar(2). Van Damme also presented the case of a child suffering from fatal diphtheria myocarditis in whom unfavourable outcomes are associated with delayed administration of anti toxin(5). My case report highlights the cardiac and neurological complications of diphtheria that developed in an incompletely vaccinated child. Various symptoms are reported in order of their occurrence. This case further highlights that  undertreatment  of child initially caused the development of complications. Furthermore the role of superstitious beliefs and  illiteracy as a hurdle in eradicating diphtheria is also discussed.