Inflow Of Diphtheria Cases In a Tertiary Care Centre

Prof. J.V Singh, Head

Deptt. of Community MedicineCSM Medical University UP,

Lucknow

Dr. Saurabh Kashyap, JR-1 Deptt. of Community Medicine

CSM Medical University UP, Lucknow

Introduction

Diphtheria is an acute respiratory tract illness, caused by Cornynebacterium diphtheriae, a facultative anaerobic gram positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane (a pseudo membrane)on the tonsils, pharynx,and/or nasal cavity. A milder form of diphtheria can be restricted to the skin. Uncommon consequences include myocarditis (about 20% cases)and peripheral neuropathy(about 10% of cases).

Introduction Contd…… The current definition of diphtheria used by the Centers for Disease

Control and Prevention (CDC) is based on both laboratory and clinical criteria.

Laboratory criteria Isolation of Corynebacterium diphtheriae from a clinical specimen, or Histopathologic diagnosis of diphtheria Clinical criteria Upper respiratory tract illness with sore throat Low-grade fever (>103°F is rare) An adherent pseudomembrane of the tonsil(s), pharynx, and/or nose.Case classification Probable: a clinically compatible case that is not laboratory-confirmed

and is not epidemiologically linked to a laboratory-confirmed case Confirmed: a clinically compatible case that is either laboratory-

confirmed or epidemiologically linked to a laboratory-confirmed case

Objectives

• To study the inflow of diphtheria cases in a tertiary care hospital in last two months.

• To study the distribution of diphtheria cases (residence, age, sex, socioeconomic status, immunization pattern, occupation, education, religion and habitat).

METHODOLOGY

Study site: The Department of Pediatrics CSMMU, Lucknow.

Study design: A Case-series studyStudy duration: 2 months from 1st August to 30th

September 2010.Study population: Clinically suspected case of

diphtheria admitted in the hospital.

RESULTS AND OBSERVATIONS

District No. of cases % Fully imm. Partially Imm. Un imm. Immunization

coverage (DLHS III)

Lucknow 33 29.20 4 15 14 40.1-55

Hardoi 20 17.70 3 9 8 25.1-40

Sitapur 18 15.93 1 7 10 <25

Barabanki 9 7.96 0 3 6 25.1-40

Lakhimpur 7 6.19 1 3 3 <25

Azamgarh 4 3.54 0 2 2 25.1-40

Bahraich 3 2.65 0 1 2 <25

Shahjahapur 3 2.65 0 1 2 <25

Basti 3 2.65 1 1 1 40.1-55

Sultanpur 3 2.65 1 1 1 40.1-55

Shravasti 2 1.77 0 0 2 <25

Siddharth Nagar 2 1.77 0 1 1 40.1-55

Deoria 1 0.88 1 0 0 55.1-70

Raibareilly 1 0.88 0 0 1 25.1-40

Balrampur 1 0.88 0 0 1 <25

Jalun 1 0.88 0 1 0 25.1-40

Unnao 1 0.88 0 0 1 25.1-40

Gonda 1 0.88 0 0 1 <25

Total 113 100.00 12 45 56

Table-1: District Wise Distribution Of Diphtheria Cases And Vaccination Status

District wise distribution of the studied diphtheria cases and actual immunisation coverage (DLHS-3 2007-08)

Table 2: Age and Sex Distribution of Diphtheria Cases

Age Males Females total %

No. % No. %

Upto 1 yr 5 4.42 7 6.19 12 10.61

1-3 yr 18 15.93 9 7.96 27 23.90

3-5 yr 26 23.0 10 8.85 36 31.86

>5 yr 18 15.93 20 17.70 38 33.63

Total 67 59.30 46 40.70 113 100.00

Table 3: Socio-economic and Immunization status of Diphtheria cases

Socio Economic Status

Immunization Status

Total %Fully Imm. Partially Imm. Un Imm.

Upper Class 2 0 0 2 1.77Upper Middle Class 2 0 1 3 2.65

Middle Class 2 1 1 4 3.54

Lower Middle Class 6 10 4 20 17.70

Lower Class 0 34 50 84 74.34

Total12 45 56 113 100.0

Percentage 10.62 39.82 49.56 100.00

Table 4: Bio-social profile of families of the diphtheria cases RELIGION No. % FULLY

IMMUNIZEDPARTIALLY IMMUNIZED

UNIMMUNIZED

HINDU 80 70.80 9 34 37

MUSLIM 31 27.43 3 11 17

SIKH 2 1.77 0 0 2

CHRISTIAN 0 0 0 0 0

TOTAL 113 100 12 45 56

EDUCATION OF HEAD OF FAMILY

UNEDUCATED 49 43.36 2 23 23

PRIMARY 42 37.17 4 15 23

HIGH SCHOOL 22 19.47 7 7 8

TOTAL 113 100 12 45 56

HABITAT OF DIPHTHERIA CASES

98; 87%

15; 13%Rural Urban

Conclusion

1. The maximum cases were seen above 1 yr of age, out of which 33.63% were of above the age of 5 yrs.

2. Maximum number of diphtheria cases (29.20%)were from Lucknow district.

3. Majority (49.56%) of cases were unimmunized and 39.82%were partially immunized.

4. 87% of the diphtheria cases were from rural background.5. The study shows predominance of diphtheria cases among

males(59.30%) as compared to that of females(40.70%).

Conclusion……

6. The number of diphtheria cases were more in lower socioeconomic class(74.34%) followed by lower middle class(17.70%).

7. Hindus were affected more(70.80%) than any other religion.

8. In 43.36% cases the Head of the family were illiterate.9. 4 cases died while on treatment , out of which 1 died

of rare complication (cardiomyopathy).10. 2 patient left the hospital against medical advice and

rest were discharged following improvement.

Thank you