A clinical profile of severe diphtheria in pediatric intensive care units of North India: A single-center, prospective observational study

Background: Myocarditis, disseminated intravascular coagulation, and renal failure have been reported to be the leading causes of mortality in patients of severe diphtheria. The aim of this article was to study the clinico-demographic profile of diphtheria patients and also to evaluate the performance of Pediatric Risk of Mortality (PRISM) III on the prediction of mortality in such patients. The objective was to study the clinical profile of severe diphtheria cases in children. Subjects and Methods: During the study period, 170 patients were admitted to the pediatric emergency unit, out of whom 26 patients were admitted with the diagnosis of clinical diphtheria. Results: Majority of the patients were categorized as having either central nervous system or respiratory illness at the time of admission. The third largest category was patients with suspected clinical diphtheria. Forty-five out of 170 were nonsurvivors among which the highest mortality was noted in patients of diphtheria. All the nonsurvivors with clinical diphtheria had signs and symptoms of myocarditis either at the time of admission or developed later during the hospital stay. On comparing the mean PRISM scores of survivors versus nonsurvivors, it was not found to be statistically significant. Conclusions: The presence of myocarditis in patients of diphtheria is highly fatal and PRISM III alone is not sufficient for mortality prediction in patients of severe diphtheria.