Year: 2013
Type: article
Study design: Observational Study
Abstract: Diphtheritic polyneuropathy is a vaccine-preventable illness caused by exotoxin-producing strains of Corynebacterium diphtheriae.We present a retrospective convenience case series of 15 children (6 girls) <15 years of age (mean age 5.2 years, case-fatality rate 53%, and 1 additional casepatient who was ventilator dependent at the time of last follow-up; median follow-up period 60 days) with signs and symptoms suggestive of diphtheritic polyneuropathy.All cases were identified through national acute flaccid paralysis surveillance, which was designed to detect poliomyelitis in India during 2002-2008.We also report data on detection of diphtheritic polyneuropathy compared with other causes of acute flaccid paralysis identified by this surveillance system. D iphtheria is caused by toxin-producing strains of thebacterium Corynebacterium diphtheriae and is spread by human-to-human contact (respiratory secretions and cutaneous lesions).Before the advent of vaccination with diphtheria toxoid in the 1940s, ≈1 in 20 persons in temperate zones had diphtheria in their lifetime and 5%-10% of cases led to death (1).The last case of diphtheria in the United States was in 2003 in a traveler who returned from Haiti (2).However, diphtheria remains a health concern among immigrants, travelers, and those with incomplete immunity and vaccination coverage in many regions.Adults may also be increasingly at risk for diphtheria because of waning immunity or incomplete immunization, especially in outbreak situations (3).Although diphtheria is preventable by vaccination, only 24% of countries worldwide reached the targeted >80% routine coverage of all districts for diphtheria-tetanus-pertussis (DTP3) vaccine in 2011 (4).In 2004, the World Health Organization (WHO) reported 5,000 deaths caused by diphtheria, all of which were in children <5 years of age (5).However, reporting of diphtheria is variable, and some countries report cases inconsistently because of limited recognition among health care workers and no dedicated surveillance systems (5).It is likely that many cases are not reported.Diphtheria is clinically considered to be a biphasic illness with initial symptoms of low-grade fever, sore throat, neck swelling, nasal twang, and usually ipsilateral palatal paralysis.The time between the first symptoms of diphtheria and the onset of polyneuropathy is deemed the latency period.Diphtheritic polyneuropathy occurs in ≈20% of patients with diphtheria.It is considered more likely with higher release of exotoxin (6,7) The classic features of diphtheritic polyneuropathy include sensory and motor signs and symptoms, most notably acute flaccid paralysis (AFP) with reduced or absent deep tendon reflexes.Limb paralysis from a segmental demyelinating process occurs with temporal regularity, with onset and resolution 35-140 days after the onset of bulbar signs and symptoms (6,7).Although serious, diphtheritic polyneuropathy is not consistently fatal and may resolve.Death from diphtheria occurs by parasympathetic dysfunction of the vagal nerve with cardiac arrhythmias, myocarditis, or from respiratory paralysis caused by laryngeal involvement (2).We report a case series of diphtheritic polyneuropathy in children in India identified by routine screening for AFP, which was performed to achieve eradication of poliomyelitis in India.The clinical characteristics of diphtheritic polyneuropathy are presented in detail to remind clinicians of the key diagnostic features of this major cause of neuropathy and the value of a throat examination in persons with AFP.
Source: Emerging infectious diseases
Institution: Johns Hopkins University
Language: English
Subfield: Endocrinology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W2025109568