Respiratory Diphtheria in Two Children Presenting to A Tertiary Hospital in South–East Nigeria

Abstract

Respiratory diphtheria is an acute and infectious disease that can progress to cardiac and neurological complications ultimately resulting in increased morbidity and mortality in affected individuals. Diagnosis was made in line with the WHO clinical case definition for Diphtheria. This is a report of two probable cases of complicated respiratory diphtheria presenting within 3 weeks of each other to the Paediatrics Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra state, South-East Nigeria. The first patient was a 5-year-old female who presented on referral with a history of fever, throat pain, noisy breathing and facial fullness, in whom bull neck appearance and membrane in the throat was observed. She was tachycardic, in respiratory distress, had elevated jugular venous pulse (JVP), soft tender liver and a greyish membrane in the throat. She was managed as a case of Diphtheric Carditis and discharged after 17 days on admission in stable condition. The second patient was also a 5-year-old, male, who presented with a history of fever, difficulty in swallowing, change of voice (progressing from hoarseness to whispers), cough and staggering gait. Onset of the illness was associated with membrane in the throat, bull neck and stridor. Examination revealed cranial nerve deficits, aphonia, hypotonia and staggering gait. CSF analysis was within normal. He was managed as a case of Diphtheric Neuropathy and was discharged home in stable condition after 16 days on admission. C. diphtheria IGG done 2 weeks post discharge was 0.19 IU/ml. The cases suggest that respiratory diphtheria still occurs in children in our environment. A high index of suspicion is needed to diagnose and properly nurse these children back to health.

Keywords: Corynbacterium diphtheriae, Paediatric Pulmonology