Prognostic significance of electrocardiographic abnormalities in diphtheritic myocarditis after hospital discharge: a long-term follow-up study

The Re-emergence of Diphtheria Amidst Multiple Outbreaks in Nigeria

Diphtheria, a vaccine-preventable disease, has resurfaced in Nigeria, where many outbreaks have been reported in recent years. The outbreaks have occurred across the country, including in areas with high vaccination coverage. Corynebacterium diphtheriae, the causal agent, is a highly contagious bacteria that can cause severe respiratory and systemic symptoms and can be fatal if not treated. The reemergence of diphtheria in Nigeria is most likely due to a combination of factors, including gaps in routine immunization regimens. The outbreak is further aggravated by multiple epidemics, which have diverted resources and attention away from the emergency of other infectious diseases. Furthermore, there is a lack of awareness of diphtheria in Nigeria. With a focus on the difficulties in controlling the disease, methods of diagnosis, available treatments, and preventive measures, this study provides a thorough analysis of diphtheria, covering its historical context, clinical presentation, associated complications, and current outbreaks. It emphasizes how important vaccination, early detection, and better access to healthcare are in reducing diphtheria outbreaks. The study highlights the serious effects of diphtheria on public health, particularly in regions with scarce resources and vaccine resistance, and offers a number of suggestions to overcome these challenges and prevent further outbreaks.

Diphtheritic myocarditis: An unusual and reversible cause of heart failure

Diphtheria is a life-threatening infectious disease caused by Corynebacterium diphtheriae. Although the disease is seen infrequently in the postvaccination era, sporadic cases continue to occur. Cardiac involvement, in the form of myocarditis, is the most serious manifestation of diphtheria and is the most common cause of mortality in these patients. The features of diphtheritic myocarditis on cardiac magnetic resonance imaging (MRI) have not been reported previously. In this brief report, we describe the cardiac MRI and histopathologic features on endomyocardial biopsy of a patient with acute heart failure who was later diagnosed to be a case of diphtheritic myocarditis.

Novel Clinical Monitoring Approaches for Reemergence of Diphtheria Myocarditis, Vietnam

Diphtheria is a life-threatening, vaccine-preventable disease caused by toxigenic Corynebacterium bacterial species that continues to cause substantial disease and death worldwide, particularly in vulnerable populations. Further outbreaks of vaccine-preventable diseases are forecast because of health service disruptions caused by the coronavirus disease pandemic. Diphtheria causes a spectrum of clinical disease, ranging from cutaneous forms to severe respiratory infections with systemic complications, including cardiac and neurologic. In this synopsis, we describe a case of oropharyngeal diphtheria in a 7-year-old boy in Vietnam who experienced severe myocarditis complications. We also review the cardiac complications of diphtheria and discuss how noninvasive bedside imaging technologies to monitor myocardial function and hemodynamic parameters can help improve the management of this neglected infectious disease.

Diphtheritic myocarditis: A case series and review of literature

Myocarditis in patients with diphtheria is a toxin-mediated complication that sets in after one week of onset of respiratory illness. Early administration of antidiphtheritic serum in patients with clinical diphtheria before the onset of myocarditis is of utmost importance to prevent this fatal complication. We report three patients who presented late in illness after the myocarditis had set in, to stress on the need of prompt administration of antitoxins by primary care physicians and highlight the importance of immunization.

Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions

Myocarditis is as an important cause of sudden cardiac death (SCD) among athletes. The incidence of SCD ascribed to myocarditis did not change after the introduction of pre-participation screening in Italy, due to the transient nature of the disease and problems in the differential diagnosis with the athlete's heart. The arrhythmic burden and the underlying mechanisms differ between the acute and chronic setting, depending on the relative impact of acute inflammation versus post-inflammatory myocardial fibrosis. In the acute phase, ventricular arrhythmias vary from isolated ventricular ectopic beats to complex tachycardias that can lead to SCD. Atrioventricular blocks are typical of specific forms of myocarditis, and supraventricular arrhythmias may be observed in case of atrial inflammation. Athletes with acute myocarditis should be temporarily restricted from physical exercise, until complete recovery. However, ventricular tachycardia may also occur in the chronic phase in the context of post-inflammatory myocardial scar.

Cardiac complications in diphtheria and predictors of outcomes

OBJECTIVE

To study the cardiac complications in diphtheria patients and to study the predictors of outcomes.

STUDY DESIGN

Single centre prospective analysis of cardiac complications in diphtheria patients.

RESULTS

In this study, there were 60 patients diagnosed with diphtheria with ECG changes. The ECG changes seen were sinus tachycardia (68.3%), T wave inversion (20%), ST segment depression (13.3%), right bundle branch block (5%), multiple atrial ectopics (3.3%). The case fatality rate in our study was 25% (15 patients). High CPK-MB, myoglobulin and cardiac troponin levels were associated with cardiac mortality. In our study, cardiac troponin T had the highest sensitivity (80%) and CK-MB had the highest specificity (95.56%).

CONCLUSION

Cardiac involvement is a common complication of infection with C. diphtheria and is associated with high mortality. As diphtheria can be prevented by adequate vaccination, efforts should be maximized for high vaccine coverage with booster doses.

[102 patients with suspected myocarditis : Clinical presentation, diagnostics, therapy and prognosis]

INTRODUCTION

Myocarditis is a disease which is difficult to diagnose and which includes a risk of the development of dilated cardiomyopathy and sudden cardiac death.

METHODS AND PATIENTS

In this study 102 patients were included from the time period 2003-2013 after diagnosis or suspected diagnosis of myocarditis in the department of internal medicine at the University Hospital Halle (Saale).

RESULTS

Of the study participants 77.5% were male and the average age was 35.5 ± 14.1 years. The symptoms reported by the patients were angina in 46.1%, dyspnea in 38.2%, performance deterioration in 29.4%, palpitations in 9.8% and syncope in 8.8%. In 45.1% of patients, symptoms were preceded by a respiratory infection. All patients underwent an echocardiogram and in 36.5% it was possible to demonstrate a regional wall motion abnormality and in 20.4% a pericardial effusion. A myocardial biopsy was performed in 15.6% of the patients. The presence of cardiotropic viruses was investigated in 37.3% of patients but was detected in only 5.9%. Cardiac magnetic resonance imaging (MRI) was performed in 82 patients of whom 33.3% showed a late enhancement and 11.9% a wall movement disorder. In this study four patients, all male, died and three suffered recurrent myocarditis.

CONCLUSION

This study showed the wide range of symptoms in myocarditis. Myocarditis is rarely severely manifested and in this study the mortality was 3.9%. For further optimization of the diagnostic and treatment algorithms, prospective, randomized studies would be desirable.

A 9-year-old boy with severe diphtherial infection and cardiac complications

The incidence of diphtheria has decreased since the introduction of an effective vaccine. However, in countries with low vaccination rates it has now become a re-emerging disease. Complications from diphtheria commonly include upper airway obstruction and cardiac complications. We present a 9-year-old boy who was diagnosed with diphtheria. He presented with fever, tonsilar plaques, respiratory failure and an incomplete vaccination history. He was endotracheal intubated and received diphtheria antitoxin and penicillin on the first day of hospitalisation. He developed progressive arrhythmias and fulminant myocarditis despite early identification and treatment with equine antitoxin and antibiotics. After a temporary transvenous pacemaker insertion due to third-degree atrioventricular block and hypotension for 1 week, he developed myocardial perforation from the pacemaker tip resulting in pericardial effusion. The treatment included emergency pericardiocentesis and pacemaker removal. His electrocardiogram showed a junctional rhythm with occasional premature ventricular complexes. He then developed ventricular tachycardia and cardiac arrest and finally died.