Peer-reviewed article
Clinical features, prognosis, and treatment outcomes of diphtheria in children: a retrospective cohort study at children's hospital, Sukkur.
Waqar Ahmed, Fareeda Bhanbhro, Fatima Memon, Sheeraz Ahmed, Sajid Ali et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined 45 children with diphtheria treated at a hospital in Sukkur, Pakistan, where the overall mortality rate was 42.2%. The most common symptoms were bull neck appearance, fever, sore throat, and difficulty breathing, with serious complications including respiratory failure and heart inflammation. Early treatment with diphtheria antitoxin within three days of illness and complete vaccination coverage were strongly associated with better survival, while delays in treatment and low immunisation rates increased deaths and complications.
Key points
- Mortality rate was 42.2% among 45 children with diphtheria
- Only 22.2% of patients were fully vaccinated
- Children receiving diphtheria antitoxin after five days of illness had 75% mortality compared to those treated within three days
- Shortness of breath, pseudomembrane formation, and elevated serum creatinine were independent predictors of mortality
- Major complications included respiratory failure (48.1%), acute kidney injury (27.8%), and myocarditis (20.4%)
Limitations
This is a retrospective study from a single tertiary care hospital in one city, so findings may not represent all diphtheria cases in Pakistan or be generalizable to other settings. The study cannot establish causation for the associations observed, only identify factors present in fatal versus non-fatal cases.
Abstract
BACKGROUND: Diphtheria remains a major pediatric health threat in under-resourced settings, particularly in populations with low immunization coverage. Despite being vaccine-preventable, outbreaks continue to occur in Pakistan due to delayed recognition, limited access to diphtheria antitoxin (DAT), and weak public health infrastructure. Sindh province, including Sukkur and surrounding districts, has reported recurrent outbreaks in recent years, highlighting the urgent need for local data to guide management and prevention strategies. OBJECTIVE: To evaluate the clinical features, complications, and treatment outcomes of children diagnosed with diphtheria at a tertiary care hospital in Sukkur, Pakistan, and to identify predictors of mortality. METHODS: This retrospective cohort study was conducted from 1 September to 30 November 2024 at Children Hospital, Sukkur (SICHN). It included 45 children aged 0–15 years who met the World Health Organization (WHO) probable case definition for diphtheria. Data on demographics, clinical presentation, laboratory parameters, vaccination status, timing of antitoxin administration, complications, and outcomes were analyzed. Statistical tests included Chi-square, independent t-test, and binary logistic regression to identify independent predictors of mortality. RESULTS: Among 45 children, 53.3% were male, and 77.8% were under 10 years of age. The overall mortality rate was 42.2%. The most frequent clinical features were bull neck (82.2%), fever (75.6%), sore throat (75.6%), shortness of breath (66.7%), and pseudomembrane formation (62.2%). Major complications included respiratory failure (48.1%), myocarditis (20.4%), acute kidney injury (27.8%), neuropathy (16.7%), and bleeding (14.8%). Shortness of breath and pseudomembrane formation were significantly associated with mortality. On multivariable logistic regression, shortness of breath (Adjusted OR = 3.9, p = 0.02), pseudomembrane formation (Adjusted OR = 2.9, p = 0.04), and elevated serum creatinine (Adjusted OR = 4.8, p = 0.01) were independent predictors of mortality. Urea was associated with mortality in univariable analysis but was not significant in the multivariable model. Children receiving DAT after five days of illness had higher mortality (75%) and complication rates (77.8%) compared to those treated within three days. Only 22.2% of patients were fully vaccinated. CONCLUSION: Shortness of breath, pseudomembrane formation, respiratory failure, and renal dysfunction were key predictors of poor prognosis in pediatric diphtheria. Early diphtheria antitoxin administration and complete vaccination are critical to improving survival. Strengthening surveillance systems, ensuring timely DAT availability, and enhancing vaccination coverage are essential to reduce morbidity and mortality in future diphtheria outbreaks. CLINICAL TRIAL NUMBER: Not applicable.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Early diphtheria antitoxin (DAT) administration within three days of illness onset combined with complete vaccination
- Population
- Children aged 0–15 years diagnosed with diphtheria at Children Hospital, Sukkur, Pakistan (n=45)
Key finding
Children receiving DAT within three days had lower mortality compared to those treated after five days (mortality increased to 75% with delayed treatment)