Diphtheria: a re-emerging infectious disease


  • Shashidhar S. Suligavi Department of ENT, S. Nijalingappa Medical College, Bagalkot, Karnataka, India
  • Divya K. Vishwanath Department of ENT, S. Nijalingappa Medical College, Bagalkot, Karnataka, India
  • Shilpa Gokale Department of Microbiology, S. Nijalingappa Medical College, Bagalkot, Karnataka, India
  • S. S. Doddamani Department of ENT, S. Nijalingappa Medical College, Bagalkot, Karnataka, India




Diphtheria, Antidiphtheritic serum, Albert stain, Myocarditis


Background: Diphtheria is a fatal bacterial infection which affects the mucous membranes of oropharyngeal and nasal cavity, caused by aerobic gram-positive bacteria Corynebacterium diphtheriae. Clinical diphtheria is on the increase worldwide, mainly affecting developing countries and leading cause of morbidity and mortality. We sought to understand its presentation among patients and also early intervention of the disease. The objective of the study was to study the clinico-demographic profile of cases, the relationship between immunization status and clinical disease, the role of microbiological investigations and to identify complications in diphtheria cases.

Methods: This study is a hospital based observational study from September 2019 - September 2020 at a tertiary care centre, S.Nijalingappa Medical College and HSK hospital, Bagalkot, Karnataka. The cases were analysed with respect to demographic details, clinical features, immunization status, microbiological confirmation and complications of diphtheria cases.

Results: 32 cases were suspected to have diphtheria on clinical examination. The mean age of presentation was 15 years. Fever, sore throat, difficulty in swallowing, neck swelling and pseudomembrane in oral cavity were the common signs and symptoms. Airway compromise, myocarditis and neurological complications were noted. Antidiphtheritic serum (ADS) was tried in all 32 cases and 8 cases had adverse reactions. Case fatality rate was 12.5%.

Conclusions: Shifting of occurrence of diphtheria in the age group of >5 years suggest the need to improve and strengthen the immunization program specially the booster doses.


Dikid T, Jain SK, Sharma A, Kumar A, Narain JP. Emerging and re-emerging infections in India: an overview. Indian J Med Res. 2013;138:19-31.

Government of India. Annual report 2012. India: Ministry of Health. 2012.

Meera M, Rajarao M. Diphtheria in Andhra Pradesh-a clinical–epidemiological study. Int J Infect Dis. 2014;19:74-78.

Efstratiou A, Engler KH, Mazurova IK, Glushkevich T, Vuopio-Varkila J, Popovic, T. Current approaches to the laboratory diagnosis of diphtheria. J Infect Dis. 2000;181:S138-45.

Clarke KEN. Review of the Epidemiology of Diphtheria (2000-2016). US Centers for Disease Control and Prevention.

World Health Organization. Diphtheria vaccine: WHO position paper, August 2017-Recommendations. Vaccine. 2018;36(2):199-201.

World Health Organisation. WHO vaccine preventable diseases: monitoring system 2017 global summary.

Ujwal MV, Pol RR, Vanaki R, Yelamali BC, Badakali AV. Resurgence of diphtheria in rural north Karnataka: Clinical profile and outcome.International journal of Medical Paediatrics and Oncology. 2019;5(1).

Meshram RM, Patil A.Clinical profile and outcome of diphtheria in central India: a retrospective observational. Study Int J Contemp Pediatr. 2018;5(4):1600-605.

Basavaraja GV, Chebbi PG, Joshi S. Resurgence of diphtheria: clinical profile and outcome- a retrospective observational study. Int J of Contemp Pediatr. 2016;3(1):60-63.

Bandichhode ST, Jatti GM, Anita MS, Nandimath VA. A clinical study of diphtheria cases in a pediatric population in tertiary care hospital in western Maharashtra. Indian J Child Health. 2016;3(3):251-53.

Maheriya KM, Pathak GH, Chauhan AV, Mehariya MK, Agrawal PC. Clinical and epidemiological profile of diphtheria in tertiary care hospital. Gujarat medical J. 2014;89(2):105-8.

Singh SN, Singh A, Chandra S. Clinical profile and prediction of poor outcome of hospitalized diphtheria cases in children from Lucknow region of North India. Clin Epidemiol Glob Health 2014;2:75-9.

Sharma NC, Banavaliker JN, Ranjan R, Kumar R. Bacteriological and epidemiological characteristics of diphtheria cases in and around Delhi-a retrospective study. Indian J Med Res. 2007;126(6):545-52.

Bairwa M, Rajput M, Sachdeva S. Modified Kuppuswamy’sSocioeconimic scale: Social researcher should include updated income criteria, 2012. Indian J Community Med 2013;38(3):185-86.

Siakia L, Nath R, Saikia NJ, Choudhary G, Sarkar M. A diphtheria outbreak in Assam, India. Southeast Asian J Trop Med Public Health. 2010;41:647-52.

Verghese MJ, Ramakrishnan SS, Saxsena A. Complete heart block due to diphtheritic myocarditis in the present era. Ann Pediatr Cardiol. 2013;6:34-8.

Jayasri M, Shruti N, Singhi S. Predictors of outcome in patients with diphtheria receiving intensive care. Indian Pediatr. 2006;43:155-60.






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