Aug 2026· The Indian journal of medical research· Vol 164, pp. 304 - 310· 0 citations· 23 references
Medicine
TL;DR
Sustained high diphtheria positivity over 15 yr indicates ongoing transmission in parts of northern India, likely driven by immunity gaps due to suboptimal booster-dose coverage.
Abstract
Background and objectives Despite the availability of effective vaccines, diphtheria continues to cause morbidity and mortality in parts of India. We analysed 15 yr of hospital-based data from a tertiary care infectious disease hospital to describe the epidemiology of diphtheria in northern India. Methods We analysed data from January 2007 to December 2021 on suspected diphtheria cases (defined as upper respiratory tract illness with an adherent membrane in pharynx, tonsils, larynx, or nose) hospitalised at an infectious diseases hospital. Information on demographic characteristics, vaccination status, laboratory findings, and clinical outcomes was abstracted from the records. We described the distribution of diphtheria by person, place, and time. Multivariable logistic regression was used to examine the association between vaccination status and culture-confirmed diphtheria. Results Among 5,493 suspected diphtheria cases hospitalised during the study period, C. diphtheriae was isolated from 2,131 (38.8%). 408 diphtheria patients died (case-fatality ratio: 19.1%). Culture positivity among suspected cases remained consistently high (range: 15% to 56%) over time. The median age of culture-confirmed cases increased from 5 yr [interquartile range (IQR) 4–8)] during 2007–2011 to 7 yr (IQR 5–9) during 2012–2016 and 7 yr (IQR 6–10) during 2017–2021. Most (n=1876, 88.0%) cases were from Uttar Pradesh and Delhi. Only 23 (1.1%) reported being fully vaccinated for age. Compared with fully vaccinated individuals, partially vaccinated [adjusted odds ratio (aOR): 4.5; 95% confidence interval (CI): 2.8–7.4] and unvaccinated or unknown-status individuals (aOR: 4.2; 95% CI: 2.7–6.5) had higher odds of having diphtheria. Interpretation and conclusions Sustained high diphtheria positivity over 15 yr indicates ongoing transmission in parts of northern India, likely driven by immunity gaps due to suboptimal booster-dose coverage. Strengthening the Universal Immunization Programme with focus on timely booster doses among preschool- and school-aged children is essential to reduce transmission.
Diphtheria is an acute, vaccine-preventable bacterial infection caused by toxigenic Corynebacterium diphtheriae. Despite available immunization, outbreaks continue to occur in resource-limited settings and are often associated with high mortality from toxin-mediated complications such as myocarditis, airway obstruction, and renal failure.
To describe the clinical patterns, treatment, and outcomes of suspected diphtheria cases managed at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria.
This was a retrospective review of children aged 0–15 years treated for suspected diphtheria between January 2017 and October 2024. Data extracted from case notes included sociodemographic profile, clinical features [fever, sore throat, odynophagia, dysphagia, dyspnea, neck swelling, dirty grey oropharyngeal membrane], vaccination history, antitoxin administration, microbiologic confirmation, and complications. Complications were defined as premortem clinical events documented in patient records during hospital admission and management. Data were analysed using IBM SPSS version 25.0. Quantitative variables were expressed as mean ± standard deviation, while categorical variables were summarised as frequencies, percentages, and charts. Associations were tested using Fisher’s Exact Test, with statistical significance set at
p
< 0.05.
Of 98 suspected cases reviewed, 48 [49.0%] were culture-positive for C. diphtheriae. The mean age was 7.0 ± 3.3 years, range 2–14 years, with 49.0% in the 1–5-year group. Females accounted for 61.2% [male: female 1:1.6]. Most patients, 83.0%, were unimmunized. The overall case fatality rate was 75.5% [74/98], with 23.5% discharged and 1.0% discharged against medical advice. Mortality was highest in children aged 1–5 years [51.4%] and among females [60.8%], though neither age nor sex was significantly associated with outcome,
p
> 0.05. Antitoxin administration, culture-positive status for C. diphtheriae, and presence of documented premortem complications were significantly associated with mortality,
p
< 0.05. Case fatality was 86.5% among unimmunized patients and 58.1% among those who did not receive antitoxin. All fatalities had documented premortem complications, with cardiorenal complications being the most frequently recorded outcome among deaths at 43.2%, followed by cardiac complications at 37.8%.
Mortality from suspected diphtheria at UDUTH was high and was associated with lack of immunization, non-receipt of antitoxin, and the presence of complications, particularly cardiorenal involvement. Although age and sex were not statistically significant, children aged 1–5 years accounted for the greatest proportion of deaths. These findings highlight the need to strengthen routine immunization coverage, improve prompt availability of diphtheria antitoxin, and enhance management of complications to potentially reduce mortality during outbreaks.
Not applicable.
A. Usamatu, K. Iseh, S. Amutta et al.· BMC Infectious Diseases· 0 citations
Background Diphtheria caused by toxigenic Corynebacterium diphtheriae re-emerged in Nigeria from December 2022 as the country's largest ever recorded outbreak, accumulating over 20,000 suspected cases and 872 confirmed deaths by December 2025. The Borno-Adamawa-Yobe (BAY) states zone in north-eastern Nigeria is a recognised high-vulnerability cluster, yet no facility-level, longitudinal epidemiological data from Adamawa State have been published. Methodology/Principal findings We conducted a retrospective cohort study of all patients admitted with diphtheria to the Isolation Ward of Modibbo Adama University Teaching Hospital (MAUTH), Yola -- the sole federal university teaching hospital in Adamawa State -- from January 2023 to April 2026, using prospective admission register records. Sixty-one patients were identified (17.9% of 330 total isolation admissions). Admissions escalated 580% from 5 (2023) to 34 (2025). Median age was 8.0 years; 91.8% were under 15 years. The overall in-hospital case fatality rate (CFR) was 41.5% (22/53 known outcomes; 95% confidence interval: 29.0-55.0%). Annual CFR declined from 60.0% (2023) to 28.6% (2025), temporally consistent with improving diphtheria antitoxin access. A critical operational finding was the persistent shortage of intravenous erythromycin -- the mandated antibiotic for patients unable to swallow -- compelling oral administration in patients with pharyngeal pseudomembrane and dysphagia. Respiratory distress at presentation carried an 80% CFR; cardiac complication, 100%. Age and sex were not statistically significant mortality predictors. Gombi local government area contributed 16.4% of cases -- the highest burden among non-capital communities -- consistent with its role as a population movement corridor from Borno State's outbreak epicentre. A September-October seasonal peak (47.5% of admissions) was identified, diverging from the national January-April pattern. Conclusions/Significance This study provides the first peer-reviewed, facility-level diphtheria epidemiological dataset from Adamawa State. The in-hospital CFR substantially exceeds national surveillance averages due to referral bias and historical drug supply constraints. The declining CFR against rising admissions signals improving case management. Pre-positioning of diphtheria antitoxin and intravenous erythromycin before each August-October peak, accelerated childhood immunisation catch-up, and strengthened surveillance in Adamawa State are identified as urgent priorities.
Diphtheria remains a life-threatening disease in low-resource settings where immunization coverage is poor and access to a laboratory is limited. Somalia is currently experiencing a resurgence of clinically suspected diphtheria among children, yet detailed case-level clinical data remain scarce. The purpose of this study was to illustrate clinical features, vaccination status, complications, and early outcomes of pediatric diphtheria in a resource-limited Somali hospital. Furthermore, it identified the factors associated with severity and mortality for enhanced early recognition and management. A prospective observational study was conducted, including 51 pediatric patients aged < 18 years admitted with clinically diagnosed diphtheria to a tertiary referral hospital in Somalia between January 2025 and December 2025. Diagnosis was based on WHO clinical criteria due to the absence of local laboratory capacity. Demographic, clinical, treatment, and outcome data were collected prospectively. The requirement for pediatric intensive care unit admission defined disease severity. Statistical comparisons between severe and non-severe cases used appropriate parametric or non-parametric tests, and univariable logistic regression explored predictors of severity and mortality. Statistical significance was set at p < 0.05. This study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to guarantee transparent, thorough, and consistent demonstration of the observational methods and results. Fifty-one children met the clinical case definition (median age 6.0 years; 52.9% male). Classical airway manifestations were frequent: pseudomembrane (88.2%), bull neck (88.2%), stridor (58.8%), and airway obstruction (52.9%). Vaccination coverage was extremely low, with only 9.8% having received any diphtheria-containing vaccine. Systemic complications included neuritis in 47.1% and myocarditis in 19.6%. Eleven patients (21.6%) required PICU admission and were classified as severe. Toxin-mediated complications strongly predicted severity: myocarditis (72.7% in severe vs 5.0% non-severe) and neuritis (100% vs 32.5%). Eight children died (overall case-fatality rate: 15.7%), all in the PICU cohort. Mortality was highest among children with myocarditis (50.0%) and neuritis (33.3%), and all deaths occurred in unvaccinated children. Univariable logistic regression revealed that toxin-mediated problems such as myocarditis and neuritis were robust predictors of severe disease and mortality (p < 0.05), whereas the classical airway features and vaccination status were not substantial. Clinically diagnosed pediatric diphtheria in Somalia is characterized by profound under-immunization, high rates of classical airway features, significant toxin-mediated complications, and substantial mortality. Early identification of severe illness is essential, particularly recognition of cardiac and neurological involvement. Strengthening immunization programs, ensuring timely diphtheria antitoxin availability, and expanding critical care capacity are urgent priorities to improve outcomes.
Farah Ali Ahmed, Mohamed Nur Ali, M. Hassan et al.· Tropical Medicine and Health· 0 citations
Background: Fever with thrombocytopenia is a common yet potentially serious clinical entity in paediatric patients in tropical countries, frequently associated with infections such as dengue, scrub typhus, enteric fever and septicaemia. This study aimed to describe the clinical profile and outcomes of such patients at a tertiary care hospital.
Methods: A prospective observational study was conducted over 18 months (July 2023 to January 2025) in children aged 1 month to 12 years admitted with fever and thrombocytopenia. A total of 260 patients were enrolled using simple random sampling. Clinical data, laboratory investigations, treatment details and outcomes were recorded. Statistical analysis used SPSS version 16 (Chi-square test, Student’s t-test; p<0.05 considered significant).
Results: The 6–10 years age group was most affected (40%), with male predominance (55%). Most participants were rural residents (65%) and admissions peaked during the monsoon (40%). Dengue fever (30%) was the most common identified aetiology; 46% remained undiagnosed. Severe thrombocytopenia was found in 47%. Overall mortality was 6.2%. Lower platelet counts (p<0.001), bleeding manifestations (p<0.002) and aetiologies of septicaemia and viral encephalitis (p=0.04) were significantly associated with mortality.
Conclusions: Dengue and scrub typhus are the predominant identified aetiologies. Low platelet counts, bleeding manifestations, septicaemia and viral encephalitis are significant predictors of poor outcomes. Early recognition and prompt targeted management are vital to reducing morbidity and mortality in paediatric febrile thrombocytopenia.
Aniruddha A. Shetye, Saleem H. Tambe· International Journal of Con...· 0 citations
BACKGROUND
Non-typhoidal Salmonella (NTS) causes illnesses ranging from gastroenteritis to invasive bloodstream infection, particularly in vulnerable hosts. We describe the clinical profile and antimicrobial susceptibility of NTS isolates recovered at a tertiary-care hospital in Navi Mumbai.
METHODS
We conducted a retrospective case series of consecutive NTS isolates recovered from blood and stool between January 2022 and December 2025. Identification and MIC-based susceptibility testing were performed using automated platforms; azithromycin and chloramphenicol were tested by gradient diffusion or disc diffusion. Results were interpreted according to CLSI M100.
RESULTS
Eighteen isolates were recovered from 17 patients (15 blood and 3 stool). The median age of patients with invasive infection was 57 years (range, 0.5-84). Among adults with invasive NTS (n=12), 11 (91.7%) had comorbidities. Three invasive cases occurred in children aged 6 months to 2 years; one had a structural urinary tract abnormality. Among invasive cases, 7/15 (46.7%) required intensive care, 3/15 (20.0%) developed septic shock, and 5/15 (33.3%) developed acute kidney injury. No in-hospital mortality occurred; one late death was unrelated to the index episode. Ciprofloxacin non-susceptibility occurred in 6/15 (40.0%) blood isolates, comprising 2 intermediate and 4 resistant isolates; one of three stool isolates was intermediate. One blood isolate was ceftriaxone-resistant with a presumptive ESBL phenotype detected by VITEK 2 AES. All isolates were susceptible to meropenem and trimethoprim-sulfamethoxazole. All tested isolates were susceptible to chloramphenicol (15/15). Azithromycin results (15/15) fell within the susceptible range using S. Typhi criteria because NTS-specific CLSI breakpoints are unavailable.
CONCLUSIONS
In this small single-centre series, most adults with invasive NTS had comorbidities, and bloodstream infections were frequently severe. Ciprofloxacin non-susceptibility and a ceftriaxone-resistant isolate with a presumptive ESBL phenotype support culture-guided therapy, local antibiogram review, antimicrobial stewardship, and continued surveillance.
Jyoti Prakash Panda, Narendra Patil, Sana Rahmani et al.· Indian Journal of Medical Mi...· 0 citations
