Journal Article

Clinical Features and Predictors of Diphtheritic Cardiomyopathy in Vietnamese Children

Rachel Kneen, Nguyen Minh Dung, Tom Solomon, Pham Ngoc Giao, Christopher M. Parry, Nguyen Thi Tuyet Hoa, Ha Thi Loan, Ann Taylor, Vo Thi Thien Huong, Nguyen Thi Thu Nga, Nicholas P. J. Day and Nicholas J. White

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 11, pages 1591-1598
Published in print December 2004 | ISSN: 1058-4838
Published online December 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/425305
Clinical Features and Predictors of Diphtheritic Cardiomyopathy in Vietnamese Children

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Background. Despite the availability of antitoxin and antibiotics, the mortality rate for diphtheria remains high, mostly because of cardiac complications.

Methods. During 1 year, 154 Vietnamese children with diphtheria admitted to a referral hospital were studied prospectively with clinical examination, including a simple pseudomembrane score, 12-lead and 24-hour electrocardiography, measurement of serum cardiac enzyme levels, and estimation of troponin T levels.

Results. Thirteen children had diphtheritic cardiomyopathy on admission, and 19 developed it subsequently. Twelve children (8%) died. The combination of pseudomembrane score of >2 and bull neck predicted the development of diphtheritic cardiomyopathy, with a positive predictive value of 83% and a negative predictive value of 93%. Administration of 24-hour electrocardiography on admission improved the ability to predict diphtheritic cardiomyopathy by 57%. Fatal outcome was best predicted by the combination of myocarditis on admission and a pseudomembrane score of >2. Of the cardiac enzyme levels measured, an elevated aspartate aminotransferase level was the best predictor. The presence of troponin T identified additional children with subclinical cardiac damage.

Conclusions. The development of diphtheritic cardiomyopathy can be predicted by means of simple measures.

Journal Article.  4346 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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