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A Clinical Study of Diphtheria.

Journal of the Korean Pediatric Society 1978;21(4):272-279.
Published online April 30, 1978.
A Clinical Study of Diphtheria.
Myung Ho Lee, Jin Ju Kim, Sung Hee Shin
Dept. of Pediatrics, Presbyterian Medical Center, Jeonju, Korea.
디프테리아에 대한 임상적 고찰
이명호, 김잔주, 신성희
전주예수병원 소아과
Abstract
The incidence of diphtheria is markedly decreased in the developed countries. But in Korea, since 1970, there has been an increased incidene of diphtheria and some clinical modifications of the classical picture were seen, such as less incidence of preudomembrane, milder constitutional symptoms and fewer positive culture of C. diphtheriae. With this in mind we reviewed the 40 cases of diphtheria, who were admitted to Ped. Dept. of PMMC during the period of past 5 years period(Feb. 1972-Dec. 1976). Thus this study is based on the clinical manifestations, the findings of routine lab. And EKG, localization of diphtheric lesions, relationship between the first visit to hospital and death rate, and the various complications of the disease esp. toxic myocarditis. The results of this study are as follow: 1. Number of patients had been increased since 1974. The 70% of diphtheric cases was developed in Winter season. 2. The age incidence was highest in the 4~8 years range and 14 cases (35%) were before 6 years of age. The sex ratio of male to female was 1.5:1. Primary DPT vaccination had been done in only 1 case. 3. The average time coming to the hospital was 5.4 days of illness. Patients with laryngeal type visited hospital earlier than patients with pharyngeal type. 4. The site of localization of diphtheria was larynx (42.5%), pharynx (37.5%), and pharyngolarynx (20%). 5. The chief clinical findings on admission was dyspnea (70%), fever (67.5%) and pseudomembrane (30%). There were marked difference in clinical manifestations with the site of localization of the disease. 6. Leucocytosis was found in almost every case. Culture studies for Corynebacterium diphtheriae were positive in 72.5% of cases. 7. The order of EKG abnormalities were S-T segment and T-wavechanges, complete A-V block, A-V dissociation, P-R interval prolongation, and right bundle branch block. 8. Complications of the disease were as follows : Bull neck (20%), myocarditis (30%), peumonia (27.5%), and proteinuria (42.5%). 9. Mortality rate was 15% of the total, 20% in pharyngeal type, 25% in pharyngolaryngeal type and 7% in laryngeal type. The cause of death was myocarditis in 5 case and pneumonia in 1 case. The mortality rate of myocarditis was 42% ( 5/12).


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