Clinical features and predictors of diphtheritic cardiomyopathy in Vietnamese children.
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.
Kneen
Rachel
R
Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam. rachel.kneen@blueyonder.co.uk <rachel.kneen@blueyonder.co.uk>
Nguyen
Minh Dung
MD
Solomon
Tom
T
Pham
Ngoc Giao
NG
Parry
Christopher M
CM
Nguyen
Thi Tuyet Hoa
TT
Ha
Thi Loan
TL
Taylor
Ann
A
Vo
Thi Thien Huong
TT
Nguyen
Thi Thu Nga
TT
Day
Nicholas P J
NP
White
Nicholas J
NJ
D000293:Adolescent; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000382:microbiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004165:Diphtheria / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D014744:Vietnam