title: Clinical features and predictors of diphtheritic cardiomyopathy in Vietnamese children.
abstract: 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.
authors.affiliation: 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>
authors.forename: Rachel
authors.initials: R
authors.lastname: Kneen
authors.forename: Minh Dung
authors.initials: MD
authors.lastname: Nguyen
authors.forename: Tom
authors.initials: T
authors.lastname: Solomon
authors.forename: Ngoc Giao
authors.initials: NG
authors.lastname: Pham
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.forename: Thi Tuyet Hoa
authors.initials: TT
authors.lastname: Nguyen
authors.forename: Thi Loan
authors.initials: TL
authors.lastname: Ha
authors.forename: Ann
authors.initials: A
authors.lastname: Taylor
authors.forename: Thi Thien Huong
authors.initials: TT
authors.lastname: Vo
authors.forename: Thi Thu Nga
authors.initials: TT
authors.lastname: Nguyen
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
mesh_terms: 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