Diphtheritic Polyneuropathy: A Rare Complication that Needs to be Acknowledged

  • Fandy Ong Jaya Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
  • Priscilla Love Lee Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
  • Kiking Ritarwan Departement of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
Keywords: complication, clinical manifestation, diphtheria, diphtheritic polyneuropathy, treatment

Abstract

Globally, diphtheria still poses a burden on public health, predominantly in developing countries. Poor vaccine coverage and boosters are the main factors in the diphtheria outbreak that should have been obliterated as the vaccine was invented a century ago. Health services are particularly burdened by diphtheria because it can lead to both short-term complications like acute airway obstruction and long-term complications like myocardial toxicity and diphtheritic polyneuropathy. Data about diphtheritic polyneuropathy is scarce, and physicians may not be aware of this condition. Herein we present the pathophysiology, clinical manifestation, diagnosis, and treatment of diphtheritic polyneuropathy.

 

References

Acosta, Anna M., Pedro L. Moro, Susan Hariri, and Tejpratap S. P. Tiwari. 2021. “Diphtheria.†97–110.

Ang, L. W., L. James, and K. T. Goh. 2016. “Prevalence of Diphtheria and Tetanus Antibodies among Adults in Singapore: A National Serological Study to Identify Most Susceptible Population Groups.†Journal of Public Health (United Kingdom) 38(1):99–105. doi: 10.1093/pubmed/fdv011.

Berkowitz, Aaron L. 2018. “Tetanus, Botulism, and Diphtheria.†CONTINUUM Lifelong Learning in Neurology 24(5, Neuroinfectious Disease):1459–88. doi: 10.1212/CON.0000000000000651.

Blumberg, L. H., M. A. Prieto, J. V. Diaz, M. J. Blanco, B. Valle, C. Pla, and D. N. Durrheim. 2018. “The Preventable Tragedy of Diphtheria in the 21st Century.†International Journal of Infectious Diseases 71:122–23. doi: 10.1016/j.ijid.2018.05.002.

Brooks, Hannah E., Lane A. McLendon, and Casey L. Daniel. 2021. “The Impact of COVID-19 on Pediatric Vaccination Rates in Alabama.†Preventive Medicine Reports 22:101320. doi: 10.1016/j.pmedr.2021.101320.

Carod-Artal, Francisco Javier. 2018. “Infectious Diseases Causing Autonomic Dysfunction.†Clinical Autonomic Research 28(1):67–81. doi: 10.1007/s10286-017-0452-4.

Centers for Disease Control and Prevention. 2022a. “Diphtheria: Clinicians.†Retrieved July 18, 2022 (https://www.cdc.gov/diphtheria/clinicians.html).

Centers for Disease Control and Prevention. 2022b. Expanded Access Investigational New Drug (IND) Protocol: Use of Diphtheria Antitoxin (DAT) for Suspected Diphtheria Cases. Protocol CDC IRB #4167. Version 70.0.

Clarke, Kristie E. N., Adam MacNeil, Stephen Hadler, Colleen Scott, Tejpratap S. P. Tiwari, and Thomas Cherian. 2019. “Global Epidemiology of Diphtheria, 2000–2017.†Emerging Infectious Diseases 25(10):1834–42. doi: 10.3201/eid2510.190271.

Ekwueme, Donatus U., Peter M. Strebel, Stephen C. Hadler, Martin I. Meltzer, James W. Allen, and John R. Livengood. 2000. “Economic Evaluation of Use of Diphtheria, Tetanus, and Acellular Pertussis Vaccine or Diphtheria, Tetanus, and Whole-Cell Pertussis Vaccine in the United States, 1997.†Archives of Pediatrics and Adolescent Medicine 154(8):797–803. doi: 10.1001/archpedi.154.8.797.

Faulkner, Amanda, Catherine H. Bozio, Anna Acosta, and Tejpratap S. P. Tiwari. 2019. “VPD Surveillance Manual, Chapter 1: Diphtheria.†1–9.

Fratelli, Fernando, José Abrahão-Neto, Aline Tojeira Prestia Caricati, Monamaris Marques Borges, Rosalvo Guidolin, and Celso Pereira Caricati. 2011. “An Alternative Method for Purifying and Detoxifying Diphtheria Toxin.†Toxicon 57(7–8):1093–1100. doi: 10.1016/j.toxicon.2011.04.015.

Gowda, Vykuntaraju K., Sukanya Vignesh, Asha Benakappa, Naveen Benakappa, and Sanjay K. Shivappa. 2022. “Clinical Profile and Outcome in Children with Post Diphtheritic Paralysis in a Tertiary Care Hospital in Southern India.†Iranian Journal of Child Neurology 16(2):107–15. doi: 10.22037/ijcn.v16i1.23092.

Gower, Charlotte M., Antonia Scobie, Norman K. Fry, David J. Litt, J. Claire Cameron, Meera A. Chand, Colin S. Brown, Sarah Collins, Joanne M. White, Mary E. Ramsay, and Gayatri Amirthalingam. 2020. “The Changing Epidemiology of Diphtheria in the United Kingdom, 2009 to 2017.†Eurosurveillance 25(11):1–10. doi: 10.2807/1560-7917.ES.2020.25.11.1900462.

Hadfield, Ted L., Peter McEvoy, Yury Polotsky, Vsevolod A. Tzinserling, and Alexey A. Yakovlev. 2000. “The Pathology of Diphtheria.†Journal of Infectious Diseases 181(SUPPL. 1):3–7. doi: 10.1086/315551.

Hanvatananukul, Pimpika, Chanidapa Prasarakee, Saowalak Sarachai, Linda Aurpibul, Kamolrawee Sintupat, Ratchaneekorn Khampan, Jutamad Saheng, and Tavitiya Sudjaritruk. 2020. “Seroprevalence of Antibodies against Diphtheria, Tetanus, and Pertussis among Healthy Thai Adolescents.†International Journal of Infectious Diseases 96:422–30. doi: 10.1016/j.ijid.2020.04.088.

Harapan, Harapan, Samsul Anwar, Herlina Dimiati, Zinatul Hayati, and Mudatsir Mudatsir. 2019. “Diphtheria Outbreak in Indonesia, 2017: An Outbreak of an Ancient and Vaccine-Preventable Disease in the Third Millennium.†Clinical Epidemiology and Global Health 7(2):261–62. doi: 10.1016/j.cegh.2018.03.007.

Hasselhorn, Hans Martin, Matthias Nübling, Friedrich W. Tiller, and Friedrich Hofmann. 1998. “Factors Influencing Immunity against Diphtheria in Adults.†Vaccine 16(1):70–75. doi: 10.1016/S0264-410X(97)00148-5.

Hong, Kai, Fangjun Zhou, Yuping Tsai, Tara C. Jatlaoui, Anna M. Acosta, Kathleen L. Dooling, Miwako Kobayashi, and Megan C. Lindley. 2021. “Decline in Receipt of Vaccines by Medicare Beneficiaries During the COVID-19 Pandemic — United States, 2020.†MMWR Surveillance Summaries 70(7):245–49. doi: 10.15585/mmwr.mm7007a4.

Jammar, Saket Kumar, Shraddha Sharma, Sunita Agarwal, Tanmaya Kataria, Prem Singh Jat, Shashank Nath Singh, Deepak Jain, Ritu Sehra, and Ajay Gupta. 2021. “Spectrum of Neurological Outcomes in Diphtheria: A Case Series.†Indian Journal of Otolaryngology and Head and Neck Surgery 4–9. doi: 10.1007/s12070-021-02706-6.

Kadirova, R., H. Ü. Kartoglu, and P. M. Strebel. 2000. “Clinical Characteristics and Management of 676 Hospitalized Diphtheria Cases, Kyrgyz Republic, 1995.†Journal of Infectious Diseases 181(SUPPL. 1):110–15. doi: 10.1086/315549.

Kanwal, Sandeep Kumar, Dinesh Yadav, Viswas Chhapola, and Virendra Kumar. 2012. “Post-Diphtheritic Neuropathy: Aclinical Study in Paediatric Intensive Care Unit of a Developing Country.†Tropical Doctor 42(4):195–97. doi: 10.1258/td.2012.120293.

Karyanti, Mulya Rahma, Erni Juwita Nelwan, Iqbal Zein Assyidiqie, Hindra Irawan Satari, and Sri Rezeki Hadinegoro. 2019. “Diphtheria Epidemiology in Indonesia during 2010-2017.†Acta Medica Indonesiana 51(3):205–13.

Katirji, Bashar. 2022. Disorders of Peripheral Nerves. Eighth Edi. Elsevier Inc.

Kementerian Kesehatan Republik Indonesia. 2017. “Pedoman Pencegahan Dan Pengendalian Difteri.†Buku Pedoman Pencegahan Dan Pengendalian Difteri 1–34.

Krumina, A., I. Logina, M. Donaghy, B. Rozentale, I. Kravale, A. Griskevica, and L. Viksna. 2005. “Diphtheria with Polyneuropathy in a Closed Community despite Receiving Recent Booster Vaccination.†Journal of Neurology, Neurosurgery and Psychiatry 76(11):1555–57. doi: 10.1136/jnnp.2004.056523.

Lodeiro-Colatosti, Adriana, Udo Reischl, Thomas Holzmann, Carlos E. Hernández-Pereira, Alejandro Rísquez, and Alberto E. Paniz-Mondolfi. 2018. “Diphtheria Outbreak in Amerindian Communities, Wonken, Venezuela, 2016–2017.†Emerging Infectious Diseases 24(7):1340–44. doi: 10.3201/eid2407.171712.

Logina, Inara, and Michael Donaghy. 1999. “Diphtheritic Polyneuropathy: A Clinical Study and Comparison with Guillain-Barré Syndrome.†Journal of Neurology Neurosurgery and Psychiatry 67(4):433–38. doi: 10.1136/jnnp.67.4.433.

Lovie-Toon, Yolanda G., Kerry K. Hall, Anne B. Chang, Jennie Anderson, and Kerry Ann F. O’Grady. 2016. “Immunisation Timeliness in a Cohort of Urban Aboriginal and Torres Strait Islander Children.†BMC Public Health 16(1):1–11. doi: 10.1186/s12889-016-3825-z.

Lu, Peng Jun, Mei Chuan Hung, Anup Srivastav, Lisa A. Grohskopf, Miwako Kobayashi, Aaron M. Harris, Kathleen L. Dooling, Lauri E. Markowitz, Alfonso Rodriguez-Lainz, and Walter W. Williams. 2021. “Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.†Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002) 70(3):1–26. doi: 10.15585/mmwr.ss7003a1.

Manikyamba, D., A. Satyavani, and P. Deepa. 2015. “Diphtheritic Polyneuropathy in the Wake of Resurgence of Diphtheria.†Journal of Pediatric Neurosciences 10(4):331–34. doi: 10.4103/1817-1745.174441.

Marlovits, Stefan, Roland Stocker, Androulla Efstratiou, Karen Broughton, Alexandra Kaider, Vilmos Vécsei, Gerhard Wiedermann, and Herwig Kollaritsch. 2000. “Seroprevalence of Diphtheria Immunity among Injured Adults in Austria.†Vaccine 19(9–10):1061–67. doi: 10.1016/S0264-410X(00)00341-8.

Mateen, Farrah J., Sunil Bahl, Ajay Khera, and Roland W. Sutter. 2013. “Detection of Diphtheritic Polyneuropathy by Acute Flaccid Paralysis Surveillance, India.†Emerging Infectious Diseases 19(9):1368–73. doi: 10.3201/eid1909.130117.

Murhekar, Manoj. 2017. “Epidemiology of Diphtheria in India, 1996-2016: Implications for Prevention and Control.†American Journal of Tropical Medicine and Hygiene 97(2):313–18. doi: 10.4269/ajtmh.17-0047.

Murthy, Bhavini Patel, Elizabeth Zell, Karen Kirtland, Nkenge Jones-Jack, La Treace Harris, Carrie Sprague, Jessica Schultz, Quan Le, Cristi A. Bramer, Sydney Kuramoto, Iris Cheng, Mary Woinarowicz, Steve Robison, Ashley McHugh, Stephanie Schauer, and Lynn Gibbs-Scharf. 2021. “Impact of the COVID-19 Pandemic on Administration of Selected Routine Childhood and Adolescent Vaccinations — 10 U.S. Jurisdictions, March-September 2020.†MMWR Recommendations and Reports 70(23):840–45. doi: 10.15585/mmwr.mm7023a2.

Padhye, Amruta, and Stephanie A. Fritz. 2022. Diphtheria ( Corynebacterium Diphtheriae ). Twenty-Fir. Elsevier Inc.

Piradov, Michael A., Victor N. Pirogov, Lubov M. Popova, and Irina A. Avduinina. 2001. “Diphtheritic Polyneuropathy: Clinical Analysis of Severe Forms.†Arch Neurol 58(9):1438–42. doi: 10.1001/archneur.58.9.1438.

Prasad, Prem L., and Preeti L. Rai. 2018. “Prospective Study of Diphtheria for Neurological Complications.†J Pediatr Neurosci. 13(3):313–16. doi: 10.4103/JPN.JPN_130_17.

Rahman, Md Ridwanur, and Khaleda Islam. 2019. “Massive Diphtheria Outbreak among Rohingya Refugees: Lessons Learnt.†Journal of Travel Medicine 26(1):1–3. doi: 10.1093/jtm/tay122.

Saleeb, Paul G. 2022. 204 - Corynebacterium Diphtheriae (Diphtheria). Ninth Edit. Elsevier Inc.

Sanghi, Viraj. 2014. Neurologic Manifestations of Diphtheria and Pertussis. Vol. 121. 1st ed. Elsevier B.V.

Saxena, Kunal, Jessica R. Marden, Cristina Carias, Alexandra Bhatti, Oscar Patterson-Lomba, Andres Gomez-Lievano, Lixia Yao, and Ya Ting Chen. 2021. “Impact of the COVID-19 Pandemic on Adolescent Vaccinations: Projected Time to Reverse Deficits in Routine Adolescent Vaccination in the United States.†Current Medical Research and Opinion 37(12):2077–87. doi: 10.1080/03007995.2021.1981842.

Sharma, Naresh Chand, Androulla Efstratiou, Igor Mokrousov, Ankur Mutreja, Bhabatosh Das, and Thandavarayan Ramamurthy. 2019. “Diphtheria.†Nature Reviews Disease Primers 5(1). doi: 10.1038/s41572-019-0131-y.

Sunarno, Febriyani Asri, Subangkit, Mursinah, Herna, Susanti Nike, Sariadji Kambang, Widoretno, Febriyana Dwi, Febrianti Tati, Saraswati Ratih Dian, and Puspandari Nelly. 2021. “Diphtheria Serology in Adults in Central Java and East Java, Indonesia: The Importance of Continuous Diphtheria Vaccination.†African Health Sciences 21(3):1148–54. doi: 10.4314/ahs.v21i3.23.

Suresh, Natarajan, Nagaraja Rao, Vasanthi Thiruvengadam, and Venkataraman Viswanathan. 2012. “An Interesting Case of Diphtheritic Neuropathy.†Journal of Pediatric Neurology 10(2):143–45. doi: 10.3233/JPN-2012-0546.

Tiwari, Tejpratap S. P., and Melinda Wharton. 2018. Diphtheria Toxoid. Seventh Ed. Elsevier Inc.

Truelove, Shaun A., Lindsay T. Keegan, William J. Moss, Lelia H. Chaisson, Emilie Macher, Andrew S. Azman, and Justin Lessler. 2020. “Clinical and Epidemiological Aspects of Diphtheria: A Systematic Review and Pooled Analysis.†Clinical Infectious Diseases 71(1):89–97. doi: 10.1093/cid/ciz808.

Völzke, H., K. M. Kloker, A. Kramer, L. Guertler, M. Dören, S. E. Baumeister, W. Hoffmann, and U. John. 2006. “Susceptibility to Diphtheria in Adults: Prevalence and Relationship to Gender and Social Variables.†Clinical Microbiology and Infection 12(10):961–67. doi: 10.1111/j.1469-0691.2006.01477.x.

WHO. 2017. “Diphtheria Vaccine: WHO Position Paper – August 2017.†Weekly Epidemiological Record 92(31):417–36.

WHO. 2018. “Diphtheria - Vaccine-Preventable Diseases Surveillance Standards.†1–15.

Van Wijhe, M., A. D. Tulen, H. Korthals Altes, S. A. McDonald, H. E. De Melker, M. J. Postma, and J. Wallinga. 2018. “Quantifying the Impact of Mass Vaccination Programmes on Notified Cases in the Netherlands.†Epidemiology and Infection 146(6):716–22. doi: 10.1017/S0950268818000481.

Published
2024-03-30
Section
Articles
Abstract viewed = 59 times
PDF downloaded = 36 times