Clinical presentation and outcome of diphtheria in health facility in North-East Nigeria

Frequent outbreak of diphtheria occurs in Nigeria and some developing nations due to poverty, poor environmental sanitation, and vaccination coverage.

To determine the clinical presentation and outcome of diphtheria in cases admitted in a Yobe Specialist Hospital Potiskum, Yobe State, North-East Nigeria.

This is an observational study involving consecutive cases of diphtheria admitted in diphtheria treatment unit (DTU) in the hospital. Cases were admitted from 27th May to 30th October 2023.

A total of 640 patients were admitted with median age of 9 (1–62), with males constituting 350 (54.6%). Only 9 (1)% of patients had vaccination. Common clinical features included pseudomembrane (90.7%), fever (79.7%), neck pain (78.3%), gross cervical lymphadenopathy (GCL; 69.1%), and sore throat (44.2%). The case fatality rate was 7%, higher in < 5 years (8.4%) than 5–14 years (7.4%) and ≥ 15 years (2.2%) respectively. Independent risk for fatality included delay in presentation (adjusted odd ratio (AOR) = 1.21, 95% confidence interval (CI) [1.10, 1.42], p < 0.001), vomiting (AOR = 3.6, 95% CI [1.36, 9.6], p = 0.01), bleeding from orifices (AOR = 3.76, 95% CI [5.76, 6.98], p < 0.001), blood transfusion (AOR = 8.12, 95% CI [3.34, 19.74], p < 0.001), and diphtheria antitoxin (DAT) administration (AOR = 3.17, 95% CI [1.37, 7.25], p = 0.07).

Clinical presentation was consistent with diphtheria. Risk of fatality included vomiting, bleeding from orifices, anemia necessitating blood transfusion, delay in presentation, and DAT administration.