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AN OBSERVATIONAL STUDY OF INCIDENCE OF POSITIVE THROAT SWABS FOR DIPHTHERIA IN CHILDREN IN A TERTIARY CARE HOSPITAL IN JHARKHAND, INDIA
*Dr. Shiv Shankar Jha, M.D, Dch, Dr. Minni Rani Akhouri, Professor, M.D, Dr. Umendra Kumar, MD
Introduction: Diphtheria is an acute toxic infection causing cough, sore throat, dysphasia, hoarseness of voice, fever or headache due to Corynebacterium species, mainly Corynebacterium diphtheriae and, less often, by few strains of Corynebacterium ulcerans. India has witnessed several outbreaks of Diphtheria in recent times as reported from various states. In scenario of changing epidemiology of diphtheria in rest of India, studies reporting clinical profile remain scanty in our state of Jharkhand. Hence we decided to analyze the clinical and demographic profile of diphtheria cases which would not only help in early recognition of cases but also in providing timely treatment which may reduce morbidity and mortality. It will also help in early preparedness to combat in case of any outbreak of diphtheria and strengthen the immunization coverage in unimmunized areas of Jharkhand. Methods: A total of 136 patients were registered and their personal records as name, age, sex, contact address and other relevant information were taken and their throat swab samples were collected using full aseptic and antiseptic precaution and samples were sent to the Microbiology Laboratory immediately after collection for gram staining and culture. Results: In this study, a total of 136 throat swabs were collected among which 16 (11.76%) samples were found to have growth and remaining 120 (88.23%) samples showed no growth. The most commonly isolated bacteria was Staphylococcus aureus (44%), followed by Candida (38%) and 3% for Streptococcus pneumoniae, Klebsiella pneumoniae and E.coli. None of the samples detected Corynebacterium diphtheriae in throat infections amongst patients examined at RIMS, Ranchi. The immunization status in the present study shows that 62.5% of children being fully immunized as per National Immunization Schedule, 33.8% of children were partially immunized while 3.7% of children were unimmunized. Among 6 months to 1 year age group 04 (28.6%) were fully immunized and 10 (71.4%) partially immunized. Similarly, among >1 year to 5 years age group 53 (58.9%) were fully immunized, 35 (38.9%) partially immunized and 02(2.2%) were unimmunized. Among age group >5 years to 18 years age group 27 (84.4%) were fully immunized, 02(6.25%) partially immunized and 03(9.4%) were unimmunized. Limitations: we could not perform Polymerase Chain Reaction (PCR) and serology in present study. Also the Official statistics were difficult to obtain as existing surveillance systems in our region rely on passive reporting where most cases are known to go unreported. Conclusion: The present study was aimed at assessing the incidence of diphtheria in children coming to RIMS, Ranchi. The absence of bacteriologically confirmed cases of diphtheria may be attributed to successful vaccination coverage against diphtheria by Pentavalent and/or DPT vaccine.[Full Text Article]