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KMID : 0351619750160020139
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Kyungpook Medical Journal
1975 Volume.16 No. 2 p.139 ~ p.151
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Clinical Studies of Diphtheria in Children
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孫榮佑/Sohn, Young Woo
安斗洪/韓東燮/Ahn, Doo Hong/Han, Dong Sup
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Abstract
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Clinical observations on diphtheria among the children, aged from less than 1 to 14 years, were made at the Kyungpook National University Hospital in the period from January, 1967 to December, 1974.
A total of 219 Children admitted to the hospital was observed during the past 8 years. It was found that the frequency of occurrence of diphtheria was s:,me~vhat constant, and no significant differnce in the annual incidence was observed. The peak incidence vas encountered in the 3 to 6 age group of children and the almost all cases were under the 10 years cf age (91.7,0.
The frequency of occurrence was higher for males than among females, with a ratio of 1.4:1. In the monthly incidence, it showed the highest rate during the two months from December to January in each year.
The disease was classified into 5 categories according to the localities of diphtheritic patches. The rate of laryngeal diphtheria was found to be the highest in percentage(45.3%) followed by pharyngeal(30.4j~;), Pharyngolaryngeal (21.6%), nasophar;Tngeal(1.8%), and nasal(0.9 ~), in decreasing order.
The preparation of specimens, taken from the nasopharynx, revealed the causative organism in 84.7% of pharyngeal region, 72.4 % of pharyngolaryngeal, and 41.5% of laryngeal, with an average value cf 66.1.
The majority patients visited was admitted to the L~ospital 1 to 6 days after initial complaints. The majority of children had fever more than 37C and revealed leulcocytosis.
On admission, 57 out of 21S or 26.1 %were proved to be abnormal in the examination of E.C.G.and twelve cases showed abnormalities on following checks among the 79 cases revealed normal findings. Therefore, the validity of abnormal findings i:n total was encounted in 31.6%.
In the abnormal findings of E.C.G. , on admission, S-T segment and T wave change was most often(8.7%), next the pr:;lcngation of Q-T interval(7.3%), and the various findings of canductiori defect were alsa noted in 15 cases(6.9%).
In this study, abnGrrnalities according to the clinical ~.ypes of illness were 28.8% in pharyngeal,. 25.5 o in pharyngolaryn~eal, and 24.2% in laryngeal types, in decreasing order.
It is evident that the abnorral findings increased with the ages of children and no significant difference between male ~::d female was observed.
The eccurence of abnormal E.C. G. findings increased in proportion to the duration of illness. Of these. almost all of the cases(53 of 57) were revealed abnormalities between third and fourteen days of illness.
At the follow-up checking the abnormaiities including; S-T segment and Twave changes, prolongatian cf P-R interval a^d to;v voltage wave were disappeard relatively early; but the prolongation cf Q-T interval and con~?uction defect were more or less sustained.
Excluding myocarditis, the complications observed were pneumonia and/or bronchitis in 17 cases (5..5;0). post-diphtheric paralysis in 7cases(3.5%), and m.reloid hypoplasia and thrombocytopenia was one in each.
In the urinalyses. 29 cut of 199 or 14.6% revealed abnormal findings suspectable for nephropathy.
Of the tcrtal cases, we lcst 10 cases(4.6%), and 5 of those considered to be due to complicated mvocarcitis.
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