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Diphtheria patients show kidney failure signs, brain complications

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The Kano State Case Manager for the diphtheria outbreak, Dr Salma Suwaid, said patients with diphtheria are presenting with renal failure, slow heart rate, low blood platelet count and neurological complications.

Dr Suwaid said the state recorded 35 cases of Sinus Bradycardia. 15 patients presented with thrombocytopenia and active bleeding, 25 cases with acute kidney Injury, and 11 cases with neurological complications.

Sinus bradycardia is a heart rhythm that’s slower than expected (fewer than 60 beats per minute in an adult) but is otherwise normal. It’s sometimes a symptom of certain heart conditions or problems, but it can also be a sign that a person is in very good shape because of regular exercise.

Thrombocytopenia is a condition in which you have a low blood platelet count.

Suwaid disclosed this on Monday at a webinar organised by the Nigeria Centre for Disease Control and Prevention with the theme ‘Diptheria outbreak in Nigeria: Vaccination Response.’

Diphtheria is a serious bacterial infection caused by the bacterium called Corynebacterium species that affects the nose, throat, and sometimes, skin of an individual.

Diphtheria spreads easily between people through direct contact with infected people, droplets from coughing or sneezing, and contact with contaminated clothing and objects.

The ongoing diphtheria outbreak and the associated high-case fatality which began in December 2022, are due to a combination of low vaccination coverage, and the absence of diphtheria antitoxin during the early stage of the outbreak.

So far, the infection has been confirmed in Kano, Yobe, Lagos, Osun, and Katsina states.

The outbreak has also claimed 61 lives in Kano state as of March 2, 2023.

Suwaid, who spoke on the ‘Management of diphtheria cases in Nigeria: The Kano experience” said a total of 783 patients have also been on admission so far. Of this number, 360 were females and 423 were males.

She said “We had 35 cases (57.3 per cent) with Sinus Bradycardia amongst 61 deaths as of March 2, 2023, out of which 14 presented with SB while 21 presented with SB, thrombocytopenia and renal failure.

“Patients with SB and circulatory collapse are placed on oxygen therapy, and antishock treatment using saline, atropine, and dopamine.

“Cases of isolated SB in otherwise stable patients are just monitored and given a high dose of Diphtheria Antitoxin.”

Suwaid, who is also a Consultant Paediatrician added that patients with thrombocytopenia rapidly deteriorated within 24 hours due to a lack of availability of plasma or platelet concentrates.

She said all the patients with thrombocytopenia died, making up 40 per cent of the total mortality.

She said out of the 25 cases of AKI recorded, 11 cases died and four had dialysis.

“Fourteen cases were managed conservatively and were discharged. All the patients that died had a triad of thrombocytopenia-bradycardia-renal failure. A high dose of DAT in patients with mildly impaired renal status and without any comorbidity was found to give a better outcome. We had two cases of nephrotic syndrome.

“We had 11 cases of neurological complications. All cases presented with progressive weakness, bulbar palsy, changes in voice, inability to swallow fluids, and ptosis. One case has associated paraesthesias. All the cases were readmitted after being managed and discharged,” she highlighted.

Ptosis is when the upper eyelid droops over the eye. Ptosis can limit or even completely block normal vision.

The expert, however, called for a strong surveillance system for early detection to mitigate their propagation at early stages.

She also recommended, “Hands-on skill training of doctors at the Diphtheria Treatment Unit by cardiologists with expertise in pacemaker insertion, bedside electrocardiogram monitoring which will enable early detection of cardiac abnormalities, provision of IV erythromycin and setting up of intensive care unit which should be manned by an intensivist and to make available all the necessary equipment needed for fresh frozen plasma/platelets supply and storage.

Meanwhile, the Director-General of the NCDC, Dr Ifedayo Adetifa said most confirmed cases of the infection are either not vaccinated or under-vaccinated.

“It is, however, important to document peculiar diphtheria cases so we can share it and it becomes a constant reference material,” Adetifa said.

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