Diphtheria Resurgence: Where did We fail?

Objective: This report aims at highlighting the persistence of diphtheria in India and the need for better vaccine coverage of both primary as well as booster doses and accessibility of antidiphtheric serum (ADS) at all tertiary medical centers. Case report: An 11-year-old girl, previously unimmunized against diphtheria, presented with history of fever, cough, difficulty in swallowing and change in voice within 1 week duration. Examination revealed bilaterally enlarged tonsils with a grayish white patch over them. A provisional diagnosis of faucial diphtheria and the patient was started on antibiotics. Next day, child developed respiratory distress and generalized swelling over the neck. An emergency tracheotomy was performed, and shifted to a center where ADS was available. She received 5 doses of ADS but succumbed to myocarditis 5 days later. Membranous patches removed from the trachea were positive for Corynebacterium diphtheriae and the diagnosis was confirmed by culture. Conclusion: Vaccination coverage for both primary as well as boosters should be improved, so as to reach coverage advocated by WHO. All tertiary hospitals should have ADS. Health care personal should be sensitized to maintain a high degree of suspicion when presented with a patch over the tonsil.