Diphtheria in Afghanistan--review of 155 cases.

During the 3-year study period, 155 culture-positive cases of diphtheria were reviewed at the Institute of Child Health, Kabul. They comprised 0.6% of hospital admissions due to medical disorders in our institute. About 80% of patients belonged to an age group of 1-10 years and only two patients were less than 1 year old. The male to female ratio was 1.3:1. There was no history of previous vaccination against diphtheria in 96.7% of patients. In the majority of patients faucial diphtheria was diagnosed (77.4%), followed by laryngeal (16.1%) an combined pharyngolaryngeal (6.5%). Clinical presentation was with a mild to moderate degree of fever, sore throat, cervical lymphadenopathy, toxaemia, tachycardia and a characteristic thick greyish-white membrane. The main early complications were laryngeal obstruction (35), myocarditis (18), shock (3), polyneuritis (3) and renal failure (2). The overall case fatality rate was 19.3%. Prognosis was unfavourable in patients with laryngeal diphtheria when there was a delay of more than 4 days before reaching the hospital and if there was a delay in relieving laryngeal obstruction by tracheostomy. Outcome was unrelated to the age of the patient.