Indian J Pediat 49 : 339-340, 1981

N e o n a t a l diphtheria : a case report

Panna Choudhary, M.D., D.C.H., M. Krishnamurthy, D.C.H., and Ramesh K. Puri, M.D., D.C.H.

Diphtheria in new born period is an extremely uncommon condition. Hospi- tal outbreaks of the disease amongst neonates have been described in the last century t as well as in the early 20th cen- tury, in Western literature. Isolated cases are very rare and have been occasionally reported in last 2 to 3 decades.~ In India, several large series of diphtheria have been published in recent years, but none of the cases were below three months of age. 3'4 We report a case of neonatal diphtheria in a 17-day-old infant.

Report of case

A 17-day-old boy was admitted in our hospital on June 1979 with refusal of feeds, diminished activity and ulcera- tive lesions over the back and tip of nose. Antenatal and natal history were unevent- ful.

At admission, the baby weighed 2.6 Kg. and had mild icterus, diminished reflexes, a cleft lip and a cleft palate. There was an ulcer of 8 x 4 cm over the back and also on tip of nose. A grey membrane covered the palate, tonsils and pharynx, which on at tempt to removal showed bleeding surfaces. Examination

From the Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research. Pondicherry-605C06.

Reprint request : Dr. R.K. Purl, Assistant Frofessor and Head.

of other systems revealed no abnormality. Laboratory tests revealed hemogram

within normal range. Blood culture was sterile and chest radiograph didn't show any abnormali ty. Swabs f rom throat and from ulcers over skin were positive for Corynebacterium diphtheriae. Swabs taken from mother ' s nose and throat were also positive for Corynebacterium diphtheriae both by direct smear and culture.

The baby was treated with crystalline penicillin, gentamicin and 40,000 units o f diphtheria anti-toxin including other sup- portive measures. There was initial im- provement. But on 9th day of admission, the infant suddenly collapsed.

Discussion

The neonates are relatively immune to diphtheria due to transplacental transfer of diphtheria anti-toxin. Poor immune status of the mother or selective transfer of antibodies across the placenta may, however, make few new borns susceptible. Rapid decline of anti-toxin level ten days after birth has been reported.~ It is possi- ble that isolated cases are missed as the disease at this age is usually nasal or nasopharyngeal in type. Faucial diph- theria is unusual and probably due to acid reaction of the mouth and poor deve- lopment of the tonsils in new born period. In the present case, the source of infec- tion is obviously from the mother. Active immunization of expectant mothers has

340 THE INDIAN JOURNAL OF PEDIATRICS

been suggested to prevent neonatal diph- theria but it might interfere with early active immunizat|on. Schick test may be of help in screening susceptible mothers. Isolation and prophylactic therapy of snspected cases appears to be the best course at the moment, till further infor- mation becomes available.

Re~rences

1. Rollenston JD : Malignant diphlheria with

Vol. 49, No. 392

multiple lesions in an infant. Lancet 2 : 947, 1910.

2. Curtin M : Neonatal diphtheria, Arch Dis Child 28 : 127, 1953

3 . Diphtheria, Pertussis, Tetanus : International Symposium 1974. A Glaxo (India) Sympo- sium, 1975. p p 180, 247

4. Pohwalla JN, Upadhaya LN, Chhaparwal BC :Clinical and bacteriological study of diphtheria in childr, n. Indian Pediatr 4:208, 1967

5. Barr M, Glenny AT, Parish HJ: Diphtheria antitoxin in cord blood. Lancet I:713, 1951

Deficiency of biotin linked svith cot deaths (SIDS)

Two Australian scientists have estab- Britain. The levels of biotin were low in lished a relationship between sudden formula based on skimmed milk and infant death syndrome (SIDS), commonly demineralised milk as the source o f called "cot death", and a low level of the protein. The loss of biotin probably vitamin biotin in the liver of the infants, occurs during dialysis, which is used to Alan Johnson and Ross Hood found that reduce that salt content of c•w's milk to stress-induced death occurred in appar- a level similar to that in human milk. ently healthy young chickens when their diet was marginally deficient in biotin. The evidence to date is circumstantial. When the birds' diet was supplemented It would be difficult to provide unequi- with biotin, the syndrome was eliminated, vocal prooflinking biotin, or any nutrient, They then, measured the biotin content with SIDS because of the difficulty in of 300 livers obtained from infant auto- undertaking biochemical studie~ with psies. The livers of infants who had died experimental and control subjects. It is inexplicably were lower in biotin that recommended to supplement infant those of infants whose deaths could be formulas with biotin. ascribed to a particular cause. They also measured biotin level in human milk and Abstracted by I.C. Verma infant formulas from Australia and From D.G.H.S, Chronicle, Feb. 1981.