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High mortality diphtheritic myocarditis with conduction disturbance, case series, and review of literature.

Ann Med Surg (Lond)

August 2023

Manamohan Cardiovascular Thoracic and Transplant Centre, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu.

Unlabelled: Diphtheria cases are still being reported in various parts of the globe. Although complete heart block resulting from diphtheric myocarditis is infrequent, it can lead to fatality. Awareness and recognition of this help strengthen the importance of vaccines and their proper management.

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Diphtheria is a life-threatening infectious disease caused by . Although the disease is seen infrequently in the postvaccination era, sporadic cases continue to occur. Cardiac involvement, in the form of myocarditis, is the most serious manifestation of diphtheria and is the most common cause of mortality in these patients.

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The re-emergence of diphtheria in South Africa in recent years warns of incomplete vaccination coverage. Recent outbreaks have been associated with a high mortality rate, due to late presentation, limited access to antitoxin and the occurrence of serious systemic complications. Death due to diphtheria is most commonly associated with diphtheritic myocarditis, which presents with heart failure, cardiogenic shock and conduction abnormalities.

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A 15-year old male patient presented to us with dyspnoea for four days. He had a history of fever, pseudo-membranous tonsillitis and cervical adenopathy twenty-five days prior to the presentation. On examination and laboratory investigations, he had features suggestive of myocarditis with biventricular failure.

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Infectious diseases causing autonomic dysfunction.

Clin Auton Res

February 2018

Neurology Department, Raigmore Hospital, Inverness, UK.

Objectives: To review infectious diseases that may cause autonomic dysfunction.

Methods: Review of published papers indexed in medline/embase.

Results: Autonomic dysfunction has been reported in retrovirus (human immunodeficiency virus (HIV), human T-lymphotropic virus), herpes viruses, flavivirus, enterovirus 71 and lyssavirus infections.

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