Favorable Effects of Corticosteroids in the Treatment of Diphtheria

Abstract

IntroductionCorticosteroid therapy of postdiphtheric paralysis was first reported by H. J. Roberts in 1956l. We also had used corticosteroid therapy in three cases of postdiphtheric paralysis with excellent results and suggested the possible involvement of allergic factors in the etiology of this disease2.As for diphtheria, combined use of antibiotics and cortisosteroids had beell reported by several authors3, 4, 5 , 6. However, limited use of corticosteroids for the alleviation of symptoms and signs caused by diphtheria bacilli has not yet been reported.In order to determine the beneficial effect of corticosteroids on the clinical course of diphtheria, 9 patients were treated with corticosteroids alone in an initial stage which was then followed by antibiotics. Material and MethodsThe patients included the total number admitted to the Department of Pediatrics, Gunma University School of Medicine, during the period between September, 1962, and August, 1963. They consisted of 4 males and 5 females and ranged in age between 2 years and 13 years except for one 30-year-old female. I n all cases the diagnosis was clinically and bacteriologically established. Treatment before admission:Neither antibiotics nor antiserum were given before admission. Findings a t admission:Fever: Six out of 9 cases had fever and 3 were afebrile: 4 were in the 37°C range; 1 in the 38°C range; and 1 in the 39°C range.Pseudomembrane : All cases had pseudomembranes in the pharynx. Depending on size and nature, they were divided into four groups: 1) Patches in both tonsils, (+) in 4 cases; 2) patches in one tonsil and a membrane on the other tonsil, (+ + ) in 2 ; 3) membranes on both tonsils, (+ + +) in 3.Bacteriological studies : Using stained slide preparation and culture (Arakawa media), diphtheria bacilli were identified in all cases. Type differentiation and virulence tests were not made.

Role of Methylprednisolone in Early Predicted Diphtheric Cardiomyopathy in Children: Is This a Solution?

“…So, we proposed that if methylprednisolone was given in asymptomatic patients on the basis of prediction of diphtheric cardiomyopathy than the outcome in the form of mortality in diphtheric cardiomyopathy can be significantly reduced. So here there is contrast observation in previous studies 11,12 where they have given steroids in symptomatic patients when full blown disease occurs and they documented that there is no role of steroids in combating mortality. This expiry rate was irrespective of the anti-diphtheritic serum (ADS) administration because almost all the patient got the ADS at admission.…”

“…7,8 Due to this high fatality of diphtheria cardiomyopathy or myocarditis people used many drugs like steroids, carnitine and pulses of methyl prednisolone so that they can combat this condition and they concluded as no role or very little role in most series. [9][10][11] But in almost all series they give the steroids or other drugs after the appearance of either symptoms or full-blown symptoms. There were many studies that predict the occurrence of diphtheria myocarditis either by clinical features or by electrocardiography.…”