Dr Salma Suwaid, the Kano State case manager for the diphtheria outbreak, reported that patients are presenting with renal failure, slow heart rate, low platelet counts, and neurological complications. Among the cases, 35 patients exhibited sinus bradycardia, 15 showed thrombocytopenia with active bleeding, 25 suffered acute kidney injury (AKI), and 11 experienced neurological problems. Sinus bradycardia is a heart rhythm slower than 60 beats per minute in adults; it can be a sign of certain heart conditions or, in some individuals, an indication of good physical fitness. Thrombocytopenia refers to a reduced blood platelet count.
Suwaid disclosed these findings on Monday during a webinar organized by the Nigeria Centre for Disease Control and Prevention titled “Diphtheria Outbreak in Nigeria: Vaccination Response.” Diphtheria, a serious bacterial infection caused by Corynebacterium species, affects the nose, throat, and sometimes the skin. It spreads easily through direct contact with infected individuals, respiratory droplets, and contaminated clothing or objects. The ongoing outbreak, which began in December 2022, has been driven by low vaccination coverage and the early absence of diphtheria antitoxin. Confirmed cases have occurred in Kano, Yobe, Lagos, Osun, and Katsina states, with 61 deaths reported in Kano alone as of 2 March 2023.
According to Suwaid, who spoke on “Management of Diphtheria Cases in Nigeria: The Kano Experience,” a total of 783 patients have been admitted so far—360 females and 423 males. Of the 61 deaths recorded by 2 March 2023, 35 (57.3 %) involved sinus bradycardia; 14 presented with bradycardia alone, while 21 had bradycardia combined with thrombocytopenia and renal failure. Patients with bradycardia and circulatory collapse receive oxygen therapy and antishock treatment with saline, atropine, and dopamine. Those with isolated bradycardia and stable conditions are monitored and given a high dose of diphtheria antitoxin (DAT).
Suwaid, also a consultant paediatrician, noted that patients with thrombocytopenia deteriorated rapidly within 24 hours due to a lack of plasma or platelet concentrates, and all such patients died, accounting for 40 % of total mortality. Of the 25 AKI cases, 11 resulted in death and four required dialysis; fourteen were managed conservatively and discharged. Every patient who died exhibited the triad of thrombocytopenia, bradycardia, and renal failure. A high dose of DAT in patients with mildly impaired renal function and no comorbidities was associated with better outcomes. Two cases of nephrotic syndrome were also reported.
Neurological complications were observed in 11 patients, all presenting with progressive weakness, bulbar palsy, voice changes, difficulty swallowing, and ptosis; one case also had paraesthesias. All of these patients were readmitted after initial discharge. Ptosis, the drooping of the upper eyelid, can impair or block vision.
The expert called for a robust surveillance system to enable early detection and limit spread. She recommended hands‑on training for doctors at diphtheria treatment units by cardiologists skilled in pacemaker insertion and bedside electrocardiogram monitoring, provision of intravenous erythromycin, establishment of an intensive care unit staffed by an intensivist, and availability of equipment for fresh‑frozen plasma and platelet storage. Meanwhile, NCDC Director‑General Dr Ifedayo Adetifa emphasized that most confirmed cases involve unvaccinated or under‑vaccinated individuals and stressed the importance of documenting unusual diphtheria cases to create a lasting reference resource.
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