Early Detection of Subclinical Diphtheritic Myocarditis by Serum Glutamic Oxaloacetic Transaminase (SGOT) Estimation

Abstract

Background & objectives: Diphtheria is endemic in India. Almost 50 - 60% of diphtheria deaths are due to myocarditis. Incidence of subclinical myocarditis is 68%. Serum Glutamic Oxaloacetic Transaminase (SGOT) level can be used as marker of extent of myocardial damage during the course of diphtheria3-7. We therefore conducted study to detect early myocarditis due to diphtheria by measuring SGOT level. Methods: This is a prospective study of 55 patients admitted over a 6 months period in a tertiary care hospital. Patients, from which Corynebacterium diphtheria was isolated in throat swab culture, were enrolled in study. The clinical parameters, ECG and SGOT level were estimated on admission. All data were collected and statistical analyzed. Results: The SGOT level was high in 65.5% (36/55) of patients. The clinical myocarditis was found in 25.8 % (6/55) patients. In 91.6% (33/36) cases of myocarditis, ECG did not reveal any abnormality, but definite elevations of the enzyme levels were noticed. The mean + SD age of children in our study was 6.6 yr + 3 SD (range 1-13) years. SGOT level was high in 36 cases out of them 30 cases (83.3%) having duration of illness less than 7 days. Out of 6 expire cases 4 patient (66.7%) having raised SGOT level. We noticed 83.3% (5/6) cases expired due to diphtheritic myocarditis had abnormal leukocyte count (p 0.01). Interpretation & Conclusion: We concluded elevated SGOT levels had high sensitivity and a negative predictive value to detect subclinical diphtheritic myocarditis. Abnormal (high or low) total leukocyte count had poor prognostic value.