All cases in this series were given a final clinical diagnosis of diphtheritic neuropathy. The European Union case definition (2002) for the National Diphtheria Surveillance category of probable diphtheria was used to look for diphtheria: "a clinically compatible case that is not laboratory confirmed and does not have an epidemiological link to a laboratory case." Diphtheria is clinically defined "as an upper respiratory tract illness characterized by sore throat, low grade fever, and an adherent membrane of the tonsils, pharynx or nose or non-respiratory diphtheria; cutaneous, conjunctival, otic, and genital lesions" (10).
Other reports of diphtheritic neuropathy in India have been bacteriologically confirmed for 15%-39% of patients (19-21).
Detection of Diphtheritic Neuropathy by AFP Surveillance Systems
Our study demonstrates that diphtheritic neuropathy can be detected through existing AFP surveillance systems designed to detect poliomyelitis and may be pragmatically expanded to include diphtheritic neuropathy in children <15 years of age.