Complications
Hypopharyngeal and palatal muscle paralysis lead to dysphonia and dysphagia. The high risk of aspiration necessitates close monitoring and preparation for possible intubation.
Erythema and induration with/without tenderness frequently occurs at the site of vaccination. Local skin reaction is self-limiting and needs no treatment.[27]
Rarely, an abscess can form, requiring treatment by incision and drainage.
Can occur as a result of pseudomembrane formation and pharyngeal oedema. Airway management with tracheostomy and mechanical ventilation may be necessary.
Diaphragmatic paralysis due to neuritis and demyelination of the phrenic nerve may occur at any time between the first and seventh week of illness. If this occurs, intubation and mechanical ventilation is warranted.
Antitoxin preparations used worldwide are derived from horse serum, which can cause anaphylactic reactions in some individuals.[27]
The World Health Organization (WHO) strongly recommends against routine sensitivity testing prior to administration of antitoxin.[45] Pre-medication with antihistamines and corticosteroids should be considered, as well as ensuring treatment occurs in a setting where trained staff are present to rapidly detect and treat anaphylaxis.[45]
This is a type III (Arthus-type) immune reaction, caused by deposition of antigen-antibody complexes in tissues, leading to the tissue-damaging effects of complement and leukocytes.
Patients present with extensive painful swelling from the shoulder to the elbow. This usually occurs in adults with a high serum antitoxin level.[27]
Often the first manifestation of cardiomyopathy. It is usually unrelated to the degree of fever.[4]
Abnormalities in the cardiac conduction system can lead to heart block, atrioventricular dissociation, and ventricular tachycardia.
Around 10% to 25% of patients with diphtheria develop clinically apparent myocarditis.[59] With prompt and appropriate treatment, recovery of cardiac function is usually complete.
If myocarditis is prolonged, it can eventually lead to dilated and hypertrophic cardiomyopathy, causing heart failure.
Blurred vision may result from oculomotor and ciliary nerve paralysis.[4]
Demyelinating polyneuropathy can cause motor weakness and decreased deep tendon reflexes.[4]
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