Before the turn of the century, the mortality from diphtheria was estimated at 30% to 50% (1). The initiation of diphtheria antitoxin use in 1894, followed by the use of large-scale vaccination practices in 1922, resulted in the dramatic fall in the mortality rate to 10% (2). Despite the refinement in the care of critically ill patients since that time, the mortality rate reported from most series varies from 5% to 10% (5). Notable risk factors for death due to diphtheria include extensive, virulent disease and delays in receiving diphtheria antitoxin, seeking medical attention, or diagnosis. Mortality rates are lower for those patients who receive antitoxin within the first two days of the illness. Vaccinated patients typically experience a mild illness. Sudden death may be caused by rapid airway obstruction due to membrane detachment, myocarditis resulting in heart failure, or respiratory paralysis from phrenic nerve involvement. Although patients who develop myocarditis or neuritis generally recover completely, some patients may sustain permanent heart damage.
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