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• Bull neck appearance is due to a

combination of swollen mucosa
and cervical adenopathy.
• In our study, 34% patients had bull
neck and its presence was
associated with a high mortality.
• The most common complication • Cardiac complications were seen
observed in our study was in 54 cases (30%).
respiratory in 80 cases (44%). • They were associated with the
• The possible factors causing airway highest mortality rate of 63% (28
obstruction could have been out of 44 cases). This result was
laryngeal involvement, extensive found to be highly significant.
pharyngotonsillar disease, florid soft • Diphtheria myocarditis occurs
tissue edema and necrosis, or due to bacterial exotoxin which
bleeding into the airways. causes DNA fragmentation &
• Signs of upper airway obstruction cytolysis by inhibiting elongation
may occur with or without laryngeal
factor-2 activity in protein
synthesis in addition to damage
involvement and should be to conduction tissue.
anticipated and treated aggressively.
In the US of America, the number of cases and deaths due to diphtheria in the pre-
vaccine era was 158 cases per million per year and 13.7 deaths per million per year,
respectively. Following the introduction of vaccine there has been a 100% reduction
in the cases and deaths due to diphtheria.

Case fatality rate in this study was 24.4%, whereas it ranged from 32 to 56.3% in
different centres in north India and 42.9% in west India.

This data suggest a decline in the fatality rate due to diphtheria which indicates
improved penetration of vaccination coverage, better health care facilities, and
increased awareness among caregivers.

However, complete eradication of the disease from the community is required.

This depends on improving the socio-economic status of the community, high
vaccination coverage and regular booster dosage.