白喉

咽腭肌麻痹导致发声和吞咽困难。 误吸风险高，需要密切监测和并做好气管插管准备。[14]Centers for Disease Control and Prevention; Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington D.C: Public Health Foundation; 2015.https://www.cdc.gov/vaccines/pubs/pinkbook/index.html

接种部位常出现有/无压痛的红斑和硬结。 局部皮肤反应是自限性的，无需治疗。[14]Centers for Disease Control and Prevention; Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington D.C: Public Health Foundation; 2015.https://www.cdc.gov/vaccines/pubs/pinkbook/index.html

少数情况下，会形成脓肿，需要切开引流治疗。

可因假膜形成和咽部水肿而发生。 气管切开术和机械通气的气道管理可能是必要的。[16]American Academy of Pediatrics Committee on Infectious Diseases. Diphtheria. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018:319-23.https://redbook.solutions.aap.org/chapter.aspx?sectionid=189640082&bookid=2205

Central airway obstruction

由于神经炎和膈神经脱髓鞘病变导致膈肌麻痹，可能发生在发病的第一周和第七周之间。 如果发生这种情况，插管和机械通气是必要的。

Acute respiratory failure

美国的抗毒素是马血清制剂，可能在某些人中引起严重的过敏反应。[14]Centers for Disease Control and Prevention; Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington D.C: Public Health Foundation; 2015.https://www.cdc.gov/vaccines/pubs/pinkbook/index.html

过敏检测应在给予抗毒素之前进行，以最大限度减少过敏风险。

Anaphylaxis

这是一种 III 型（阿瑟氏）免疫反应，因抗原抗体复合物在组织中沉积而引发的补体和白细胞的组织破坏作用。

患者从肩膀到肘部出现广泛的疼痛肿胀。 这通常发生在血清抗毒素水平高的成人。[14]Centers for Disease Control and Prevention; Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington D.C: Public Health Foundation; 2015.https://www.cdc.gov/vaccines/pubs/pinkbook/index.html

常为心肌病变的首发表现。 它通常与发热程度无关。[26]Stephen Buescher. Diphtheria. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson textbook of pediatrics. 17th ed. Philadelphia, PA: WB Saunders Co; 2004:886-9.

Assessment of tachycardia

心脏传导系统的异常会导致心脏传导阻滞、房室分离和室性心动过速。[16]American Academy of Pediatrics Committee on Infectious Diseases. Diphtheria. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018:319-23.https://redbook.solutions.aap.org/chapter.aspx?sectionid=189640082&bookid=2205

Overview of dysrhythmias (cardiac)

大约 10%-25% 的白喉患者临床上发展为明显的心肌炎。[33]Logina I, Donaghy M. Diphtheritic polyneuropathy: a clinical study and comparison with Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 1999 Oct;67(4):433-8.http://www.ncbi.nlm.nih.gov/pubmed/10486387?tool=bestpractice.com 随着及时和适当的治疗，心脏功能通常完全恢复。

Myocarditis

如果心肌炎持续，最终会导致扩张和肥厚型心肌病，导致心脏衰竭。

Acute exacerbation of congestive heart failure

视力模糊可能是由于动眼神经和睫状神经麻痹。[26]Stephen Buescher. Diphtheria. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson textbook of pediatrics. 17th ed. Philadelphia, PA: WB Saunders Co; 2004:886-9.

脊髓前角细胞脱髓鞘可引起运动力弱和深腱反射减弱。 这通常从远端发展到近端肌肉，但也可以从近端发展到远端。[26]Stephen Buescher. Diphtheria. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson textbook of pediatrics. 17th ed. Philadelphia, PA: WB Saunders Co; 2004:886-9.