呼吸道机械性梗阻和心肌炎是白喉相关死亡的最主要原因。[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 20 世纪 40 年代白喉总死亡率为 2.4%,90 年代俄罗斯暴发时仍在 2%-3%。 如果发展为白喉性多发性神经病,报道的死亡率为 16%。[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
在实现有效治疗之前,病死率约为 50%;随着治疗和疫苗接种的广泛应用,病死率保持在 10% 左右。[1]Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases. Chapter 1: diphtheria. Mar 2018 [internet publication].https://www.cdc.gov/vaccines/pubs/surv-manual/chpt01-dip.html
心肌炎后心脏功能通常完全恢复。 然而,出现严重的心律失常患者可能会有永久性心脏传导系统损害的风险。[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.
通常神经功能障碍会完全恢复。 少数情况下,血管运动中心功能障碍可导致低血压和心力衰竭。[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.
患者的年龄和免疫状况是影响预后的重要因素:高龄和年幼患者通常预后较差,而免疫接种史常常预后更好。
白喉抗毒素治疗时机对于结果至关重要;早期给药可以预防许多疾病的毒性后遗症。[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. 皮肤感染很少引起全身症状。[2]Lee PL, Lemos B, O'Brien SH, et al. Cutaneous diphtheroid infection and review of other cutaneous Gram-positive Bacillus infections. Cutis. 2007 May;79(5):371-7.http://www.ncbi.nlm.nih.gov/pubmed/17569399?tool=bestpractice.com