Clinical features of diphtheria in the respiratory tract.

Clinical features of 44 culture-confirmed cases of diphtheria involving the respiratory tract treated at the University of Washington and affiliated hospitals in Seattle over a five-year period were studied. Of 42 patients treated primarily in Seattle, five (11.9%) died; nonfatal, toxin-induced complications occurred in seven (16.7%). Airway obstruction was the most common cause of death in this series. Diphtheritic membrane (especially in the larynx), dyspnea, and leukocytosis were dire prognostic signs. We urge indirect laryngoscopyin all cases showing membrane formation; tracheotomy should be considered when laryngeal membrane is present. Diphtheria should be suspected in any patient with pharyngitis who has been in contact with endemic areas, especially when pharyngeal membrane is present.