The disease may remain manageable, but in more severe cases, lymph nodes in the neck may swell, and breathing and swallowing are more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later and can lead to heart failure.<unk>  can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases are put in a hospital intensive care unit and given<unk>  antitoxin (consisting of antibodies isolated from the serum of horses that have been challenged with<unk>  toxin). Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration increases risk of death. Therefore, the decision to administer<unk>  antitoxin is based on clinical diagnosis, and should not await laboratory confirmation. Antibiotics have not been demonstrated to affect healing of local infection in<unk>  patients treated with antitoxin. Antibiotics are used in patients or carriers to eradicate C.<unk> e and prevent its transmission to others. The Centers for Disease Control and Prevention recommends either: * Metronidazole * Erythromycin is given (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or * Procaine penicillin G is given intramuscularly for 14 days (300,000 U/d for patients weighing 10 kg); patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin. In cases that progress beyond a throat infection,<unk>  toxin spreads through the blood and can lead to potentially life-threatening complications that affect other organs, such as the heart and kidneys. Damage to the heart caused by the toxin affects the heart's ability to pump blood or the kidneys' ability to clear wastes. It can also cause nerve damage, eventually leading to paralysis. About 40% to 50% of those left untreated can die.
Diphtheria
Spanish flu
Swine influenza
Plague 
Anthrax
Periodic fever syndrome
Murine typhus
Influenza