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Parak M, Asgari A, Hasani Nourian Y, Ghanei M. A review of poisoning with various types of biotoxins and its common clinical symptoms. Toxicon 2024; 240:107629. [PMID: 38336277 DOI: 10.1016/j.toxicon.2024.107629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/01/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Biotoxins are toxic substances that originate from living organisms and are harmful to humans. Therefore, we need to know the symptoms of biotoxins poisoning to manage the damage. The purpose of this study is to establish a practical diagnostic protocol for dealing with poisoned patients exposed to biotoxins. MATERIALS AND METHODS The present study is a review study. Our studied community is articles and books matching the title of the project and relevant keywords. First, by searching the key words sign, symptom, biotoxins, relevant articles were extracted and studied from valid databases. By reviewing the studies based on the search strategy, four groups of biotoxins that were studied the most were identified. These four groups are marine biotoxins, bacterial biotoxins, fungal biotoxins and plant biotoxins. In each of these biotoxin groups, important toxins were selected and studied. RESULTS A total of 1864 articles were initially identified from the databases searched in present study. After screening titles and abstracts, 26 articles were included in the systematic review. Specifically, 7 articles were included for bacterial toxins, 9 articles for marine toxins, 5 articles for plant toxins and 5 articles for fungal toxins. CONCLUSION The symptoms of plant biotoxins poisoning may include cardiovascular, hematologic, neurologic, respiratory, renal, and gastrointestinal symptoms, while the symptoms of fungal biotoxins poisoning may include hepatic, renal, gastrointestinal, musculoskeletal, metabolic, respiratory, neurological, and cardiovascular symptoms. marine biotoxins poisoning presents with gastrointestinal and neurological symptoms, with varying incubation periods and recovery times. bacterial biotoxins exposure can lead to a wide range of clinical symptoms, with diarrhea, vomiting, and abdominal pain being the most common, and hemoglobinuria or hematuria being a sensitive and specific clinical manifestation for diagnosing ongoing HUS in children.
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Affiliation(s)
- Mohammadreza Parak
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Alireza Asgari
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Yazdan Hasani Nourian
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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DeWaard S, Dewyer Z, Al Assil T, Gallap R, Patrick L, Fukuda N, Ford M. An educational intervention in the emergency department seeking to improve COVID-19 vaccination rates among unvaccinated patients aged 20-64. Infect Dis Health 2023; 28:276-281. [PMID: 37524612 DOI: 10.1016/j.idh.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The COVID-19 vaccination rate in the US has plateaued, especially among minorities and young populations. Previous efforts within the Emergency Department (ED) setting to address this disparity have shown positive results. The ED can play a crucial role in engaging vaccine-hesitant individuals, particularly those with limited access to healthcare. By providing education, addressing concerns, and using positive framing, vaccination rates can be improved in the ED. This quality improvement project aimed to increase vaccination rates through one-on-one educational interventions and open discussions with patients. METHODS Between November 2021 and June 2022, unvaccinated adult patients aged 20 to 64 visiting a local ED in Kalamazoo, MI were approached for a discussion on COVID vaccines. A research team, trained in motivational interviewing techniques, provided an educational intervention, offering evidence-based information and resources to unvaccinated participants. RESULTS A total of 37 participants were enrolled, and their demographics were recorded. The participants expressed various concerns about the vaccine, including potential side effects, speed of testing and production, perceived ineffectiveness, mistrust, and low personal risk. At the four-week follow-up, three participants (8%) had received their first dose of the COVID-19 vaccine. CONCLUSION The study fell short of its desired sample size and the intervention failed to raise vaccination rates among ED patients. Factors like low perceived risk, vaccine hesitancy, and limited resources may have influenced these outcomes. Future research should focus on staffing, operational hours, repeated educational interventions, and targeted approaches for different populations. Improving participant recruitment through institutional engagement and involvement of multiple EDs should be explored. Addressing these factors can help inform effective interventions to increase COVID-19 vaccination rates in the ED.
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Affiliation(s)
- Shelby DeWaard
- Western Michigan Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA.
| | - Zachary Dewyer
- Western Michigan Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA
| | - Talal Al Assil
- Western Michigan Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA
| | - Rachael Gallap
- Bronson Methodist Hospital Emergency Department, 601 John St 1st Floor, Kalamazoo, MI 49007, USA
| | - Lauren Patrick
- Western Michigan Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA
| | - Noelle Fukuda
- Western Michigan Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA
| | - Maureen Ford
- Western Michigan Homer Stryker MD School of Medicine, 300 Portage Street, Kalamazoo, MI 49007, USA; Bronson Methodist Hospital Emergency Department, 601 John St 1st Floor, Kalamazoo, MI 49007, USA
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Walter K, Thomas R, Gyawali S, Kallur S. Suspected tetanus in an unvaccinated pediatric patient. Proc AMIA Symp 2023; 36:383-385. [PMID: 37091757 PMCID: PMC10120531 DOI: 10.1080/08998280.2023.2167048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Tetanus is a vaccine-preventable neuromuscular disease with a high mortality rate. The incidence of tetanus in developed countries has significantly declined due to preventive vaccination measures, but the potential for long-term complications and mortality from this disease remains high in the unvaccinated population. There are only a few individual case reports of tetanus in the pediatric population in the United States. We present a case of suspected tetanus in a 10-year-old unvaccinated child in Central Texas who sustained multiple cardiovascular and pulmonary complications during a 1-month hospitalization course. This case highlights the importance of pediatric immunization for prevention of this potentially fatal disease process and its long-term complications. Physicians should maintain a high clinical suspicion for tetanus infection in unvaccinated children to prevent delay in necessary treatment.
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Affiliation(s)
| | - Renita Thomas
- Department of Pediatrics Critical Care, Baylor Scott & White McLane Children’s Medical Center, Temple, Texas
| | - Swasti Gyawali
- Department of Pediatrics Critical Care, Baylor Scott & White McLane Children’s Medical Center, Temple, Texas
| | - Sowmya Kallur
- Department of Pediatrics Critical Care, Baylor Scott & White McLane Children’s Medical Center, Temple, Texas
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Mohammadi M, Zangooei M, Abbasi E, Ebrahimi Fana S, Aminian M. Production of anti-tetanus toxin IgY and study of its protective effects in a mouse model. J Immunoassay Immunochem 2022; 44:283-295. [PMID: 36300827 DOI: 10.1080/15321819.2022.2138718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Tetanus is an acute and often fatal infectious disease caused by Clostridium tetani. Tetanus toxin (TT) is responsible for spastic paralysis observed in tetanus. Anti-tetanus antibodies obtained from horses and humans are the most antitoxins used for tetanus treatment, although some clinical side effects and disadvantages have been reported in their application. The aim of this study is the production of anti-TT IgY and evaluation of its protective effects in a mouse model. Anti-TT IgY was purified from the egg yolk using PEG6000 precipitation and water dilution methods, and its purity was verified by SDS-PAGE. Finally, the potency of purified anti-TT IgY in neutralizing the lethal effects of TT was studied in vivo using a mouse model. PEG6000 precipitation method had better results. Animal studies showed that the purified IgY neutralized the toxic effects of 100 MLD of TT and multiple intravenous-dose injections of anti-TT IgY also had a continuous effect of TT neutralization. The purified anti-TT IgY was effective in neutralizing the lethal activity of TT in a mouse model. Our results suggested that IgY could be an alternative therapeutic source for the management of tetanus in the future.Abbreviations Anti-TT, Anti-tetanus toxin; ELISA, Enzyme-linked immunosorbent assay; IgY, Immunoglobulin Y; MLD, Minimum lethal dose; PBS, Phosphate buffer solution; PEG, Polyethylene glycol; SDS-PAGE, Sodium dodecyl sulfate polyacrylamide gel electrophoresis; TIG, Tetanus immune globulin; TT, Tetanus toxin; WD, Water dilution; RT, Room temperature.
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Affiliation(s)
- Mohammad Mohammadi
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Zangooei
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Abbasi
- Department of Bacterial Vaccines, Razi Vaccine and Serum Research Institute, Karaj, Iran
| | - Saeed Ebrahimi Fana
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Aminian
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Recombinant Vaccine Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Dutta S, McEvoy DS, Stump T, McCabe J, Mahendra-Rajah A, McMurry R, White BA, Rubins D. Clinical Decision Support Reduces Unnecessary Tetanus Vaccinations in the Emergency Department. Ann Emerg Med 2021; 78:370-380. [PMID: 33975733 DOI: 10.1016/j.annemergmed.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Tetanus is the most common vaccination given in the emergency department; yet, administrations of tetanus vaccine boosters in the ED may not comply with the US Centers for Disease Control and Prevention's recommended vaccination schedule. We implemented a clinical decision support alert in the electronic health record that warned providers when ordering a tetanus vaccine if a prior one had been given within 10 years and studied its efficacy to reduce potentially unnecessary vaccines in the ED. METHODS This was a retrospective, quasi-experimental, 1-group, pretest-posttest study in 3 hospital EDs in Boston, MA. We studied adult patients for whom tetanus vaccines were ordered despite a history of vaccination within the prior 10 years. We compared the number of potentially unnecessary tetanus vaccine administrations in a baseline phase (when the clinical decision support alert was not visible) versus an intervention phase. RESULTS Of eligible patients, 22.1% (95% confidence interval [CI] 21.8% to 22.4%) had prior tetanus vaccines within 5 years, 12.8% (95% CI 12.5% to 13.0%) within 5 to 10 years, 3.8% (95% CI 3.6% to 3.9%) more than 10 years ago, and 61.3% (95% CI 60.9% to 61.7%) had no prior tetanus vaccination documentation. Of 60,983 encounters, 337 met the inclusion criteria. A tetanus vaccination was administered in 91% (95% CI 87% to 96%) of encounters in the baseline phase, compared to 55% (95% CI 47% to 62%) during the intervention. The absolute risk reduction was 36.7% (95% CI 28.0% to 45.4%), and the number of encounters needed to alert to avoid 1 potentially unnecessary tetanus vaccine (number needed to treat) was 2.7 (95% CI 2.2% to 3.6%). For patients with tetanus vaccines within the prior 5 years, the absolute risk reduction was 47.9% (95% CI 35.5 % to 60.3%) and the number needed to treat was 2.1 (95% CI 1.7% to 2.8%). CONCLUSION A clinical decision support alert that warns ED clinicians that a patient may have an up-to-date tetanus vaccination status reduces potentially unnecessary vaccinations.
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Affiliation(s)
- Sayon Dutta
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Massachusetts General Brigham Digital Health, Boston, MA; Harvard Medical School, Boston, MA.
| | | | - Timothy Stump
- Massachusetts General Brigham Digital Health, Boston, MA
| | - Jonathan McCabe
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Massachusetts General Brigham Digital Health, Boston, MA
| | | | - Reid McMurry
- Boston University School of Medicine, Boston, MA
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - David Rubins
- Massachusetts General Brigham Digital Health, Boston, MA
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Imtiaz H, Hakeem H, Alam A, Kanwar D. Making an objective diagnosis of tetanus-utility of a simple neurophysiological test. BMJ Case Rep 2019; 12:12/12/e232344. [PMID: 31796435 DOI: 10.1136/bcr-2019-232344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tetanus remains a significant cause of mortality especially in the developing world. Early diagnosis and institution of treatment is critical to prevent fatal complications. The diagnosis is made on clinical grounds, which may sometimes be difficult, especially in case of localised tetanus. Being able to diagnose tetanus objectively is invaluable in such cases. In this regard, masseter inhibitory reflex (MIR) is a simple neurophysiological test that can be performed at the bedside. Herein, we report a case of craniocervical tetanus that was objectively diagnosed using MIR and adequately treated.
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Affiliation(s)
- Hina Imtiaz
- Section of Neurology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Haris Hakeem
- Section of Neurology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Anusha Alam
- Section of Neurology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Dureshahwar Kanwar
- Section of Neurology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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A 28-Year-Old Woman With Tetanus. J Emerg Nurs 2018; 45:197-199. [PMID: 30078616 DOI: 10.1016/j.jen.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/07/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
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Tetanus Vaccination and Extra-Immunization among Adult Populations: Eight-Year Follow Up Cohort Study of 771,443 Adults in Taiwan, 2006⁻2013. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081622. [PMID: 30071598 PMCID: PMC6121571 DOI: 10.3390/ijerph15081622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 07/22/2018] [Accepted: 07/31/2018] [Indexed: 01/05/2023]
Abstract
Under-and extra-immunization of tetanus boosters are important issues to consider in reducing the burden of vaccine-preventable disease in adults. The present study aimed to analyze the trend of vaccination coverage (VC) and risk factors associated with extra-immunization of tetanus during an 8-year period using a national-scale cohort database. Taiwan’s one-million representative research database, the Longitudinal Health Insurance Database (LHID2005) was used. A total of 771,443 adults aged between 20 and 79 years were enrolled and followed from 1 January 2006 to 31 December 2013. VC at the beginning was as low as 35.1%, declining gradually and dropping to 33.9% at the end of follow-up. While a total of 303,480 tetanus boosters were used during the study period, more than half (55.5%) of these boosters were considered as extra-immunized. Both individual characteristics and visit characteristics were strongly associated with extra-immunization. Males, young and older adults, and those with a higher number of comorbidities were more likely to receive extra-immunization boosters, especially when they had more severe symptoms, visited an emergency room, or visited a hospital with lower accreditation levels located in a less urbanized area. This information could enhance implementation of evidence-based programs for tetanus boosters.
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Chiang T, Deng Y, Lu T, Lin C. Autonomic Dysfunction as an Unusual Initial Presentation of Generalised Tetanus. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this paper, we report a rare case of a 65-year-old Chinese male farmer who was brought to an emergency department (ED) with a puncture wound on the left ankle. One week after being treated, the patient returned to the ED and exhibited signs of diaphoresis, hypertension, and slight rigidity and pain in the neck region. Eight hours after being admitted to the surgical ward, the patient developed typical signs of generalised tetanus, including abdominal muscle rigidity, trismus, and dysphagia. This case is unique because of the early manifestation of autonomic dysfunction, which is not common in people with tetanus. Therefore, to establish an early diagnosis of tetanus, physicians in EDs must obtain detailed patient histories and recognise acute changes in vital signs. (Hong Kong j.emerg.med. 2014;21:392-395)
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Affiliation(s)
- Tl Chiang
- Fu Jen Catholic University, College of Medicine, No.510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205 Taiwan (R.O.C.)
| | - Yw Deng
- Landseed Hospital, No.77, Kwang-Tai Road, Ping-jen City, Tao-Yuan County 32449, Taiwan (R.O.C.)
| | - Tc Lu
- National Taiwan University Hospital Hsin-Chu Branch, No.25, Lane 442, Sec. 1, Jingguo Road, Hsinchu City 30059, Taiwan (R.O.C.)
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Nóbrega MVDD, Reis RC, Aguiar ICV, Queiroz TV, Lima ACF, Pereira EDB, Ferreira RFDA. Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality. Braz J Infect Dis 2016; 20:457-61. [PMID: 27478080 PMCID: PMC9425500 DOI: 10.1016/j.bjid.2016.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 01/26/2016] [Accepted: 06/29/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Tetanus, an acute infectious disease, is highly prevalent worldwide, especially in developing countries. Due to respiratory failure and hemodynamic instability associated with dysautonomia, severe cases require intensive care, but little has been published regarding the management in the Intensive Care Unit. Objective To draw a 10-year clinical–epidemiological profile of Intensive Care Unit patients with severe tetanus, observe their evolution in the Intensive Care Unit and identify risk factors for mortality. Methods In this retrospective study, we used a standardized questionnaire to collect information from the records of patients with severe tetanus admitted to the intensive care unit of a referral hospital for infectious and contagious diseases in Northeastern Brazil. Results The initial sample included 144 patients, of whom 29 were excluded due to incomplete information, leaving a cohort of 115 subjects. The average age was 49.6 ± 15.3 years, most patients had no (or incomplete) vaccination against tetanus, and most were male. The main intensive care-related complications were pneumonia (84.8%) and dysautonomia (69.7%). Mortality (44.5%) was higher than expected from the mean APACHE II score (11.8), with shock/multiple organ failure as the main cause of death (72.9%). The independent factors most predictive of mortality were APACHE II score, dysautonomia, continuous neuromuscular blockade and age. Conclusion A high mortality rate was observed in our cohort of Intensive Care Unit patients with severe tetanus and a number of risk factors for mortality were identified. Our results provide important insights for the development of intervention protocols capable of reducing complications and mortality in this patient population.
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Kumar R, Taneja DK, Dabas P, Ingle GK. Practices and Knowledge regarding Prevention of Tetanus among Doctors in Delhi. Asia Pac J Public Health 2016; 18:30-2. [PMID: 17153079 DOI: 10.1177/10105395060180030601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cross-sectional study was conducted in Delhi to study immunisation practices regarding prevention of tetanus among doctors and their knowledge regarding its prevention. Delhi was divided into five zones, and from each zone two hospitals and five dispensaries were selected, giving due representation agency-wise. All the doctors posted for casualty duty in the selected hospitals, all doctors posted in the selected dispensaries and two private practitioners selected randomly from the nearby area of the selected dispensaries were included in the study. Only 7% of doctors had received their last dose of tetanus toxoid to complete the immunisation schedule and majority had received it following injury. As much as 38.3% of doctors favoured TT after every injury. Out of the remaining who opposed it only 59.5% could provide the correct reason for this. Less than half of the doctors knew the indications of anti-tetanus serum. There is a need for the doctors to take TT immunisation more seriously and adopt recommended immunisation practices, because if they themselves are not following the guidelines, it is likely to be reflected in their advice and motivation to patients.
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Affiliation(s)
- R Kumar
- Department of Community Medicine, Maulana Azad Medical College, Delhi, India.
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Naseem F, Mahar IA, Arif F. Two years' study of Tetanus cases in a Paediatric Intensive Care Unit. Pak J Med Sci 2016; 32:641-5. [PMID: 27375706 PMCID: PMC4928415 DOI: 10.12669/pjms.323.9165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the demographic and clinical features, outcome, complications and treatment cost of tetanus patients admitted in Paediatirc Intensive Care Unit (PICU) of Civil Hospital Karachi (CHK). METHODS It is a descriptive observational study conducted at Civil Hospital Karachi from July 2013 to June 2015. Patients of tetanus admitted in PICU during the study period were enrolled. Data was collected from the file records of patients and included the demographic profile, clinical presentation, grade of severity, length of stay, complications and outcome. It also included the cost of treatment. Descriptive statistics were applied to describe the results. RESULTS During the study period, 23 cases of tetanus were admitted in P.I.C.U. twelve were male and 11 female. Majority of cases (13) belonged to age group 2-6 years. Seventeen cases were unvaccinated and 6 had received only BCG & OPV. None was appropriately vaccinated for age. There were 9 cases of post injury tetanus, 6 of them were males, 5 cases of otogenic tetanus and 9 cases had no clinically identifiable portal of entry. Eleven cases belonged to grade III severity of Ablett classification and 6 had grade IV severity. Mortality in our case series was 26%. Autonomic instability was seen in 17 patients and all of them needed ionotropic support. The estimated cost of per day treatment of a tetanus patient with mechanical ventilation was approximatly 31, 979/Pak Rs and without mechanical ventilation was 20,000/Pak Rs. CONCLUSION Tetanus is an entirely preventable disease with a high mortality. Treatment is very costly as compared to vaccination which is free of cost. Complete vaccination and proper wound care is the only option to reduce the ongoing burden of tetanus.
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Affiliation(s)
- Faizia Naseem
- Faizia Naseem, MBBS, DCH, MCPS, FCPS. Senior W.M.O, Paediatric Unit-II, Civil Hospital, Karachi, Pakistan
| | - Imtiaz Ahmad Mahar
- Imtiaz Ahmad Mahar, MBBS, DCH. Senior M.O, PICU, Civil Hospital, Karachi, Pakistan
| | - Fehmina Arif
- Fehmina Arif, MBBS, DCH, FCPS. Professor, Department of Paediatrics, Dow Medical College, Dow University of Health Sciences, Karachi. Pakistan. Civil Hospital, Karachi, Pakistan
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Chatterjee K, Ghosh A, Sengupta RS. A toe that pointed the wrong way: An unusual presentation of tetanus. J Neurosci Rural Pract 2016; 7:150-2. [PMID: 26933367 PMCID: PMC4750318 DOI: 10.4103/0976-3147.165354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 15-year-old girl who was initially diagnosed to have a striatal toe. Her condition progressed and she later developed clinical features consistent with tetanus. History of blunt trauma to nose was elicited retrospectively. Antimicrobial therapy with metronidazole and both active and passive immunization was started immediately. The patient went on to make a complete recovery.
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Affiliation(s)
- Krishnarpan Chatterjee
- Department of Medicine, ESI-PGIMSR and ESI Medical College, Joka, Kolkata, West Bengal, India
| | - Anirban Ghosh
- Department of Medicine, ESI-PGIMSR and ESI Medical College, Joka, Kolkata, West Bengal, India
| | - Rimi Som Sengupta
- Department of Medicine, ESI-PGIMSR and ESI Medical College, Joka, Kolkata, West Bengal, India
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Torrez PPQ, Quiroga MM, Said R, Abati PAM, França FOS. Tetanus after envenomations caused by freshwater stingrays. Toxicon 2015; 97:32-5. [PMID: 25576234 DOI: 10.1016/j.toxicon.2014.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
Injuries caused by freshwater stingray are common in several regions of South America, although they are underreported. The riverside inhabitants are the main victims in the Amazonian and Midwest regions of South America. The fishermen are injured mainly in the new focus of colonization of the rivers by freshwater stingrays. With the increasing population in these regions, where freshwater stingrays are found, there has been a significant increase in injuries within the general population. The highest increase occurred among tourists from other regions, where these animals are not known, when visiting these areas. The envenomations from the stingray causes prolonged and intense pain, both local and regionally. Generally these are associated with other local inflammatory manifestations, such as swelling and erythema. The injury often progresses to necrosis and it is considered potentially tetanogenic. A secondary infection is also a frequent local complication and most frequently is caused by Aeromonas species, usually Aeromonas hydrophila. Herein we report the first 2 cases of tetanus after freshwater stingray injuries: a 51-year-old men who had tetanus and recovered without sequel and the second a 67-year-old men who had severe tetanus and a deep, necrotizing soft-tissue infection with sepsis, septic shock and evolution to death.
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Affiliation(s)
- Pasesa P Q Torrez
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| | - Mariana M Quiroga
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Renato Said
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Paulo A M Abati
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Francisco O S França
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil; Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Joelsons D, Ho YL, Park M. Ultrasound-guided percutaneous tracheostomy: a feasible alternative for tetanus patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:441. [PMID: 25043740 PMCID: PMC4224035 DOI: 10.1186/cc13946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Maxillofacial trauma in the emergency department: A review. Surgeon 2014; 12:106-14. [DOI: 10.1016/j.surge.2013.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/06/2013] [Accepted: 07/08/2013] [Indexed: 12/16/2022]
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Lee SJ, Lim SO, Jeong JY, Park MJ, Park JE. The Clinical Pathology Characteristics and Tetanus Quick Stick Evaluation for Tetanus Patients in Daegu Emergency Medical Center. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2014. [DOI: 10.15324/kjcls.2014.46.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seung-Jin Lee
- Department of Laboratory Medicine, Daegu Catholic University Medical Center, Daegu 705-718, Korea
| | - Soon-Ok Lim
- Department of Laboratory Medicine, Daegu Catholic University Medical Center, Daegu 705-718, Korea
| | - Jae-Yeop Jeong
- Department of Laboratory Medicine, Daegu Catholic University Medical Center, Daegu 705-718, Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Daegu Catholic University Medical Center, Daegu 705-718, Korea
| | - Ju-Eun Park
- Department of Laboratory Medicine, Daegu Catholic University Medical Center, Daegu 705-718, Korea
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Serinken M, Gozlukaya A, Sari I, Karcioglu O. Thrombocytopenia after tetanus prophylaxis with tetanus-diphtheria (Td) vaccine. J Emerg Med 2013; 44:e287-e288. [PMID: 23141562 DOI: 10.1016/j.jemermed.2012.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 02/15/2012] [Accepted: 05/08/2012] [Indexed: 06/01/2023]
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El Koraichi A, Aggoug B, Tadili J, Benjelloun MY, El Haddoury M, El Kettani SE. [Severe tetanus complicated with rhabdomyolysis and acute renal failure: a pediatric case report]. Arch Pediatr 2012; 19:726-8. [PMID: 22652517 DOI: 10.1016/j.arcped.2012.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/27/2012] [Accepted: 04/25/2012] [Indexed: 10/26/2022]
Abstract
Renal failure is a rare complication of tetanus in children. It occurs following poorly controlled muscle spasms and rigidity. We describe a severe case of tetanus complicated with rhabdomyolysis and acute renal failure in a child.
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Affiliation(s)
- A El Koraichi
- Service d'anesthésie-réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, Rabat, Maroc.
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Abstract
Tetanus is a preventable illness occurring worldwide with a high mortality, mostly affecting neonates in developing countries. Effects are toxin mediated and the diagnosis is clinical. Antibiotics, antitoxin, immunoglobulin and wound care are the mainstays of management.
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Farnworth E, Roberts A, Rangaraj A, Minhas U, Holloway S, Harding K. Tetanus in patients with chronic wounds - are we aware? Int Wound J 2011; 9:93-9. [PMID: 21923663 DOI: 10.1111/j.1742-481x.2011.00850.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The incidence of tetanus in patients with wounds is unknown; however, recently concern has been raised over the proportion of tetanus cases in which a chronic wound is the portal of entry for Clostridium tetani. Varicose ulcers, dermatosis and necrosed tumours are estimated to be the point of entry for C. tetani spores in 11-14% of three cases. Of diabetic patients in the USA who contracted tetanus, a diabetic foot ulcer was responsible in 25% of cases despite this chronic wounds have yet to be considered as a risk factor for tetanus. An audit was undertaken and a survey devised to form the basis of the data collection to assess if patients with chronic wounds are up-to-date in accordance with the tetanus immunisation programme. Over a 5-day period, the data were prospectively collected and the tetanus status of a 100 patients retrospectively analysed. The status was then compared with general practitioner (GP) records via telephone follow-up. One hundred patients (n = 100) were available in the audit period, with the majority being male (n = 51). The age range was 22-91 years old (median 70 years). Nearly half of the samples (n = 48) were diabetic, with the majority of patients (n = 35) having venous leg ulcers. Only 15% had a biopsy of their wound. The duration of wounds varied from 1 to 480 months. Patients were asked to confirm their tetanus status. Almost half of the patients were unsure of their tetanus status 48% (n = 48), almost a third 30% (n = 30) thought they were not covered and 22% (n = 22) thought they were up-to-date. After confirming with the GP records, the results were as follows: almost half of the patients, 43% (n = 43) were not covered, 33% (n = 33) were up-to-date, 13% had no immunisation records available at the GPs, 10% had no GP contact details and 1% no contact was possible. Currently, tetanus prophylaxis is given based on the vaccination history of the patient but as identified that this can prove to be unreliable. With the burden of chronic wound and ageing population set to increase, levels of protection amplify the risk of tetanus faced by those suffering from chronic wounds. Strict caution should be taken in those patients who were born before the national childhood vaccination programme, implemented in 1961. Moreover, every effort should be made to ensure that such individuals complete their primary course. By ensuring each patient is actively immunised, protection against tetanus, a potential killer, is provided.
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Affiliation(s)
- Elizabeth Farnworth
- Department of Wound Healing and Dermatology, Cardiff University, Cardiff, UK
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Neves FF, Faiolla RCL, Napoli EMGD, Lima GMND, Muniz RZDA, Pazin-Filho A. [Clinical and epidemiological profile of accidental tetanus cases in Ribeirão Preto in the State of São Paulo from 1990 to 2009]. Rev Soc Bras Med Trop 2011; 44:481-5. [PMID: 21860895 DOI: 10.1590/s0037-86822011000400016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 04/07/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Tetanus remains a major health problem in developing countries. In Brazil, despite technological advances, no significant decrease in the lethality rate of tetanus have been documented in recent years. Clinical and epidemiological data from patients who were treated in Ribeirão Preto in the state of São Paulo, Brazil in the last two decades were analyzed in this case series. METHODS Retrospective data regarding the demographics, clinical presentations and prognoses of patients admitted with clinical suspicion of tetanus to a tertiary referral university hospital from 1990 to 2009 were identified. The tetanus diagnosis was defined according to the Brazilian Ministry of Health criteria. RESULTS Eleven cases out of 23 patients with suspected tetanus were included in this study (47.8% of positive cases). The Tetanus Severity Score ranged from 0 to 8 points. There were no deaths, but two (18.2%) patients had permanent neurological deficits. The median length of hospital stay was 17 days (6-98 days). The absence of deaths can be explained by early clinical diagnosis and prompt treatment. CONCLUSIONS Ribeirão Preto is an area in which tetanus is not a severe public health problem.
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Öncü S, Önde M, Öncü S, Ergin F, Öztürk B. Tetanus seroepidemiology and factors influencing immunity status among farmers of advanced age. Health Policy 2011; 100:305-9. [DOI: 10.1016/j.healthpol.2010.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/11/2010] [Accepted: 11/25/2010] [Indexed: 11/24/2022]
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Fratelli F, Siquini TJ, Prado SMA, Higashi HG, Converti A, de Carvalho JCM. Effect of Medium Composition on the Production of Tetanus Toxin by Clostridium tetani. Biotechnol Prog 2008; 21:756-61. [PMID: 15932253 DOI: 10.1021/bp049571b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The tetanus toxin is a neurotoxin synthesized by the bacillus Clostridium tetani that, after detoxification with formaldehyde, still exhibits antigenic and immunologic properties, hence its denomination of tetanus toxoid. Such a neurotoxin is produced by cultivation of the microorganism in vegetative form on a relatively complex specific medium containing glucose and peptone. The simultaneous effects of the starting levels of glucose (G0) and N-Z Case TT (NZ0) as carbon and nitrogen sources, respectively, on the production of tetanus toxin have been investigated in this work in static cultivations by means of a five-level star-shaped experimental design and evaluated by response surface methodology (RSM) for optimization purposes. The highest final average yield of tetanus toxin (72 Lf/mL), achieved at G0= 9.7 g/L and NZ0= 43.5 g/L, was 80% higher than that obtained with standard cultivations (G0= 8.0 g/L and NZ0= 25.0 g/L).
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Affiliation(s)
- Fernando Fratelli
- Division of Technology and Production Development of Institute Butantan, Av. Vital Brazil, 1500, 05504-900 São Paulo-SP, Brazil.
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Abstract
Tetanus remains an important disease worldwide. In the United Kingdom, the elderly and intravenous drug users are at particular risk of acquiring clinical tetanus. Tetanus is associated with a high morbidity and mortality. Once the diagnosis of tetanus is suspected, intensive management is necessary. In this article we review the history, epidemiology, microbiology, clinical features, mode of transmission, pathogenesis, differential diagnosis, management, complications and prevention of this life threatening disease.
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Affiliation(s)
- I H Mallick
- University Dept of Surgery, Royal Free & University College Medical School, London, UK.
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Turillazzi E, Neri M, Pomara C, Riezzo I, Fineschi V. An immunohistochemical study on a tetanus fatal case using toxin fragment C (TTC). Should it be a useful diagnostic tool? Neuropathology 2008; 29:68-71. [PMID: 18422910 DOI: 10.1111/j.1440-1789.2008.00912.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 65-year-old man fell in his garden and sustained a right pre-radial cutaneous laceration associated with a Colles' fracture. His status for tetanus immunization was uncertain; so a course of antitetanus treatment was immediately started. Two days after admission the man suddenly developed severe nucal pain, rigidity and dysphagia. A brain CT scan was negative. His condition progressively worsened and then he developed trismus. Cultures from the wound were negative for Clostridium tetani; the CSF analysis was negative. On the 9th day after admission, the man died. A presumptive clinical diagnosis of tetanus was made. Autopsy was performed 24 h after death. An immunohistochemical study was conducted with an antibody directed against tetanus toxin fragment C (TTC). By immunohistochemical evaluation, large motor neurons in the ventral horn were immunopositive for TTC. High power magnification of the ventral horn of spinal cord gray matter samples showed TTC immunoreactivity in motor neuron axons and cell bodies, using a confocal laser scanning microscope. The correct diagnosis could be established on the basis of pathological examination with TTC immunostaining.
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Frink M, Müller CW, Ziesing S, Krettek C. [Tetanus vaccination in the accident and emergency department]. Unfallchirurg 2007; 109:977-82; quiz 983. [PMID: 17021900 DOI: 10.1007/s00113-006-1169-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While tetanus is a rare disease in industrialized countries, this infectious disease is still responsible for up to 1,000,000 deaths per year in the developing world. In Germany, the introduction of a country-wide vaccination program (STIKO) has led to a decrease in the frequency of tetanus infection from 115 cases per year in the 1960s to fewer than 15 cases per year in the years from 1990 to 2000. In spite of all the treatment now available, tetanus infection still has a lethal outcome in up to 40% of cases. The Robert-Koch Institute recommends active or passive vaccination depending on the wound classification and the patient's current vaccination status. Since when patients have multiple trauma the emphasis while they are being treated for shock is on stabilisation and diagnosis, there is a real risk of underestimating the size and the level of contamination of existing wounds. Since it is not possible to ascertain the patient's vaccination status in most cases, we recommend simultaneous immunization of polytraumatized patients with skin lesions using Tetanol-Tetagam early in the course of the diagnostic procedures while the patients are still in the emergency room.
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Affiliation(s)
- M Frink
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Deutschland.
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Stubbe M, Mortelmans LJM, Desruelles D, Swinnen R, Vranckx M, Brasseur E, Lheureux PE. Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study. Emerg Med J 2007; 24:648-53. [PMID: 17711944 PMCID: PMC2464632 DOI: 10.1136/emj.2007.048520] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve the evaluation of tetanus immunity and thus help to avoid inadequate prophylactic measures and reduce costs. OBJECTIVES To evaluate the contribution of the TQS in the choice of tetanus prophylaxis and to perform a cost-effectiveness analysis. The final aim was to define the place of the TQS in a modified algorithm for assessment of tetanus immunity in the emergency department. METHOD In this Belgian prospective, double-blind, multicentre study, 611 adult patients with a wound were included; 498 (81.5%) records were valid. The TQS test was performed by a nurse before the vaccination history was taken and the choice of prophylaxis was made, using the official algorithm (Belgian Superior Health Council), by a doctor who was unaware of the TQS result. RESULTS The prevalence of protective anti-tetanus immunity was 74.1%. Immunity was lower in older patients and in female patients. The TQS was a cost-effective tool for patients presenting with a tetanus-prone wound and considered from the vaccination history to be unprotected. Use of the TQS would have improved management in 56.9% (95% CI 47.7% to 65.7%) of patients by avoiding unnecessary treatments, leading to a reduction in the mean cost per patient (10.58 euros/patient with the TQS versus 11.34 euros/patient without). The benefits of the TQS use were significantly greater in patients <61 years old: unnecessary treatment would have been avoided in 76.9% (95% CI 65.8% to 85.4%) of cases and the mean cost per patient reduced to 8.31 euros. CONCLUSION In selected patients, the TQS is a cost-effective tool to evaluate tetanus immunity. An algorithm is proposed for ED assessment of tetanus immunity integrating age and the TQS result.
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Affiliation(s)
- Muriel Stubbe
- Department of Emergency Medicine, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium.
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Affiliation(s)
- Jee-Eun Lee
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Lee
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Stubbe M, Swinnen R, Crusiaux A, Mascart F, Lheureux PE. Seroprotection against tetanus in patients attending an emergency department in Belgium and evaluation of a bedside immunotest. Eur J Emerg Med 2007; 14:14-24. [PMID: 17198321 DOI: 10.1097/01.mej.0000228449.37974.7e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In most emergency departments, tetanus prophylaxis currently relies on vaccination history. Bedside evaluation of tetanus immunity may improve this process. OBJECTIVES (i) To determine the seroprevalence of tetanus immunity; (ii) to evaluate the accuracy of vaccination history in assessing tetanus immunity; (iii) to identify factors predictive of seroprotection and incorrect history. METHOD In a prospective observational study, tetanus immunity was assessed in 784 adults using Tétanos Quick Stick (TQS). A questionnaire was completed to obtain vaccination and general histories. Immunity assessed by TQS and by vaccination history were compared with anti-tetanus antibody levels measured by the enzyme-linked immunosorbent assay (seroprotection threshold >0.15 IU/ml). RESULTS Overall, 64.2% of patients were protected according to TQS results. Four independent predictors of seroprotection were identified: young age, birthplace in Belgium, male sex and occupational medicine consultation. TQS performance was good: kappa=0.71, sensitivity 85.3%, specificity 87.2%, positive predictive value 92.1% and negative predictive value 77.2%. Seven hundred and sixty-two participants responded to the vaccination history: 23.4% said they were protected, 22.1% that they were not and 54.5% did not know. History performance was poor: kappa=0.27, sensitivity 60.3%, specificity 73.3%, positive predictive value 81.8% and negative predictive value 45.8%. Compared with history, TQS offered a significantly better sensitivity, negative and positive predictive values, but specificity was similar. No predictor of an incorrect history was identified. CONCLUSION Lack of protective immunity against tetanus is frequent but poorly evaluated by history taking. Several demographic characteristics are good predictors of seroprotection. TQS could be a valuable tool in selected patients to improve tetanus prophylaxis in the emergency department.
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Affiliation(s)
- Muriel Stubbe
- Department of Emergency Medicine, Erasme University Hospital, Brussels, Belgium.
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Linnenbrink T, McMichael M. Tetanus: pathophysiology, clinical signs, diagnosis, and update on new treatment modalities. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2006.00192.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Howdieshell TR, Heffernan D, Dipiro JT. Surgical Infection Society Guidelines for Vaccination after Traumatic Injury. Surg Infect (Larchmt) 2006; 7:275-303. [PMID: 16875461 DOI: 10.1089/sur.2006.7.275] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recommendations for vaccination of injured patients against infection are evolving. Newly-recognized infections, safety considerations, changing epidemiology, and redefinition of patient groups at risk are factors that may influence vaccine development priorities and recommendations for immunization. However, recommendations must often be formulated based on incomplete data, forcing reliance on expert opinion to address some crucial questions. These guidelines provide evidence-based recommendations for the prevention or treatment of infectious morbidity and mortality after traumatic injury, such as soft tissue wounds, human or animal bites, or after splenectomy. METHODS A panel of experts conducted a thorough review of published literature, as well as information posted on the internet at the websites of the U.S. Centers for Disease Control and Prevention, among others. MEDLINE was searched for the period 1966-2004 using relevant terms including "anthrax," "rabies," "tetanus," "tetanus toxoid," and " splenectomy," in combination with "vaccine" and "immunization." The Cochrane database was searched also. Reference lists were cross-referenced for additional relevant citations. All published reports were analyzed for quality and graded, with the strength of the recommendation proportionate to the quality of the supporting evidence. RESULTS Recommendations are provided for pre- and post-exposure prophylaxis of rabies and anthrax. For tetanus prophylaxis, recommendations are provided for prophylaxis of acute wounds stratified y age and prior immunization status, and for immunization of persons at high risk. After splenectomy, it is recommended that all persons ages 2-64 years receive 23- valent pneumococcal vaccine and meningococcal vaccine, with Haemophilus influenzae type B vaccine administered to high-risk patients as well (all are Grade D recommendations). Vaccination should be given two weeks before elective splenectomy (Grade C), or two weeks after emergency splenectomy (Grade D). A booster dose of pneumococcal vaccine is recommended after five years (Grade D); no re- vaccination recommendation is made for meningococcal or Haemophilus influenzae type B vaccine. Recommendations for prophylaxis of splenectomized children under the age of five years are also provided. CONCLUSION There are limited data on the use of vaccines after injury. This document brings together a disparate literature of variable quality into a discussion of the infectious risks after injury relevant to vaccine administration, a summary of safety and adverse effects of vaccines, and evidence-based recommendations for vaccination.
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Affiliation(s)
- Thomas R Howdieshell
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA.
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Low RM, Lambert RJ, Pesillo SA. Successful management of severe generalized tetanus in two dogs. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2005.00160.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Meaudre E, Pernod G, Gaillard PE, Kaiser E, Cantais E, Ripart J, Palmier B. Mandibular Nerve Blocks for the Removal of Dentures During Trismus Caused by Tetanus. Anesth Analg 2005; 101:282-3, table of contents. [PMID: 15976246 DOI: 10.1213/01.ane.0000153501.96734.3f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of trismus caused by tetanus in an 80-yr-old woman who developed severe and painful masseter spasms during which she violently bit the tip of her tongue with her dentures. Bilateral mandibular blocks were performed to remove the dentures. The patient fully recovered. We suggest that mandibular blocks are a useful tool in the management of oral events during trismus in conscious patients.
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Affiliation(s)
- Eric Meaudre
- Department of Anaesthesiology and Intensive Care, Military Teaching Hospital, Hôpital d'Instruction des Armées Sainte Anne, Bvd Ste Anne, Service de Réanimation, 83800 Toulon-Naval, France.
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Blum A, Schubotz-Mitgau C, Stuck BA, Hörmann K. Akute Aspiration und Kieferklemme durch Tetanus. HNO 2005; 53:560-2. [PMID: 15241509 DOI: 10.1007/s00106-004-1125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tetanus is a worldwide health problem, causing the deaths of approximately 1,000,000 people every year. In Germany, about 15 infections are reported annually. The initial symptoms often develop in the head and neck region. As a result, some patients are referred to the otorhinolaryngologist. We report on a 83 year old female who suffered from recurrent aspiration and trismus. She had acquired a small injury on her lower leg 2 weeks earlier; protective antibody levels did not exist. The neurophysiological examination showed a result typical of tetanus. The patient received tetanus immunoglobulin, metronidazole and benzodiazepines. Due to respiratory problems, tracheotomy and ventilation became necessary. Elderly people often lack protective antibody levels against tetanus. If typical symptoms are manifest, tetanus has to be considered as a possibility. A complete history, including recent injuries and past vaccinations, should be compiled.
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Affiliation(s)
- A Blum
- Universitäts-HNO-Klinik Mannheim.
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Teng Q, Tanase D, Tanase DK, Liu JK, Garrity-Moses ME, Baker KB, Boulis NM. Adenoviral clostridial light chain gene-based synaptic inhibition through neuronal synaptobrevin elimination. Gene Ther 2005; 12:108-19. [PMID: 15496959 DOI: 10.1038/sj.gt.3302400] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Clostridial neurotoxins have assumed increasing importance in clinical application. The toxin's light chain component (LC) inhibits synaptic transmission by digesting vesicle-docking proteins without directly altering neuronal health. To study the properties of LC gene expression in the nervous system, an adenoviral vector containing the LC of tetanus toxin (AdLC) was constructed. LC expressed in differentiated neuronal PC12 cells was shown to induce time- and concentration-dependent digestion of mouse brain synaptobrevin in vitro as compared to control transgene products. LC gene expression in the rat lumbar spinal cord disrupted hindlimb sensorimotor function in comparison to control vectors as measured by the Basso-Beattie-Bresnahan (BBB) scale (P<0.001) and rotarod assay (P<0.003). Evoked electromyography (EMG) showed increased stimulus threshold and decreased response current amplitude in LC gene-transferred rats. At the peak of functional impairment, neither neuronal TUNEL staining nor reduced motor neuron density could be detected. Spontaneous functional recovery was observed to parallel the cessation of LC gene expression. These results suggest that light chain gene delivery within the nervous system may provide a nondestructive means for focused neural inhibition to treat a variety of disorders related to excessive synaptic activity, and prove useful for the study of neural circuitry.
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Affiliation(s)
- Q Teng
- Department of Neuroscience, Lerner Research Institute, Cleveland, OH, USA
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39
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Abstract
Tetanus is a potentially lethal disease that is preventable with appropriate vaccination. The diagnosis is made exclusively on clinical criteria, and early recognition and treatment are essential for positive outcome. Patients should be monitored in the intensive care unit immediately on diagnosis. Early intubation and mechanical ventilation have drastically reduced the mortality from tetanus. Autonomic instability is associated with a high fatality rate and therefore must be aggressively treated. Metronidazole, human tetanus immunoglobulin, and active immunization should also be initiated on presentation. Because of extremely high metabolic demands in patients with tetanus, care must be taken to provide adequate nutrition and fluids. Prevention of sequelae of long-term critical illness, such as nosocomial pneumonia and deep venous thrombosis, are also important for achieving good outcomes.
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Affiliation(s)
- Sarice L. Bassin
- Department of Neurology, University of Virginia School of Medicine, PO Box 800566, Charlottesville, VA 22909, USA.
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