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Dutta M, Panja T, Dutta I. Craniocervical Tetanus: A Practical Consideration During Work-up of Acute-Onset Trismus. EAR, NOSE & THROAT JOURNAL 2024:1455613231223895. [PMID: 38366878 DOI: 10.1177/01455613231223895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
This clinical record revisits the classical and pathognomonic features of craniocervical tetanus in a 65-year-old farmer who presented with acute-onset trismus, multiple cranial nerve pareses (III, IX, and X), risus sardonicus, and spasm of the head-neck musculature. This paper explores the relevant literature and presents a brief pictorial analysis of the global epidemiologic data. With most countries successfully adopting the maternal and neonatal tetanus elimination (MNTE) program, the incidence and mortality of tetanus across age groups have sharply reduced in high-income and most middle-income nations. In adults, tetanus is now encountered in specialized situations like waning immunity and incomplete vaccination, in the resource-poor and low-income nations, in countries achieving MNTE recently, and as cluster cases in the aftermath of natural disasters involving human settlements. Therefore, present-day practicing otolaryngologists and residents who have limited exposure to the tell-tale clinical features of craniocervical tetanus should consider it during work-up of acute-onset trismus in adults in susceptible situations and with a conducive background. The clinical spectrum of craniocervical tetanus as depicted in this report, including the demonstration of the pathognomonic positive spatula test, provides valuable learning points for otolaryngologists in this regard.
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Affiliation(s)
- Mainak Dutta
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, WB, India
| | - Tanaya Panja
- Department of Otorhinolaryngology and Head-Neck Surgery, Medical College and Hospital, Kolkata, WB, India
| | - Indranil Dutta
- Department of Neuromedicine, Medical College and Hospital, Kolkata, WB, India
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An Y, Guo Y, Li L, Li Z, Fan M, Peng Y, Yi X, Lv H. Management and outcome of adult generalized tetanus in a Chinese tertiary hospital. Front Public Health 2024; 12:1301724. [PMID: 38425467 PMCID: PMC10902116 DOI: 10.3389/fpubh.2024.1301724] [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: 09/28/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Tetanus is a rare surgical infectious disease with a high reported relevant mortality. It still remains a serious problem in public health, particularly in low-income and middle-income countries. The purpose of this study was to investigate the management and prognosis of adult generalized tetanus in our hospital. Methods A total of 20 adult generalized tetanus patients were recruited in this retrospective observational study. Patients were retrieved from the hospital data base via discharge diagnosis. Patients were divided into two groups (Severe or Non-severe tetanus group) based on the severity of tetanus by using the Ablett classification. The differences between the two groups were compared. Results The study included 11 males (55%) and 9 females (45%). All tetanus patients recovered. The median age was 53.5 years [IQR: 19-78]. There were 1 mild (Grade 1) case (5%),5 moderate (Grade 2) cases (25%), 2 severe (Grade 3) cases (10%), and 12 very severe (Grade 4) cases (60%). Nineteen patients (95%) did not have tetanus immunization before. The majority of patients were farmers (60%), and came from rural areas (60%). Thirteen (65%) patients had a history of puncture injury. The rate of wound debridement after admission was 60% overall. Thirteen (65%) patients required mechanical ventilation for a median of 21 [IQR:12-41] days. Autonomic instability occurred in 13 (65%) patients. Pulmonary infections occurred in 12 (60%) patients. Median duration of hospital stay was 29.5 [IQR:12-68] days. More patients in the Severe group needed ICU admission, wound debridement, mechanical ventilation and heavy sedation combined with muscle relaxants (p < 0.05). The hospital stay was significantly longer in patients in the Severe group (p < 0.05). Conclusion After effective treatment, all adult patients with generalized tetanus in this study were cured and discharged. Severe tetanus requires early ICU treatment, wound debridement and effective treatment of autonomic instability.
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Affiliation(s)
- Yuling An
- Department of Surgical Intensive Care Unit, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yi Guo
- Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Lijuan Li
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ziyu Li
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingming Fan
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - You Peng
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaomeng Yi
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haijin Lv
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Wang Y, Zhang L. Risk assessment of severe adult tetanus using the NLR and AST level and construction of a nomogram prediction model. Heliyon 2024; 10:e23487. [PMID: 38173491 PMCID: PMC10761575 DOI: 10.1016/j.heliyon.2023.e23487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
We sought to examine high-risk factors for severe tetanus, construct a nomogram model, and predict the risk probability of severe tetanus in adult patients to provide a theoretical basis for clinical intervention. Methods: A retrospective analysis was employed in this study, which enrolled 65 adult patients with tetanus diagnosed at the Second Affiliated Hospital of Hainan Medical University from January 2017 to September 2022. Study participants were divided into severe and mild groups based on the Ablett classification. The general data and laboratory markers of both groups were compared, and logistic regression analysis was used to screen for independent risk factors for severe tetanus. A nomogram prediction model was constructed, and receiver operating characteristic (ROC), calibration curve, and decision curve analysis (DCA) were constructed and used to assess discrimination, calibration, and net benefit. Results: Of the 65 adults patients with tetanus, 28 were placed in the severe group and 37 were placed in the mild group. Univariate logistic regression analysis showed that there were statistically significant differences in the incubation period, time from disease onset to treatment, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase level (LDH), myoglobin level (Mb), and aspartate aminotransferase (AST) level between the two groups (P < 0.05). while the differences in age; sex; and creatine kinase, creatine kinase isoenzyme, and alanine aminotransferase levels were not statistically significant (P > 0.05). Multivariate analysis showed that NLR (odds ratio [OR] = 4.998, 95 % confidence interval [CI] = 1.154-21.649, P = 0.031), AST (OR = 1.074, 95 % CI = 1.007-1.146, P = 0.031), PLT (OR = 1.055, 95 % CI = 1.006-1.106, P = 0.027), and incubation period (OR = 0.597, 95 % CI = 0.423-0.843, P = 0.003) are independent risk factor for severe tetanus. A Nomogram for predicting Severe Tetanus (N-ST) prediction model was constructed based on variables in the multivariate analysis with P < 0.05. The ROC curve showed that the optimal cutoff point was 108.044 points. At this point, the sensitivity was 86.5 %, the specificity was 89.3 %, the area under the ROC curve was 0.936, and model discrimination was good. The calibration curve overlapped with the ideal curve, and the DCA curve showed that the model can provide clinical benefits. Conclusion: NLR, AST, PLT, and incubation period are predictors of severe tetanus. The constructed N-ST model can provide a new, convenient, and rapid method to predict the risk probability of severe tetanus in adults and guide early clinical intervention.
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Affiliation(s)
- Yuyan Wang
- Department of Infectious Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
| | - Liyuan Zhang
- Department of Infectious Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou 570311, Hainan Province, China
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Allison LE, Alhaffar M, Checchi F, Abdelmagid N, Nor B, Sabahelzain MM, Light PM, Singh NS. A Systematic Review of Vaccination Guidance for Humanitarian Responses. Vaccines (Basel) 2023; 11:1743. [PMID: 38140148 PMCID: PMC10747938 DOI: 10.3390/vaccines11121743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
Delivering vaccines in humanitarian response requires rigourous and continuous analysis of evidence. This systematic review mapped the normative landscape of vaccination guidance on vaccine-preventable diseases in crisis-affected settings. Guidance published between 2000 and 2022 was searched for, in English and French, on websites of humanitarian actors, Google, and Bing. Peer-reviewed database searches were performed in Global Health and Embase. Reference lists of all included documents were screened. We disseminated an online survey to professionals working in vaccination delivery in humanitarian contexts. There was a total of 48 eligible guidance documents, including technical guidance (n = 17), descriptive guidance (n = 16), operational guidance (n = 11), evidence reviews (n = 3), and ethical guidance (n = 1). Most were World Health Organization documents (n = 21) targeting children under 5 years of age. Critical appraisal revealed insufficient inclusion of affected populations and limited rigour in guideline development. We found limited information on vaccines including, yellow fever, cholera, meningococcal, hepatitis A, and varicella, as well as human papilloma virus (HPV). There is a plethora of vaccination guidance for vaccine-preventable diseases in humanitarian contexts. However, gaps remain in the critical and systematic inclusion of evidence, inclusion of the concept of "zero-dose" children and affected populations, ethical guidance, and specific recommendations for HPV and non-universally recommended vaccines, which must be addressed.
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Affiliation(s)
- Lauren E. Allison
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Mervat Alhaffar
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
- Syria Research Group, Co-Hosted between London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK and National University of Singapore Saw Swee Hock School of Public Health, Singapore 117549, Singapore
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Nada Abdelmagid
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Barni Nor
- Department of Women’s Children’s Health, Uppsala University, 751 05 Uppsala, Sweden;
| | - Majdi M. Sabahelzain
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
| | - Page M. Light
- Department of Infectious Disease Epidemiology and International Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (L.E.A.); (M.A.); (F.C.); (N.A.); (P.M.L.)
| | - Neha S. Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Liu XY, Wei DK, Li ZY, Lu JS, Xie XM, Yu YZ, Pang XB. Immunogenicity and immunoprotection of the functional TL-HN fragment derived from tetanus toxin. Vaccine 2023; 41:6834-6841. [PMID: 37816654 DOI: 10.1016/j.vaccine.2023.09.032] [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: 05/18/2022] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023]
Abstract
Tetanus toxin (TeNT) is a protein toxin produced by Clostridium tetani bacteria, which causes hyperreflexia and rhabdomyolysis by spastic paralysis. Like botulinum neurotoxin, TeNT comprises a heavy chain (HC) and a light chain (LC) linked via an interchain disulfide bond, which include the following three functional domains: a receptor-binding domain (Hc), a translocation domain (HN), and a catalytic domain (LC). Herein, we produced and characterized three functional domains of TeNT and three types of TeNT-derived L-HN fragments (TL-HN, TL-GS-HN and TL-2A-HN), which contained L and HN domains but lacked the Hc domain. The immunological effects of these different functional domains or fragments of TeNT were explored in an animal model. Our investigations showed the TL-HN functional fragment provided the best immunoprotection among all the TeNT functional domains. The TL-HN fragment, as a protective antigen, induced the highest levels of neutralizing antibodies, indicating that it might contain some crucial epitopes. Further experiments revealed that the protective effect of TL-HN was superior to that of the THc, TL, or THN fragments, either individually or in combination. Therefore, the TL-HN fragment exerts an important function in immune protection against tetanus toxin, providing a good basis for the development of TeNT vaccines or antibodies, and could serve as a promising subunit vaccine to replace THc or tetanus toxoid (TT).
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Affiliation(s)
- Xu-Yang Liu
- Pharmaceutical College, Henan University, Kaifeng 475001, China; Beijing Institute of Biotechnology, Beijing 100071, China
| | - Dong-Kui Wei
- Pharmaceutical College, Henan University, Kaifeng 475001, China; Beijing Institute of Biotechnology, Beijing 100071, China
| | - Zhi-Ying Li
- Pharmaceutical College, Henan University, Kaifeng 475001, China; Beijing Institute of Biotechnology, Beijing 100071, China
| | - Jian-Sheng Lu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Xin-Mei Xie
- Pharmaceutical College, Henan University, Kaifeng 475001, China.
| | - Yun-Zhou Yu
- Beijing Institute of Biotechnology, Beijing 100071, China.
| | - Xiao-Bin Pang
- Pharmaceutical College, Henan University, Kaifeng 475001, China.
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6
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Nasiri MJ, Silva DR, Rommasi F, Zahmatkesh MM, Tajabadi Z, Khelghati F, Sarmastzadeh T, Centis R, D'Ambrosio L, Bombarda S, Dalcolmo MP, Galvão T, de Queiroz Mello FC, Rabahi MF, Pontali E, Solovic I, Tadolini M, Marconi L, Tiberi S, van den Boom M, Sotgiu G, Migliori GB. Vaccination in post-tuberculosis lung disease management: A review of the evidence. Pulmonology 2023:S2531-0437(23)00129-0. [PMID: 37679219 DOI: 10.1016/j.pulmoe.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Post-tuberculosis lung disease (PTLD), as other chronic respiratory disorders, may have infectious complications; some of them can be prevented with vaccinations. So far, no document has discussed the potential role of vaccination in PTLD. Therefore, the objective of this review was to describe vaccination recommendations to prevent infections potentially capable of complicating PTLD. MATERIALS AND METHODS A non-systematic review of the literature was conducted. The following keywords were used: tuberculosis, vaccination, vaccines and PTLD. PubMed/MEDLINE and Embase were used as the search engine, focusing on English-language literature only. RESULTS We identified 9 vaccines potentially useful in PTLD. Influenza, pneumococcal and anti-COVID-19 vaccinations should be recommended. Patients with PTLD can also benefit from vaccination against shingles. Vaccination against pertussis is mainly relevant during childhood. Diphtheria, tetanus and measles vaccination are recommended for general population and should be considered in patients with PTLD not previously vaccinated. Tdap (Tetanus, diphtheria, and pertussis) booster should be repeated in every adult every ten years. Vaccination against BCG retains its importance during early childhood in countries where TB is endemic. CONCLUSIONS Vaccination deserves to be considered among the strategies to prevent and/or mitigate PTLD complications. Further evidence is necessary to better understand which vaccines have the greatest impact and cost-benefit.
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Affiliation(s)
- M J Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - F Rommasi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M M Zahmatkesh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z Tajabadi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Khelghati
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - T Sarmastzadeh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - L D'Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - S Bombarda
- Secretaria de Estado da Saúde de São Paulo, Programa de Controle da Tuberculose, São Paulo, Brazil
| | - M P Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - T Galvão
- Serviço de Pneumologia, Hospital Especializado Octávio Mangabeira, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - F C de Queiroz Mello
- Thorax Diseases Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - M F Rabahi
- Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia, Brazil
| | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - I Solovic
- Department of Public Health, Faculty of Health, Catholic University, Ruzomberok, Slovakia; National Institute of Tuberculosis, Pulmonary Diseases and Thoracic Surgery, Vysne Hagy, Slovakia
| | - M Tadolini
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - L Marconi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - S Tiberi
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, E1 2AT United Kingdom
| | - M van den Boom
- World Health Organisation, Regional Office for the Eastern Mediterranean Region, Cairo, Egypt
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
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Gao J, Yu X, Cao G, He X, Zhang P, Walline J, Wang Y, Yu X, Xu J, Thach TQ, Liu Y. Assessing the impact of the 2018 tetanus guidelines on knowledge and practices of emergency physicians in trauma patients: a national survey study. PeerJ 2023; 11:e16032. [PMID: 37692124 PMCID: PMC10484204 DOI: 10.7717/peerj.16032] [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: 01/17/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023] Open
Abstract
Background Tetanus remains a significant public health issue in China, with the approach of anti-tetanus prophylaxis in the emergency department resulting in both overuse, particularly of human tetanus immune globulin (TIG), and underuse with the tetanus vaccine. This is largely due to the absence of updated guidelines on tetanus prophylaxis before 2018. Our study aimed to evaluate the effects of the 2018 Chinese tetanus guidelines on the knowledge and practices of emergency physicians about tetanus prevention in trauma patients. Methods From November 2019 to April 2020, we conducted a web-based survey involving 499 emergency physicians. The survey included a questionnaire covering knowledge, attitudes, and practices related to tetanus. We assessed the influence of the 2018 tetanus guidelines on the knowledge and practices of emergency physicians related to tetanus prevention for patients with trauma using multiple regression analysis. Results The survey results showed that only 45.3% of the participants had received formal training on tetanus immunization, despite 53.3% reporting the availability of tetanus vaccines at their institutions. Physicians typically prescribed tetanus antitoxin or human TIG instead of tetanus toxoid (TT) to treat injuries, regardless of the patient's TT vaccination history. Among the respondents, those who were aware of the 2018 tetanus guidelines had higher mean scores on the general knowledge, risk knowledge, and treatment knowledge scales, with increases of 6%, 13%, and 9%, respectively, compared to those who were unaware of the guidelines. Awareness of the 2018 tetanus guidelines was associated with a high level of knowledge, as indicated by the general knowledge score, recommendation knowledge score, and total knowledge score, after adjusting for the effects of all variables on the knowledge, attitudes, and practices of the participants. A high level of education was also associated with a high level of knowledge indicated by the recommendation knowledge score and total knowledge score. Conclusions Our study highlights a substantial gap in the attitudes, knowledge, and practices of emergency physicians in China regarding tetanus immunization. The results suggest an urgent need to promote the Chinese Expert Consensus Guidelines on tetanus to improve emergency physicians' knowledge and competence in tetanus prophylaxis. The findings underscore the importance of enhancing physicians' awareness of the latest guidelines to ensure appropriate and effective treatment for patients with tetanus-prone injuries.
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Affiliation(s)
- Junling Gao
- Buddhist Practices and Counselling Science Lab, Centre of Buddhist Studies, The University of Hong Kong, Hong Kong SAR, China
- Department of Intensive Care Unit, Southern Medical University, Shenzhen, China
| | - Xiaxia Yu
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Guanghui Cao
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoming He
- Department of Neurology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, China
| | - Pingde Zhang
- Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Joseph Walline
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuanxi Wang
- Department of Cardiac and Vascular Interventional Surgery, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xingjuan Yu
- Department of Traditional Chinese Medicine, Shandong College of Traditional Chinese Medicine, Yantai, China
| | - Jun Xu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Thuan-Quoc Thach
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Yong Liu
- Department of Intensive Care Unit, Southern Medical University, Shenzhen, China
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8
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Li Y, Chen Y, Cui J, Liu D, Zhang W, Xue C, Xiong X, Liu G, Chen H. Preparation and characterization of a neutralizing murine monoclonal antibody against tetanus toxin. J Immunol Methods 2023; 513:113427. [PMID: 36652969 DOI: 10.1016/j.jim.2023.113427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/11/2022] [Accepted: 01/11/2023] [Indexed: 01/16/2023]
Abstract
After Clostridium tetani infects the human body, it propagates under anaerobic conditions and produces tetanus neurotoxin (TeNT). TeNT can affect the central nervous system, inhibit the release of neurotransmitters, and result in respiratory failure, which are the root causes of death in tetanus patients. Identifying monoclonal antibodies (mAbs) targeting TeNT with neutralizing activity is urgently needed for the prevention and treatment of tetanus infection. In this study, through immunizing BALB/c mice with tetanus toxoid (TT), we obtained six positive hybridoma cell lines (1A7, 2C7, 3A7, 3H4, 4C1, and 4E12). Antibody isotyping showed that the antibodies are all of the IgG1/κ subclass. Ascites fluid was prepared by allogeneic ascites induction and the antibodies were purified through protein G affinity chromatography columns. Purities of the produced murine mAbs were all greater than 95%. All six antibodies bound to linear epitopes, among which 3A7 bound to the TeNT/L domain and the other five antibodies bound to the TeNT/Hc domain. Moreover, the affinity constants of these six antibodies against the antigen were all in the nanomolar range, and the affinity of 4E12 antibody reached the picomolar range. Results from toxin-neutralization assays in mice showed that 2C7 antibody delayed animal death, while 1A7, 3A7, 3H4, and 4E12 antibodies conferred partial protection. Additionally, 4C1 antibody offered complete protection, as 200 μg of 4C1 antibody fully protected against toxin challenge with 10 LD50 of TeNT and had a window period of 1 h. Antibody epitope grouping results revealed that the binding epitopes of 4C1 antibody were different from those of the other five antibodies. When 4C1 antibody was used in combination with another antibody, the neutralizing activities of antibodies were all evidently enhanced. Specifically, 4C1 combined with 3A7 antibody led to the greatest improvement in neutralizing activities, and 20 μg antibodies total (10 + 10 μg) fully protected against toxin challenge with 10 LD50. When 4E12, 3A7, and 4C1 antibodies were used in combination, 18 μg antibodies total (6 + 6 + 6 μg) completely neutralized 10 LD50 toxin. The present study derived murine mAbs with neutralizing activities and laid the foundation for follow-up therapeutic drug development for TeNT poisoning as well as establishment of TeNT detection methods.
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Affiliation(s)
- Yi Li
- Academy of Military Medical Sciences, Beijing 100080, China
| | - Yangyang Chen
- College of Pharmacy, Harbin University of Commerce, Harbin 1500076, China
| | - Jiazhen Cui
- Academy of Military Medical Sciences, Beijing 100080, China
| | - Dongqi Liu
- College of Pharmacy, Harbin University of Commerce, Harbin 1500076, China
| | - Weicai Zhang
- Academy of Military Medical Sciences, Beijing 100080, China
| | - Chong Xue
- Academy of Military Medical Sciences, Beijing 100080, China
| | - Xianghua Xiong
- Academy of Military Medical Sciences, Beijing 100080, China.
| | - Gang Liu
- Academy of Military Medical Sciences, Beijing 100080, China.
| | - Huipeng Chen
- Academy of Military Medical Sciences, Beijing 100080, China.
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Yamaguchi J, Kinoshita K. The threat of a new tetanus outbreak due to urban flooding disaster requires vigilance: a narrative review. Acute Med Surg 2023; 10:e839. [PMID: 37077453 PMCID: PMC10106935 DOI: 10.1002/ams2.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 04/21/2023] Open
Abstract
Vaccines for tetanus prevention have rapidly progressed, and the number of outbreaks, especially the incidence of tetanus in developed countries, has decreased dramatically. However, the mortality rate associated with severe tetanus remains high. Tetanus eradication is difficult owing to the widespread presence of the spores of tetanus bacteria in the environment, but tetanus can be prevented by acquired immunity from vaccines. Older people, intravenous drug users, and migrants are at a high risk of tetanus in developed countries owing to the lack of booster vaccination programs. Natural disasters, especially floods, often cause an increase in the prevalence of tetanus because of the associated injuries. Precautions should be taken to combat the threat of a new tetanus outbreak due to floods in urban areas owing to global warming. In particular, Japan is facing a high risk of urban flooding-induced tetanus, despite its status as a developed country. This review aims to highlight the data on the epidemiology, causes, treatment, and prevention of tetanus and problems associated with tetanus countermeasures during future floods.
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Affiliation(s)
- Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute MedicineNihon University School of MedicineTokyoJapan
| | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute MedicineNihon University School of MedicineTokyoJapan
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Zhang C, Hu W, Ma Y, Li L, Si Y, Zhang S. Seroepidemiology of Tetanus among Healthy People Aged 1-59 Years Old in Shaanxi Province, China. Vaccines (Basel) 2022; 10:vaccines10111806. [PMID: 36366315 PMCID: PMC9698734 DOI: 10.3390/vaccines10111806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
The study aims to determine the seroprevalence of antibodies against tetanus among healthy people aged 1−59 years old in Shaanxi province. IgG against tetanus in serum samples were detected by ELISA. 6,439 subjects were enrolled. The positive rate (≥0.01 IU/mL) was 84.39% and GMC was 0.03 IU/mL. There were significant differences in positive rates (χ2 = 308.944, p < 0.01) and GMC (Z = 5,200,000, p < 0.01) among different age groups. The positive rates (χ2 = 304.3, p < 0.01) and GMCs (χ2 = 146.417, p < 0.01) showed regional differences. Both full protection rate (≥0.1 IU/mL) (χ2 = 36.834, p < 0.01) and GMC (Z = 688,000, p < 0.01) increased with the doses of tetanus-toxoid-containing vaccines (TTCVs) administered. The positive rate (χ2 = 54.136, p < 0.01) and GMC (Z = 140,200, p < 0.01) decreased gradually with the time interval after full immunization with TTCVs. The full protection rate (≥0.1 IU/mL) (χ2 = 176.201, p < 0.01) and GMC (Z = 629,900, p < 0.01) decreased with the interval (years) since the last dose of TTCVs. There were significant differences in the positive rates and GMCs for different ages, regions, immunization histories of TTCVs, and doses of TTCVs administered. The full protection rate and GMC decreased with the interval following full immunization with TTCVs and the interval since the last dose of TTCVs. The importance of using tetanus booster doses should be emphasized in adolescents and adults.
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Nguyen TH, Le XTT, Nguyen LH, Le HT, Do TTT, Nguyen HLT, Nguyen HT, Latkin CA, Ho CSH, Ho RCM. Resource mobilization for tetanus vaccination in Vietnam: Uptake, demand and willingness to pay among women of reproductive age. Front Public Health 2022; 10:980850. [PMID: 36330125 PMCID: PMC9623147 DOI: 10.3389/fpubh.2022.980850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Tetanus vaccine coverage in Vietnam has been declining in recent years due to a rapid population growth rate, shrinking budget, and inefficient resource mobilization strategy. This study examined the uptake, demand, and willingness to pay (WTP) for tetanus vaccines in Vietnamese women of reproductive age as well as determined associated factors and assessed the feasibility of the long-term tetanus vaccine resource mobilization scheme. Methods Cross-sectional data were obtained on 807 women of childbearing age in Hanoi, Vietnam in 2016. Tetanus vaccine uptake, demand, and willingness to pay were collected by using a structured questionnaire. Multivariable logistic and interval regression models were used to examine associated factors with vaccine uptake, demand, and WTP. Results Of 807 participants, 42.4 and 64.8% had sufficient tetanus vaccination (i.e., received at least three doses of vaccine) and were willing to pay for tetanus vaccination. The mean amount of WTP for one dose of tetanus was US$ 7.3 (95% CI = 6.7-7.9). Having children or being aware that the tetanus vaccine was free-of-charge were negatively associated with WTP for tetanus vaccine. Having a high school education, living in a rural area, and not being aware of vaccine prices or being aware that vaccines were provided freely reduced the amount of WTP. WTP increased among women receiving information from friends and relatives. Conclusion Despite of exemption from the tetanus vaccination programs, this study indicated a low tetanus vaccination coverage and a moderate degree of WTP for tetanus vaccine among Vietnamese women of childbearing age. Target-specific educational and financial support interventions, along with efforts to reduce vaccination costs are critical to improving the vaccine uptake, demand, and WTP for tetanus immunization among women.
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Affiliation(s)
- Thang Huu Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Xuan Thi Thanh Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Long Hoang Nguyen
- VNU School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Toan Thanh Thi Do
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam,*Correspondence: Huong Lan Thi Nguyen
| | - Hien Thu Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Caprylate/chromatography process to produce highly purified tetanus immune globulin from human plasma. Epidemiol Infect 2022; 150:e172. [PMID: 36097692 PMCID: PMC9980923 DOI: 10.1017/s095026882200142x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
While tetanus toxoid vaccination has reduced the incidence of tetanus in the developed world, this disease remains a substantial health problem in developing nations. Tetanus immune globulin (TIG) is used along with vaccination for prevention of infection after major or contaminated wounds if vaccination status cannot be verified or for active tetanus infection. These studies describe the characterisation of a TIG produced by a caprylate/chromatography process. The TIG potency and presence of plasma protein impurities were analysed at early/late steps in the manufacturing process by chromatography, immunoassay, coagulation and potency tests. The caprylate/chromatography process has been previously shown to effectively eliminate or inactivate potentially transmissible agents from plasma-derived products. In this study, the caprylate/chromatography process was shown to effectively concentrate TIG activity and efficiently remove pro-coagulation factors, naturally present in plasma. This TIG drug product builds on the long-term evidence of the safety and efficacy of TIG by providing a product with higher purity and low pro-coagulant protein impurities.
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High rates of COVID-19 vaccine refusal among Afghan pregnant women: a cross sectional study. Sci Rep 2022; 12:14057. [PMID: 35982167 PMCID: PMC9387420 DOI: 10.1038/s41598-022-18497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/12/2022] [Indexed: 11/11/2022] Open
Abstract
Severe Acute Respiratory Syndrome Corona Virus Type-2 (SARS-COV-2) was first detected in China and created a global pandemic rapidly. Subsequently after serious efforts different types of vaccines produced against the virus and recommended for all people including pregnant women. The aim of this study was to realize the willingness of pregnant women to accept the COVID-19 vaccine in Kabul Afghanistan. For this purpose, a cross-sectional study was conducted in gynecology wards of several hospitals in Kabul, Afghanistan from 10th of July to 20th of August 2021 through direct interview with the pregnant women who had come for prenatal care to the healthcare centers. The collected data were analyzed through Statistical Package for Social Studies (SPSS) version 25. Simple descriptive analysis computed for demographic characteristics and bi-variable (Chi-square) analysis was carried out to find out the associations of taking vaccine with demographic variables. A p-value of < 0.05 was considered significant at 95% confidence interval. A total of 491 who were completed the inclusion criteria included in the analysis. A small portion of pregnant women (8.6%) illustrated the intent to get the COVID-19 vaccine if it is recommended by the health authorities in Afghanistan. Our study found a high rate of COVID-19 vaccine refusal among pregnant women in Kabul, Afghanistan. They showed the concern on adverse effects of the vaccine as the main reason for refusal, emphasizing the need to reduce the misconception on vaccine efficacy and campaigns to enhance awareness on the vaccine safety and benefits for mothers and babies.
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Imanishi K, Yasuo K. Application of noninvasive positive pressure ventilation to respiratory complications of severe tetanus: a case report. Int J Infect Dis 2022; 119:160-162. [DOI: 10.1016/j.ijid.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022] Open
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Pichlinski E, Hoff E, Epperson LC, Morley E, Cao JD, Thoppil J, Field S, Mehta P, Good D, Nijhawan A. Tetanus: A Rare Complication of Black Tar Heroin Use. Open Forum Infect Dis 2021; 9:ofab613. [PMID: 35146041 PMCID: PMC8826085 DOI: 10.1093/ofid/ofab613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022] Open
Abstract
Tetanus is associated with high morbidity and mortality, although this is rarely encountered in high-income countries. We present a case of tetanus in an unvaccinated patient secondary to black tar heroin use that highlights the importance of considering tetanus in appropriate clinical contexts, harm reduction interventions, and universal tetanus vaccination campaigns.
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Affiliation(s)
- Elisa Pichlinski
- Parkland Health and Hospital Systems, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emily Hoff
- Parkland Health and Hospital Systems, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lindsey Claire Epperson
- Parkland Health and Hospital Systems, Dallas, Texas, USA
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth Morley
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James Dazhe Cao
- Department of Emergency Medicine, Division of Medical Toxicology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joby Thoppil
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven Field
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Prayag Mehta
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel Good
- Parkland Health and Hospital Systems, Dallas, Texas, USA
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ank Nijhawan
- Parkland Health and Hospital Systems, Dallas, Texas, USA
- Department of Internal Medicine, Division of Infectious Disease, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Carvalho LCD, Marques CPC, Rodrigues VP. Temporal trends in tetanus incidence and lethality in Brazil: analysis of the national database from 2009 to 2018. Rev Assoc Med Bras (1992) 2021; 67:1804-1809. [PMID: 34909953 DOI: 10.1590/1806-9282.20210736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the epidemiological and hospital characteristics of cases and deaths due to accidental tetanus in Brazil. METHODS A time-series study with secondary data extracted from the Department of Informatics of the Brazilian Unified Health System. The time series were evaluated by linear regression parameters, considering a significance level of 1%. RESULTS A total of 2,772 cases were reported between 2009-2018. Predominant cases were men and aged between 40-59 years old, with incomplete 1st-4th grade. The lethality rate was found to be predominant in women, whites, illiterates, and those who aged above 80 years. The overall lethality was 32.5%. The incidence rate reduced from 1.6 in 2009 to 0.95 per million inhabitants in 2018, but lethality increased from 30.77-40.70%. The highest rate of incidence and lethality occurred in the elderly people and in the northern region. CONCLUSION The high cost and lethality of tetanus configure it as a public health problem. The demonstration of the epidemiology of patients who most evolve to death can help to contribute to a reduction in lethality, which shows an increase in the analysis period. Finally, special attention should be given to the elderly people and those living in the northern region.
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Almas T, Niaz MA, Zaidi SMJ, Haroon M, Khedro T, Alsufyani R, Al-Awaid AH, Tran E, Khan AW, Alaeddin H, Rifai A, Manamperi KT, Khan A, Haadi A. The Spectrum of Clinical Characteristics and Complications of Tetanus: A Retrospective Cross-Sectional Study From a Developing Nation. Cureus 2021; 13:e15484. [PMID: 34268020 PMCID: PMC8261793 DOI: 10.7759/cureus.15484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction While tetanus has largely been eradicated with the advent of the tetanus vaccine, its prevalence in Pakistan remains alarmingly high due to insufficient uptake of the vaccination program. The clinical presentations that the disease elicits range from mere opisthotonos to more sinister complications, including respiratory failure and death, often posing an insurmountable challenge for hospitals. Methods A retrospective cross-sectional study was conducted and analyzed the medical charts of 43 patients with a confirmed diagnosis of tetanus infection. The charts were perused for the patients' demographics, clinical characteristics, and disease outcomes. The prevalence of various clinical symptoms and complications were reported in terms of frequencies and percentages. Results The mean age of the patients hovered at 29.53 ± 16.53 years, with a range of 12 to 65 years. Of those affected, 83.7% were males while 16.3% were females. Notably, none of the infected patients had a prior history of vaccination against tetanus. Trismus was noted to be the most prevalent clinical manifestation and was found in 90.70% of the patients while paraesthesia at the site of infection, found in 6.98%, was the least prevalent. The overall mortality was noted to hover at 46.5%. Conclusion While tetanus has largely been eradicated, its prevalence in Pakistan remains alarmingly high. The complications noted in the study have implications for the country's public health system and aims to better inform the current state of the national vaccination program.
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Affiliation(s)
- Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | | | | | - Tarek Khedro
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Reema Alsufyani
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Estelle Tran
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Abdul Wali Khan
- Internal Medicine, College of Physicians and Surgeons Pakistan, Peshawar, PAK
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Hasan Alaeddin
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Ali Rifai
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Abat Khan
- Cardiology, Khyber Teaching Hospital, Peshawar, PAK
| | - Abdul Haadi
- Internal Medicine, Royal College of Surgeons In Ireland, Dublin, IRL
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Mahran MA, Khalifa AA, Elsherif ME, Refai O. Neglected reactive arthritis complicated by bilateral hip and temporomandibular joints ankylosis after a suspected tetanus infection: a case report. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00044-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
Reactive arthritis had been reported to occur after various vaccinations, including the tetanus toxoid vaccine; here, we report a case of ankylosing arthropathy suggested to be a complication of missed neglected reactive arthritis after tetanus infection.
Case presentation
A healthy 20-year-old woman presented with subtrochanteric right femoral fracture; imaging studies showed bilateral ankylosed hip, kyphoscoliosis, bilateral fused temporomandibular joints, and normal sacroiliac joints bilaterally. Laboratory investigations for a rheumatic or autoimmune disease were all within normal ranges. Detailed history revealed admission of the patient to an ICU unit (1 year before the trauma) for a month as she was diagnosed as having tetanus infection, after which she was unable to walk or feed herself. At the final follow-up, the patient started walking with a moderate limb after having a series of surgeries including femoral fracture fixation, temporomandibular joint excision arthroplasty, and bilateral total hip arthroplasty.
Conclusion
Unusual complications after tetanus infection can occur in the form of joint ankylosis, which could be presented after prolonged immobilization possibly due to improper management of reactive arthritis.
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Zhang G, Yu R, Chi X, Chen Z, Hao M, Du P, Fan P, Liu Y, Dong Y, Fang T, Chen Y, Song X, Liu S, Li J, Yu C, Chen W. Tetanus vaccine-induced human neutralizing antibodies provide full protection against neurotoxin challenge in mice. Int Immunopharmacol 2021; 91:107297. [PMID: 33360088 DOI: 10.1016/j.intimp.2020.107297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Clostridium tetani causes life-threatening disease by producing tetanus neurotoxin (TeNT), one of the most toxic protein substances. Toxicosis can be prevented and cured by administration of anti-TeNT neutralizing antibodies. Here, we identified a series of monoclonal antibodies (mAbs) derived from memory B cells of a healthy adult immunized with the C-terminal domain of TeNT (TeNT-Hc). Thirteen mAbs bound to both tetanus toxoid (TT) and TeNT-Hc, while two mAbs recognized only TT. VH3-23 was the most frequently used germline gene in these TT-binding mAbs, and the pairwise identity values of the VH gene sequences ranged from 27% to 69%. Three of these mAbs-T3, T7, and T9-6-completely protected mice from challenge with 2× LD50 of TeNT, and two (T2 and T18) significantly prolonged the survival time. The five neutralizing mAbs recognized distinct epitopes on TT, with binding affinities ranging from 0.123 to 11.9 nM. Our study provides promising therapeutic candidates for tetanus.
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Affiliation(s)
- Guanying Zhang
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Rui Yu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Xiangyang Chi
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Zhengshan Chen
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Meng Hao
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Peng Du
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Pengfei Fan
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Yujiao Liu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Yunzhu Dong
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Ting Fang
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Yi Chen
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Xiaohong Song
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Shuling Liu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Jianmin Li
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Changming Yu
- Beijing Institute of Biotechnology, Beijing 100071, China
| | - Wei Chen
- Beijing Institute of Biotechnology, Beijing 100071, China.
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Gupta N, Chaudhuri S, Varma M, Saravu K. Tetanus After Trivial Trauma: A Case Series and Review of Pharamocotherapeutic Management. Cureus 2020; 12:e11089. [PMID: 33224681 PMCID: PMC7678887 DOI: 10.7759/cureus.11089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tetanus is a vaccine-preventable disease that is still endemic in developing countries. We discuss two cases of tetanus in unvaccinated individuals. The first case was a young goat herder who was initially started on benzodiazepine and muscle relaxants. Magnesium sulphate was added later on due to inadequate control after which the patient improved significantly. The second case was an old farmer who was started on magnesium sulphate along with benzodiazepine from the outset. His clinical recovery was faster compared to the first case. We report these cases to discuss the pharmacological options in the management of generalized tetanus with particular reference to magnesium sulphate.
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Affiliation(s)
- Nitin Gupta
- Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, IND
| | - Souvik Chaudhuri
- Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, IND
| | - Muralidhar Varma
- Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, IND
| | - Kavitha Saravu
- Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, IND
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