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Gou Y, Li SM, Zhang JF, Hei XP, Lv BH, Feng K. 6084 Cases of Adult Tetanus from China: A Literature Analysis. Infect Drug Resist 2023; 16:2007-2018. [PMID: 37038478 PMCID: PMC10082574 DOI: 10.2147/idr.s404747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Objective To describe the clinical characteristics, treatments, and outcomes of tetanus and determine the most appropriate focus for tetanus prevention and treatment to reduce morbidity and mortality in China. Methods Four databases, including the Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, were searched from 1 January, 2000 to 30 October, 2022. Results In total, 151 articles including 6084 tetanus patients met the inclusion criteria. Additionally, 5925 patients had their gender recorded in detail, among which 66.67% (3950/5925) were male, and 33.33% (1975/ 5925) were female. The average age in the detailed records was reported in 4773 cases, with an overall average age of 46.69. The number of patients' places of residence was 580. Those from rural areas comprised the highest percentage with 88.62% (514 / 580). The causes of injury were recorded in 1592 cases in total; injuries caused by metals, wood, and wooden spikes accounted for the highest percentage with 54.52% (868/1592). Patient outcomes were recorded in 4305 cases, with a mortality of 9.34% (402/4305). The leading causes of death included treatment terminated by family members, asphyxia due to persistent spasms, respiratory failure, and autonomic dysfunction, family automatic abandonment and asphyxia accounted for the highest percentage, both 24.00% (54/225). Conclusion The overall success rate of tetanus treatment in China has dramatically improved, but the prevention and control of non-neonatal tetanus is still challenging. Focus should be placed on the prevention of adult tetanus and standardizing the use of sedative and spasmolytic drugs. Additionally, medical professionals should popularize tetanus prevention and treatment knowledge among the people and strengthen training in grass-roots hospitals.
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Affiliation(s)
- Yi Gou
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Sheng-Ming Li
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Jun-Fei Zhang
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Xiao-Ping Hei
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Bo-Hui Lv
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Ke Feng
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- Correspondence: Ke Feng, Department of Emergency Medical, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, People’s Republic of China, Tel +86 18709676586, Email
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Dafallah MA, Ragab EA, Mohamed Ahmed Elawad OA. Experience with Tetanus in a Tertiary Care Hospital in Sudan: A Retrospective Review. Emerg Med Int 2021; 2021:4818312. [PMID: 34970455 PMCID: PMC8714357 DOI: 10.1155/2021/4818312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/26/2021] [Accepted: 12/08/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Tetanus is still a major health issue, especially in rural areas, and is associated with high morbidity and mortality rate. This study was conducted to describe the pattern of presentation and treatment outcome among adult patients infected with tetanus in our environment. MATERIALS AND METHODS This is a descriptive retrospective hospital-based study conducted in Wad Medani teaching hospital, central Sudan. A total of thirty-one patients were enrolled in this study in the period between January 2018 and December 2020. RESULTS Thirty-one patients were infected with tetanus during the study period. They were 23 (74.2%) males and 8 (25.8%) females with a male-to-female ratio of 2.875 : 1. Their ages ranged from 20 to 70 years, and most of them (48.4%) were free workers. Acute injuries were the most common portal of entry (64.51%), and commonly involved the lower limbs (48.38%). Lock jaw (54.8%), muscle spasm (51.6%), and neck pain and stiffness (45.2%) were the most common presentation. Supportive measures along with surgical toilet and debridement, human tetanus immunoglobulin, antibiotics, and muscle relaxants were initiated in all patients. The most common antibiotics used were Penicillin V and Ceftriaxone. A muscle relaxant was administered to aid in relieving the spasms. Complication rate was 61.29% and included pulmonary and cardiovascular complications. Fifteen patients died accounting for an overall mortality rate of 48.4%. CONCLUSIONS Tetanus remains a disease with high morbidity and mortality. The unknown/incomplete vaccination status among study participants, inadequate management, and lack of equipped resources lead to a devastating outcome as in Sudan.
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Affiliation(s)
| | - Esraa Ahmed Ragab
- Faculty of Medicine, University of Gezira, Wad Medani, Gezira State, Sudan
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Hao NV, Yen LM, Davies-Foote R, Trung TN, Duoc NVT, Trang VTN, Nhat PTH, Duc DH, Anh NTK, Lieu PT, Thuy TTD, Thuy DB, Phong NT, Truong NT, Thanh PB, Tam DTH, Puthucheary Z, Thwaites CL. The management of tetanus in adults in an intensive care unit in Southern Vietnam. Wellcome Open Res 2021; 6:107. [PMID: 34136651 PMCID: PMC8185581 DOI: 10.12688/wellcomeopenres.16731.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common.
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Affiliation(s)
- Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Du Hong Duc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Ba Thanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dong Thi Hoai Tam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Zudin Puthucheary
- William Harvey Research Institute, Queen Mary, University of London, London, UK.,Royal London Hospital, London, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Hao NV, Yen LM, Davies-Foote R, Trung TN, Duoc NVT, Trang VTN, Nhat PTH, Duc DH, Anh NTK, Lieu PT, Thuy TTD, Thuy DB, Phong NT, Truong NT, Thanh PB, Tam DTH, Puthucheary Z, Thwaites CL. The management of tetanus in adults in an intensive care unit in Southern Vietnam. Wellcome Open Res 2021; 6:107. [PMID: 34136651 DOI: 10.12688/wellcomeopenres.16731.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common.
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Affiliation(s)
- Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Du Hong Duc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Ba Thanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dong Thi Hoai Tam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Zudin Puthucheary
- William Harvey Research Institute, Queen Mary, University of London, London, UK.,Royal London Hospital, London, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Abstract
Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58,000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure.
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Affiliation(s)
- C Louise Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
| | - Nicholas J Beeching
- Liverpool School of Tropical Medicine, and Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
| | - Charles R Newton
- Kenya Medical Research Institute - Wellcome Trust Collaborative Programme, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
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Marulappa VG, Manjunath R, Mahesh Babu N, Maligegowda L. A Ten Year Retrospective Study on Adult Tetanus at the Epidemic Disease (ED) Hospital, Mysore in Southern India: A Review of 512 Cases. J Clin Diagn Res 2012. [PMID: 23205351 DOI: 10.7860/jcdr/2012/4137.2363] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tetanus still remains a major public health problem in India like in most other developing countries, with a high morbidity and mortality. OBJECTIVES To study the socio-demographic profile and the clinical profile that they presented with, as well as the outcome of the tetanus patients who were admitted to the E.D Hospital, Mysore in India. METHODOLOGY The data of all the patients of tetanus who were above the age of 15 years, who were admitted from January 2001 to December 2010, were collected, compiled and analyzed from the Medical Records Department of the Hospital. RESULTS Out of the 512 cases of tetanus, 379 (74%) were males and 133 (26%) were females. Their ages varied from 15 to 81 years, with a mean and a standard deviation respectively of 47.7 and 15.0 years. The overall mortality rate was 42.2%. The most common presenting symptoms were trismus (95.7%), neck stiffness (89.3%), body spasms/stiffness (73%) and dysphagia (38.9%). The ages of the patients and the presence of complications had a statistically significant relationship with respect to the outcome (survival versus death).
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Affiliation(s)
- Vamadeva Giriyapura Marulappa
- Dist Surgeon and Medical Officer, ED Hospital (Health and Family Welfare Department, Government of Karnataka) Mysore , Karnataka State, India
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Amare A, Melkamu Y, Mekonnen D. Tetanus in adults: clinical presentation, treatment and predictors of mortality in a tertiary hospital in Ethiopia. J Neurol Sci 2012; 317:62-5. [PMID: 22425013 DOI: 10.1016/j.jns.2012.02.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/20/2012] [Accepted: 02/23/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tetanus remains a major health problem in the developing world. The aim of this study was to evaluate the clinical presentation, risk factors, complications, treatment, outcome and predictors of death in patients with tetanus. METHODS Patients aged ≥ 13 years admitted to Tikur Anbessa Hospital from June 2001 to May 2009 with the diagnosis of tetanus were included in this retrospective study. RESULTS Data from 68 patients were analyzed; majority (77.9%) were males, the mean age was 33.8 years. None of them was vaccinated for tetanus. The types were: generalized (91.2%), cephalic (7.4%), localized (1.5%), severe (72.1%), moderate (19.1%) and mild (8.8%). One or more complication(s) occurred in 75%; dysautonomia (58.8%), pneumonia (44.1%) and hypoxemia (41.2%). Tracheostomy and mechanical ventilation was used in 45.6% and 11.8%, respectively. Case-fatality was 35.3%. Predictors of mortality were age ≥ 40 years, duration of symptoms prior to presentation < 4 days, severe tetanus, incubation period < 7 days, period of onset < 3 days and dysautonomia. The cause of death was early acute respiratory failure due to uncontrolled spasms in 87.5%. CONCLUSIONS Most tetanus patients were young males and there was high case fatality due to acute respiratory failure. Age ≥ 40 years and dysautonomia were independent predictors of mortality. Preventing tetanus by vaccination and treating patients in a well equipped ICU is recommended.
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Affiliation(s)
- Amanuel Amare
- Addis Ababa University, Medical Faculty, Department of Neurology, Addis Ababa, Ethiopia.
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Chalya PL, Mabula JB, Dass RM, Mbelenge N, Mshana SE, Gilyoma JM. Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases. World J Emerg Surg 2011; 6:20. [PMID: 21740539 PMCID: PMC3159100 DOI: 10.1186/1749-7922-6-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/08/2011] [Indexed: 12/03/2022] Open
Abstract
Background Tetanus is still a major health problem in developing countries and it is associated with a high morbidity and mortality rate. There is paucity of published data regarding the management of tetanus in Tanzania, especially the study area. This study was conducted to describe our own experiences with tetanus outlining the clinical characteristics and treatment outcome of tetanus patients in our environment and to identify predictors of outcome of these patients. Methods This was a ten-year period retrospective study of patients who presented with a clinical diagnosis of tetanus at Bugando Medical Centre between January 2001 and December 2010. Data was analyzed using SPSS computer software system. Results A total of 102 patients were studied. The male to female ratio was 11.8: 1. The majority of patients (74.5%) were aged < 40 years and 51.0% of them were farmers. Only 23.5% of patients had prior tetanus immunization. 53.5% of patients had a reasonably identifiable acute injury prior to the onset of tetanus and commonly involved the lower limbs (53.8%). The majority of patients (97.1%) had generalized tetanus. The mean incubation period and period of onset were 8.62 ± 4.34 and 3.8 ± 2.2 days respectively. Complication rate was 54.9%. The average overall duration of hospitalization was 34.12 ± 38.44 days (1-120 days). Mortality rate was 43.1%. According to multivariate logistic regression analysis, the age ≥ 40 years (P = 0.002), incubation period < 7 days (P = 0.014), tracheostomy (P = 0.004), severity of tetanus (P = 0.001) and need for ventilatory support (P = 0.013) were found to be significantly associated with higher mortality. Conclusion Tetanus remains a major public health problem in our centre and still carries unacceptably high morbidity and mortality despite the available advanced management facilities including ICU care. Young adult males are commonly affected. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.
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Affiliation(s)
- Phillipo L Chalya
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Joseph B Mabula
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Ramesh M Dass
- Department of Orthopedics, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Nkinda Mbelenge
- Department of Orthopedics, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Japhet M Gilyoma
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
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Amare A, Yami A. Case-fatality of adult tetanus at Jimma University Teaching Hospital, Southwest Ethiopia. Afr Health Sci 2011; 11:36-40. [PMID: 21572855 PMCID: PMC3092314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Tetanus remains a major health problem in Ethiopia like in most other developing countries. OBJECTIVES To assess the clinical presentation, complications and outcome of tetanus patients. METHODS In this retrospective study, patients (age > 13 years) who were admitted to Jimma University Teaching Hospital from 1996 to 2009 were included. RESULTS Data from 171 patients were analyzed (129 males, 42 females, mean age 33 years). The mean hospital stay for patients discharged cured and deceased was 21.5 ± 12 and 6.5 ± 6.7 days, respectively. None of our patients was immunized for tetanus. Tracheostomy and mechanical ventilation (MV) was done in 10.5% and 11 %, respectively. The case-fatality was 38%. The mean annual admission and case-fatality increased over the study period from 9 to 20.5 and from 21 % to 51%, respectively. Establishment of intensive care unit (ICU) did not improve mortality due to infrequent tracheostomy and MV. CONCLUSIONS The case-fatality was high like in most other studies and the majority of patients died in the first few days indicating that adequate respiratory support was not given. Establishment of ICU did not improve mortality. Tetanus can be prevented by vaccination and if it occurs it needs well equipped ICU.
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Affiliation(s)
- A Amare
- Addis Ababa University, Medical Faculty, Department of Neurology, Addis Ababa, Ethiopia.
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