1
|
Roy MTHM, Loh CH, Sriranganathan M, Takano Pena AM, Raghuram J. Idiopathic recurrent serositis-Off the beaten track. Respirol Case Rep 2021; 9:e0859. [PMID: 34667614 PMCID: PMC8506259 DOI: 10.1002/rcr2.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/19/2021] [Accepted: 09/15/2021] [Indexed: 11/07/2022] Open
Abstract
A 63-year-old female presented with chest pain and fever, and was found to have recurrent pleuropericardial effusions. Extensive investigations including infection screen and serologies, autoimmune screen and pleural and pericardial biopsy revealed no secondary aetiologies. She was diagnosed with idiopathic recurrent serositis (IRS). Our patient developed rash to naproxen, so she was started on colchicine monotherapy and responded well clinically. A review of the literature demonstrated that pleuropericardial effusions are rare occurrences, with patients occasionally being perceived as a medical enigma. This case study recommends an approach to guide physicians in their diagnosis and management of patients with pleuropericardial syndrome. Our case had an inflammatory phenotype, either autoimmune or seronegative serositis of unclear aetiology, which was recurrent and required pharmacological treatment. While the treatment for IRS lies in combined therapy with Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and colchicine, monotherapy with colchicine was effective in the treatment and preventing recurrence in our unique case.
Collapse
Affiliation(s)
| | - Chee Hong Loh
- Department of Respiratory and Critical Care MedicineChangi General HospitalSingapore
| | | | | | - Jagadesan Raghuram
- Department of Respiratory and Critical Care MedicineChangi General HospitalSingapore
| |
Collapse
|
2
|
Thompson HA, Mousa A, Dighe A, Fu H, Arnedo-Pena A, Barrett P, Bellido-Blasco J, Bi Q, Caputi A, Chaw L, De Maria L, Hoffmann M, Mahapure K, Ng K, Raghuram J, Singh G, Soman B, Soriano V, Valent F, Vimercati L, Wee LE, Wong J, Ghani AC, Ferguson NM. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Setting-specific Transmission Rates: A Systematic Review and Meta-analysis. Clin Infect Dis 2021; 73:e754-e764. [PMID: 33560412 PMCID: PMC7929012 DOI: 10.1093/cid/ciab100] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Understanding the drivers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is crucial for control policies, but evidence of transmission rates in different settings remains limited. METHODS We conducted a systematic review to estimate secondary attack rates (SARs) and observed reproduction numbers (Robs) in different settings exploring differences by age, symptom status, and duration of exposure. To account for additional study heterogeneity, we employed a beta-binomial model to pool SARs across studies and a negative-binomial model to estimate Robs. RESULTS Households showed the highest transmission rates, with a pooled SAR of 21.1% (95% confidence interval [CI]:17.4-24.8). SARs were significantly higher where the duration of household exposure exceeded 5 days compared with exposure of ≤5 days. SARs related to contacts at social events with family and friends were higher than those for low-risk casual contacts (5.9% vs 1.2%). Estimates of SARs and Robs for asymptomatic index cases were approximately one-seventh, and for presymptomatic two-thirds of those for symptomatic index cases. We found some evidence for reduced transmission potential both from and to individuals younger than 20 years of age in the household context, which is more limited when examining all settings. CONCLUSIONS Our results suggest that exposure in settings with familiar contacts increases SARS-CoV-2 transmission potential. Additionally, the differences observed in transmissibility by index case symptom status and duration of exposure have important implications for control strategies, such as contact tracing, testing, and rapid isolation of cases. There were limited data to explore transmission patterns in workplaces, schools, and care homes, highlighting the need for further research in such settings.
Collapse
Affiliation(s)
- Hayley A Thompson
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Andria Mousa
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Amy Dighe
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Han Fu
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Alberto Arnedo-Pena
- Sección de Epidemiología, Centro de Salud Pública de Castellón, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Valencia, Spain
| | - Peter Barrett
- School of Public Health, University College Cork, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| | - Juan Bellido-Blasco
- Sección de Epidemiología, Centro de Salud Pública de Castellón, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Valencia, Spain
- Facultad de Ciencias de la Salud, Universitat Jaime I (UJI), Castelló, Spain
| | - Qifang Bi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Brunei
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - Matthias Hoffmann
- Division of General Internal Medicine, Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Olten, Olten, Switzerland
| | - Kiran Mahapure
- Department of Plastic Surgery, Dr Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
| | | | | | - Gurpreet Singh
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Biju Soman
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Francesca Valent
- SOC Istituto di Igiene ed Epidemiologia Clinica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, Unit of Occupational Medicine, University Hospital of Bari, Bari, Italy
| | - Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Justin Wong
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link, Brunei
- Disease Control Division, Ministry of Health, Brunei
| | - Azra C Ghani
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Neil M Ferguson
- MRC Centre for Global Infectious Disease Analysis & World Health Organization Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| |
Collapse
|
3
|
Affiliation(s)
- Kangqi Ng
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Beng Hoong Poon
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Troy Hai Kiat Puar
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Jessica Li Shan Quah
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Wann Jia Loh
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Yu Jun Wong
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Thean Yen Tan
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Jagadesan Raghuram
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| |
Collapse
|
4
|
Anitha N, Mamatha T, Raghuram J, Maheen W. Evaluation of Medication Errors in an Acute Multi Care Unit in a Tertiary Care Hospital. Journal of Pharmaceutical Research 2016. [DOI: 10.18579/jpcrkc/2016/15/3/103328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
5
|
Affiliation(s)
- Jansen Koh
- Department of Respiratory and Critical Care, Changi General Hospital, Singapore
| | | | | |
Collapse
|
6
|
Siau C, Tee A, Au V, Raghuram J, Oh HML, Fock KM, Teo EK. Influenza A H1N1 (2009): clinical spectrum of disease among adult patients admitted to a regional hospital in Singapore. Singapore Med J 2011; 52:475-480. [PMID: 21808956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The worldwide spread of Influenza A H1N1 (2009) has proceeded at an unprecedented rate, with the World Health Organization rapidly raising its influenza pandemic alert to phase six. We describe the disease spectrum of H1N1 (2009) to aid the triaging and identification of patients at risk. METHODS This is a retrospective chart review of all confirmed H1N1 (2009) cases admitted to our institution between June and September 2009. RESULTS The disease severity of the 153 patients studied was classified as mild (n is 75), moderate (n is 55) and severe (n is 23). 81 patients were female. The median age was 26 years. While comorbidities were more prevalent among patients with moderate-severe illness, 47.4 percent reported no pre-existing illness. Presenting complaints of breathlessness, tachycardia, low-pulse oximetry, higher leukocyte counts and C-reactive protein with low albumin levels were more commonly noted in moderate-severe illness (p-value less than 0.001). All patients received oseltamivir at a median of four days from illness onset. 18 required intensive care unit admission, with the majority (94.4 percent) within the first 24 hours of hospitalisation. The overall mortality rate was 4.6 percent. Median lengths of hospitalisation were four and nine days for moderate and severe cases, respectively. CONCLUSION While the majority of H1N1 (2009) patients have mild illness, a subgroup can become critically ill. Prior good health is not necessarily a good discriminator against severe illness. The presence of dyspnoea, tachycardia and desaturation at triage should heighten the index of suspicion for H1N1 (2009)-related complications.
Collapse
Affiliation(s)
- C Siau
- Department of Respiratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | | | | | | | | | | | | |
Collapse
|
7
|
Siau C, Law J, Tee A, Poulose V, Raghuram J. Severe refractory hypoxaemia in H1N1 (2009) intensive care patients: initial experience in an Asian regional hospital. Singapore Med J 2010; 51:490-495. [PMID: 20658109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The management of Influenza A (H1N1) patients with acute respiratory distress syndrome (ARDS) is an emerging challenge, especially during the 2009 pandemic. These patients frequently require advanced mechanical ventilation (MV) and on occasion, rescue therapy. We describe the demographics, presentation, course and outcomes of the first 12 H1N1 patients with ARDS who were admitted to our institution. METHODS This was a retrospective chart review of H1N1 patients with ARDS who were admitted to our intensive care unit (ICU) between July and September 2009. RESULTS Seven of the 12 patients were female. The median age was 46 (range 27-66) years. 25 percent of the patients had good health prior to the infection. The presenting symptoms were mainly cough (100 percent), fever (92 percent) and dyspnoea (64 percent). The median times from symptom onset to both hospitalisation and ICU admission were five (range 2-9) days. Ten (83 percent) patients required invasive MV within 24 hours of presentation. The mean PaO2/ FiO2 ratio was 87.9 +/- 37.3 mmHg, with a mean positive end expiratory pressure at 16.1 +/- 7.3 cm H2O. Three patients required either unconventional MV and/or prone positioning, inhaled nitric oxide or nebulised prostacyclin. The mean Acute Physiology and Chronic Health Evaluation II score was 12.7 +/- 9.1. Among survivors, the median number of ventilator days was 7.5 (range 5-11), with a median length of ICU stay of ten (range 6-14) days. The median length of hospitalisation was 13.5 (range 9-31) days. The mortality rate in our case series was 50 percent. CONCLUSION Unlike patients of seasonal influenza, our severe H1N1 patients were of a younger age. A significant proportion had no underlying risk factors. Despite high ventilatory requirements, unconventional MV and adjunct therapy, the mortality rate remained high.
Collapse
Affiliation(s)
- C Siau
- Division of Respiratory Medicine, Department of Medicine, Changi General Hospital, Singapore.
| | | | | | | | | |
Collapse
|
8
|
Affiliation(s)
- Wen Yee Chay
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Alvin Penafiel
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | | | | | - Chian Min Loo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Pyng Lee
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
| |
Collapse
|
9
|
Nagar AM, Teh HS, Khoo RN, Morani AC, Vrishni K, Raghuram J. Multifocal pneumocyte hyperplasia in tuberous sclerosis. Case Reports 2009; 2009:bcr2006076604. [DOI: 10.1136/bcr.2006.076604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
10
|
Affiliation(s)
- A M Nagar
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 560623
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
STUDY OBJECTIVE To describe the clinical characteristics and outcome of patients with severe melioidosis requiring intensive care. DESIGN Retrospective chart review. SETTING Two ICUs from a tertiary-care teaching hospital. PATIENTS Twenty-seven adult ICU patients with microbiologically documented melioidosis. INTERVENTIONS None. MEASUREMENTS AND RESULTS The median age was 59 years with a male preponderance (26:1). Twenty patients (74%) had medical comorbidities, with diabetes mellitus being the most common (59.3%). Almost all patients (96.3%) were bacteremic. Twenty patients (74.1%) presented with pneumonia. Twenty patients (74.1%) were in septic shock, and 16 patients (59.3%) had ARDS. Twelve patients (44.4%) required hemodialysis. The patients had a median of three organ dysfunctions, and the median APACHE (acute physiology and chronic health evaluation) II score was 27. The overall mortality was 48.1%. Mortality among patients with septic shock was 60%. The median ICU length of stay for survivors and nonsurvivors was 11 days and 2 days, respectively. Multivariate analysis revealed that the number of organ dysfunctions is an independent predictor of mortality (odds ratio, 8.2; 95% confidence interval, 1.3 to 51.4). CONCLUSIONS The outcome of severe melioidosis requiring intensive care is poor, with death being predicted by the number of organ dysfunctions.
Collapse
Affiliation(s)
- Kenneth P W Chan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital.
| | | | | | | | | |
Collapse
|
12
|
|
13
|
Tan E, Hsu A, Eng P, Tan K, Lee P, Raghuram J, Lo C, Loo C, Cheah F, Toh C, Leong S, Lim W, Lau J, Hui K. P-123 Molecular profiling of lung cancers: Can it be used as a clinicaltool? Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80617-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Tan HK, Lim JSS, Tan CK, Ng HS, Chow P, Lui HF, Wong GC, Tan PHC, Raghuram J, Ng HN, Choong LHL, Wong KS, Woo KT. MARS therapy in critically ill patients with advanced malignancy: a clinical and technical report. Liver Int 2004; 23 Suppl 3:52-60. [PMID: 12950962 DOI: 10.1034/j.1478-3231.23.s.3.3.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND/METHODS Molecular Adsorbent Recirculating System (MARS) was used in three consecutive critically ill patients at the Singapore General Hospital with advanced malignancy and acute liver failure (ALF). Case 1 was a male patient with hepatocellular carcinoma (HCC) for which initial right hepatectomy was followed by left hepatectomy 5 months later for recurrent HCC. The postoperative course following second surgery was complicated by severe methicillin-resistant Staphylococcus aureus (MRSA) sepsis, mild azotaemia and subacute cholestatic liver failure. MARS was used thrice in this patient. Case 2 was a female patient with advanced acute lymphoblastic leukaemia (ALL) with post bone marrow transplantation (BMT) acute haemolytic-uraemic syndrome (HUS) secondary to cyclosporin A (Cy A), cytomegalovirus (CMV) infection, severe nosocomial pneumonia, acute renal failure (ARF) treated with continuous haemofiltration and acute veno-occlusive disease resulting in Budd-Chiari syndrome. The latter precipitated ALF. MARS was instituted twice. Case 3 was a male patient with advanced, refractory Hodgkin's disease previously treated with multiple courses of chemotherapy. ALF developed secondary to acute viral hepatitis B flare. He was given a trial of MARS once in the ICU. All the three patients eventually died. RESULTS Mean MARS intradialytic systemic pressures were as follows: systolic pressure range was 95 +/- 17 to 128 +/- 17 mmHg and diastolic pressure range was 51 +/- 5 to 67 +/- 7 mmHg. Pressure at albumin dialysate exit point from dialyser 1 (Ae) ranged from 253 +/- 11 to 339 +/- 15 mmHg and that at albumin dialysate entry point into dialyser 1 (Aa) ranged from 142 +/- 11 to 210 +/- 6 mmHg. Ultrafiltration (UF) was 633 +/- 622 mL over mean treatment duration of 6.3 +/- 0.9 h with a total heparin dose of 1583 +/- 817 IU. Coagulation status pre- and 6-h post-MARS was similar: aPTT (P=0.116) and platelet count (P=0.753). There were no bleeding complications or circuit thromboses. MARS had a significant de-uraemization effect (pre- and post-MARS serum creatinine and urea: P=0.046 and 0.028, respectively) but did not significantly attenuate blood lactate, ammonia or total bilirubin levels. Albumin dialysate (Ae - Aa) urea and creatinine concentrations appeared to be sharply attenuated after 6 h of MARS. In contrast, the removal of total bilirubin by albumin dialysate from the blood compartment appeared to plateau after 4 h of continuous MARS operation. CONCLUSIONS MARS was well-tolerated in critically ill patients with advanced and complicated cancer. Low-dose heparin was safe and did not compromise MARS circuit integrity. Although MARS had a significant de-uraemization effect, this appeared to be limited by the duration of MARS operation. Our data suggested that such a limit was reached earlier for total bilirubin. More data are needed to confirm the present findings and further delineate the saturation limit of MARS for different toxins that accumulate in ALF. This would affect the optimal duration of MARS therapy.
Collapse
Affiliation(s)
- H K Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
OBJECTIVE Differing success rates of various pleurodesis agents have been reported in the management of malignant pleural effusions. A randomized clinical trial was conducted to compare the efficacy of two commonly used agents, talc and bleomycin, for the pleurodesis of malignant pleural effusions. METHODOLOGY Inclusion in the study required proof of a malignant pleural effusion by fluid cytology or pleural biopsy. Exclusion criteria included trapped lung, loculated effusions, recurrent effusions and life expectancy < 1 month. Five grams of talc or 1 unit per kilogram bodyweight of bleomycin mixed in 150 mL of normal saline was administered via tube thoracostomy after complete drainage of the pleural effusion in each patient. Treatment success was defined as the absence of recurrent pleural effusion on the chest radiograph 1 month after pleurodesis. RESULTS Treatment success was achieved in 16 out of 18 patients (89%) in the talc slurry group versus 14 out of 20 patients (70%) in the bleomycin group (P=0.168). Fever and pain were the only side-effects of pleurodesis in both groups. CONCLUSION These results indicate that talc slurry is as effective as bleomycin in preventing early recurrence of malignant pleural effusions. Pleurodesis with talc instead of bleomycin can result in significant cost savings.
Collapse
Affiliation(s)
- K C Ong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
| | | | | | | |
Collapse
|
16
|
Raghuram J, Eng P, Ong YY. The oxygen delivery debate--a review. Ann Acad Med Singap 1998; 27:404-8. [PMID: 9777088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Tissue hypoxia is an important cause for the development of multisystem organ failure in the critically ill. Achieving adequate haemodynamic support of oxygen demand is the mainstay of treatment in these patients. Controversies regarding therapeutic end-points do exist but in general maintaining oxygen delivery by ensuring adequate cardiac output, oxygen saturation and haemoglobin is important in the critically ill.
Collapse
Affiliation(s)
- J Raghuram
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | | | | |
Collapse
|
17
|
Raghuram J, Ong YY, Wong SY. Tetanus in Singapore: report of three cases. Ann Acad Med Singap 1995; 24:869-73. [PMID: 8838999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Three cases of tetanus in Singapore are presented. One local resident had cephalic tetanus most likely secondary to otitis media and the other two, residents from surrounding Asean countries, had generalised tetanus. The portal of entry was a puncture wound on the foot in one patient and the ear in another. No portal of entry was identified in one patient. All three patients required tracheostomy, ventilatory support and intensive care management for periods ranging from 11 to 22 days. One patient died from complications of nosocomial septicaemia and one patient required prolonged rehabilitation. There was a questionable history of tetanus immunization in the Singapore resident whereas the other two patients who were foreigners had never received any immunization. Tetanus is an uncommon but important disease in Singapore. In spite of the availability of intensive care management, it continues to be a disease with significant morbidity and mortality. Early recognition and treatment of the disease are critical factors in determining the prognosis. This is a disease that may be largely prevented by adequate immunization.
Collapse
Affiliation(s)
- J Raghuram
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital
| | | | | |
Collapse
|