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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Grasselli Kmet N, Muzlovič I, Martinčič Ž, Štubljar D, Jereb M. Adult patients with tetanus in Slovenia 2006-2021 : Results of a national cohort study. Wien Klin Wochenschr 2023; 135:625-630. [PMID: 37278856 DOI: 10.1007/s00508-023-02222-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/07/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of the present study was to determine the demographic, epidemiological and clinical characteristics of adult patients with tetanus in Slovenia between 2006 and 2021, as well as to determine the therapeutic approaches which have been successfully used in the intensive care unit (ICU) of the Infectious Diseases Department in the University Medical Centre Ljubljana (UMC). METHODS We included all adult patients who were treated for tetanus in the ICU of the Department of Infectious Diseases Ljubljana between January 1st, 2006, and December 31th, 2021, in the retrospective study. Available epidemiological and clinical characteristics were reviewed from the medical documentation. RESULTS There were 31 patients included in the study, four (12.9%) males and 27 (87.1%) females. The vast majority of patients required mechanical ventilation (MV) (87.1%) which lasted (± SD) on average 35.4 ± 16.0 days. Autonomic dysfunction was present in 29 (93.5%) patients and was statistically significantly associated with shorter disease evolution (p = 0.005) and presence of healthcare-associated infection (p = 0.020). During the hospitalization, 27 (87.1%) patients acquired at least one healthcare-associated infection, most commonly ventilator-associated pneumonia. The average length of stay in the ICU (± SD) was 42.5 ± 21.3 days. With increasing age, MV lasted statistically significantly longer (p = 0.001), length of stay was longer (p = 0.015), and healthcare-associated infections occurred (p = 0.003) more frequently. Four patients (12.9%) died. CONCLUSIONS Although the tetanus incidence rate in Slovenia is high in comparison to other European countries on average, our therapeutic approach resulted in a good survival rate and low mortality.
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Affiliation(s)
- Nina Grasselli Kmet
- Infectious Diseases Department, University Medical Centre, Japljeva 2, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Igor Muzlovič
- Infectious Diseases Department, University Medical Centre, Japljeva 2, 1000, Ljubljana, Slovenia
| | | | - David Štubljar
- In-Medico, Department of Research and Development, Mestni trg 11, Metlika, Slovenia
| | - Matjaž Jereb
- Infectious Diseases Department, University Medical Centre, Japljeva 2, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Deniz M, Erat T. Generalized tetanus: a pediatric case report and literature review. Rev Inst Med Trop Sao Paulo 2023; 65:e40. [PMID: 37377323 PMCID: PMC10313328 DOI: 10.1590/s1678-9946202365040] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023] Open
Abstract
Pediatric tetanus is a rare and forgotten disease in countries with high childhood tetanus toxoid vaccination rates. Therefore, the clinical manifestations, treatment and management of this potentially life-threatening disease are not well known. With a literature review and discussion of tetanus management in pediatric patients, we describe a clinical course of a rare and fatal but vaccine-preventable disease, the generalized tetanus, in an adolescent who was successfully treated.
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Affiliation(s)
- Melis Deniz
- Sanlıurfa Training and Research Hospital, Department of Pediatric Infectious Diseases, Sanlıurfa, Turkey
| | - Tugba Erat
- Ankara City Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
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Ueno A, Sakamaki I, Yamamoto Y. An elderly man with a locked jaw. Eur J Intern Med 2021; 89:108-109. [PMID: 34120816 DOI: 10.1016/j.ejim.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Akitoshi Ueno
- Department of Clinical Infectious Diseases, Toyama University Hospital, 2630 Sugitani, Toyama 930-0194, Japan
| | - Ippei Sakamaki
- Department of Clinical Infectious Diseases, Toyama University Hospital, 2630 Sugitani, Toyama 930-0194, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Hospital, 2630 Sugitani, Toyama 930-0194, Japan.
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Meli H, Kaboré M, Cissé MA, Zaré A, Soumaré M, Cissoko Y, Dembélé JP, Konaté I, Fofana A, Dao S. [Localised tetanus with no obvious entry site: about a case in Bamako (Mali)]. Pan Afr Med J 2020; 36:377. [PMID: 33235654 PMCID: PMC7666701 DOI: 10.11604/pamj.2020.36.377.22721] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 11/11/2022] Open
Abstract
Tetanus is a major public health problem in sub-Saharan Africa. Localised tetanus is rare, unlike generalized tetanus which has been sufficiently described in the literature. We report a case of localised tetanus with no obvious entry site managed in the Department of Infectious Diseases in Bamako. The study involved a retired nurse aged 59 years who had not undergone tetanus booster immunisation within the last 10 years, corresponding to the date of her last delivery. She was referred to our Hospital with dysphagia associated with inability to open the buccal cavity. Patient's history was characterized by long-term therapy associated with many specialized consultations without any improvement. The diagnosis of localised tetanus with no obvious entry site was retained after having excluded any other local disorder. Outcome was favorable ten days after adequate management. Underdiagnosed or unknown to health-care providers, localised tetanus may mimic other diseases delaying diagnosis and management. Targeted campaign to build awareness should be implemented in order to improve adherence with immunization schedules.
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Affiliation(s)
- Hermine Meli
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Mikaila Kaboré
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Mohamed Aly Cissé
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Abdoulaye Zaré
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Mariam Soumaré
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Yacouba Cissoko
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Jean Paul Dembélé
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Issa Konaté
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Assetou Fofana
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
| | - Sounkalo Dao
- Service des Maladies Infectieuses Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d´Odontostomatologie, Bamako, Mali
- Centre de Recherche et de Formation sur la Tuberculose et le VIH (SEREFO), Bamako, Mali
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Hasan MK, Patwary MI, Fatema K, Alam ST, Tabrez MS, Rahman MM, Haq SS, Kabir MR, Akther M, Noman AF, Zafrin N. Demography and Symptom Profile of Tetanus: A Cross-sectional Observation in an Infectious Disease Hospital of Bangladesh. Mymensingh Med J 2020; 29:129-135. [PMID: 31915348] [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: 06/10/2023]
Abstract
Tetanus is a potentially preventable neurological infectious disorder with paucity of literature in Bangladesh. We aimed to see the demography and symptom profile of tetanus cases managed at the Infectious disease Hospital Sylhet. This hospital based cross-sectional descriptive study was conducted within the time period of January to December 2012 among 50 consecutive admitted patients in the Infectious Disease Hospital, Sylhet, Bangladesh who were diagnosed as a case of tetanus and fulfilling the inclusion criteria and exclusion criteria. Neonatal tetanus was considered as exclusion criteria and clinical diagnosis of tetanus was considered as the tetanus. Data were collected purposively with pretested predesigned questionnaire. Data were processed manually and analyzed with the help of SPSS Version 16.0. The mean±SD age was 33.00±16.8 years, ranging from 10 to 70 years. Among the 50 respondents, 72.0% were male, 50% from lower class, 34% were students and 30.0% had their educational status of primary level, 60.0% from rural social background. Trismus was found in 98.0% of the cases, rigidity in 96.0% cases, body ache in 94.0% cases, dysphagia in 92.0% cases, neck pain in 78.0% cases, dysarthria in 92.0% cases, reflex spasm in 66.0% cases, opisthotonus in 46.0% cases and urinary retention in 26.0% cases. In this study rural male people with lower socioeconomic status individuals were mostly affected with trismus, rigidity, body ache and dysphagia symptoms.
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Affiliation(s)
- M K Hasan
- Dr Mohammed Kamrul Hasan, MD (Chest Diseases) Final Part Student, National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka, Bangladesh
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Abstract
A previously healthy 79-year-old woman underwent an urgent laparotomy and resection of a strangulated loop of small bowel. On the second postoperative day, she developed symptoms suspicious for postoperative tetanus. A transfer to the intensive care unit was necessary for aggressive supportive therapy. The patient required 5 months of intensive physiotherapy and rehabilitation and was successfully discharged home. New cases of tetanus have become rare in developed countries. This potentially lethal disease affects both non-immunised and inadequately immunised patients. The occurrence of tetanus after gastrointestinal surgery is extremely rare. Prevention is key and can be achieved with correct immunoprophylaxis. Older patients are often inadequately immunised. Should tetanus immunoprophylaxis routinely be checked for elderly patients undergoing gastrointestinal surgery? Or can we limit the immunisation to severe cases of ischaemic bowel injury with necrosis and/or soiling of the abdominal cavity?
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Affiliation(s)
| | - Simon Claeys
- General and Abdominal Surgery, AZ Delta Campus Wilgenstraat, Roeselare, Belgium
| | - Bart Smet
- General and Abdominal Surgery, AZ Delta Campus Wilgenstraat, Roeselare, Belgium
| | - Paul Pattyn
- General and Abdominal Surgery, AZ Delta Campus Wilgenstraat, Roeselare, Belgium
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9
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Price S. Talk to Patients About: Tetanus. Tex Med 2019; 115:47. [PMID: 30995333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Almost all U.S. tetanus cases occur among people who are unvaccinated or did not receive a booster shot, according to the U.S. Centers for Disease Control and Prevention.
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10
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Aziz R, Colombe S, Mwakisambwe G, Ndezi S, Todd J, Kalluvya S, Mangat HS, Magleby R, Koebler A, Kenemo B, Peck RN, Downs JA. Pre-post effects of a tetanus care protocol implementation in a sub-Saharan African intensive care unit. PLoS Negl Trop Dis 2018; 12:e0006667. [PMID: 30161119 PMCID: PMC6116918 DOI: 10.1371/journal.pntd.0006667] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/09/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Tetanus is a vaccine-preventable, neglected disease that is life threatening if acquired and occurs most frequently in regions where vaccination coverage is incomplete. Challenges in vaccination coverage contribute to the occurrence of non-neonatal tetanus in sub-Saharan countries, with high case fatality rates. The current WHO recommendations for the management of tetanus include close patient monitoring, administration of immune globulin, sedation, analgesia, wound hygiene and airway support [1]. In response to these recommendations, our tertiary referral hospital in Tanzania implemented a standardized clinical protocol for care of patients with tetanus in 2006 and a subsequent modification in 2012. In this study we aimed to assess the impact of the protocol on clinical care of tetanus patients and their outcomes. METHODS AND FINDINGS We examined provision of care and outcomes among all patients admitted with non-neonatal tetanus to the ICU at Bugando Medical Centre between 2001 and 2016 in this retrospective cohort study. We compared three groups: the pre-protocol group (2001-2005), the Early protocol group (2006-2011), and the Late protocol group (2012-2016) and determined associations with mortality by univariable logistic regression. We observed a significant increase in provision of care as per protocol between the Early and Late groups. Patients in the Late group had a significantly higher utilization of mechanical ventilation (69.9% vs 22.0%, p< 0.0001), provision of surgical wound care (39.8% vs 20.3%, p = 0.011), and performance of tracheostomies (36.8% vs 6.7%, <0.0001) than patients in the Early group. Despite the increased provision of care, we found no significant decrease in overall mortality in the Early versus the Late groups (55.4% versus 40.3%, p = 0.069), or between the pre-protocol and post-protocol groups (60.7% versus 50.0%, p = 0.28). There was also no difference in 7-day ICU mortality (30.1% versus 27.8%, p = 0.70). Analysis of the causes of death revealed a decrease in deaths related to airway compromise (30.0% to 1.8%, p<0.001) but an increase in deaths due to presumed sepsis (15.0% to 44.6%, p = 0.018). CONCLUSION The overall mortality in patients suffering non-neonatal tetanus is high (>40%). Institution of a standardized tetanus management protocol, in accordance with WHO recommendations, decreased immediate mortality related to primary causes of death after tetanus. However, this was offset by an increase in death due to later ICU complications such as sepsis. Our results illustrate the complexity in achieving mortality reduction even in illnesses thought to require few critical care interventions. Improving basic ICU care and strengthening vaccination programs to prevent tetanus altogether are essential components of efforts to decrease the mortality caused by this lethal, neglected disease.
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Affiliation(s)
- Riaz Aziz
- Intensive Care Department, Bugando Medical Centre, Mwanza, Tanzania
- * E-mail:
| | - Soledad Colombe
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | | | - Solomon Ndezi
- Intensive Care Department, Bugando Medical Centre, Mwanza, Tanzania
| | - Jim Todd
- Department of Applied Biostatistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Samuel Kalluvya
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Halinder S. Mangat
- Department of Neurology, New York-Presbyterian Hospital/Weill Cornell Medical Centre, New York, NY, United States of America
| | - Reed Magleby
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | | | - Bernard Kenemo
- Intensive Care Department, Bugando Medical Centre, Mwanza, Tanzania
| | - Robert N. Peck
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | - Jennifer A. Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
- Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania
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Akane Y, Tsugawa T, Hori T, Togashi A, Yoto Y, Inazawa N, Ito N, Kyan R, Senoh M, Kato H, Tsutsumi H. Tetanus in a partially immunized child. J Infect Chemother 2018; 24:980-982. [PMID: 29866490 DOI: 10.1016/j.jiac.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/25/2018] [Accepted: 05/06/2018] [Indexed: 11/15/2022]
Abstract
A 13-year-old boy developed tetanus, although he had protective antitoxin antibody raised by three doses of tetanus toxoid vaccine. Four days after injury, he presented with muscle rigidity of his posterior neck, excessive diaphoresis, and risus sardonicus and was subsequently diagnosed with tetanus. Tetanus is rare in developed countries, particularly during childhood, but must be promptly diagnosed based on clinical symptoms.
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Affiliation(s)
- Yusuke Akane
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Takeshi Tsugawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsuo Togashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuko Yoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Natsuko Inazawa
- Department of Pediatrics, Japan Community Health Care Organization (JCHO), Sapporo Hokushin Hospital, Sapporo, Japan
| | - Nozomi Ito
- Department of Pediatrics, Japan Community Health Care Organization (JCHO), Sapporo Hokushin Hospital, Sapporo, Japan
| | - Ryoko Kyan
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsutoshi Senoh
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Haru Kato
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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12
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Trieu HT, Anh NTK, Vuong HNT, Dao TTM, Hoa NTX, Tuong VNC, Dinh PT, Wills B, Qui PT, Van Tan L, Yen LM, Sabanathan S, Thwaites CL. Long-term outcome in survivors of neonatal tetanus following specialist intensive care in Vietnam. BMC Infect Dis 2017; 17:646. [PMID: 28946862 PMCID: PMC5613471 DOI: 10.1186/s12879-017-2748-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/07/2017] [Accepted: 09/19/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neonatal tetanus continues to occur in many resource-limited settings but there are few data regarding long-term neurological outcome from the disease, especially in settings with critical care facilities. METHODS We assessed long-term outcome following neonatal tetanus in infants treated in a pediatric intensive care unit in southern Vietnam. Neurological and neurodevelopmental testing was performed in 17 survivors of neonatal tetanus and 18 control children from the same communities using tools previously validated in Vietnamese children. RESULTS The median age of children assessed was 36 months. Eight neonatal tetanus survivors and 9 community control cases aged < 42 months were tested using the Bayley III Scales of Infant and Toddler Development (Bayley III-VN) and 8 neonatal tetanus survivors and 9 community controls aged ≥42 months were tested using the Movement Assessment Battery for Children. No significant reductions in growth indices or neurodevelopmental scores were shown in survivors of neonatal tetanus compared to controls although there was a trend towards lower scores in neonatal tetanus survivors. Neurological examination was normal in all children except for two neonatal tetanus survivors with perceptive deafness and one child with mild gross motor abnormality. Neonatal tetanus survivors who had expienced severe disease (Ablett grade ≥ 3) had lower total Bayley III-VN scores than those with mild disease (15 (IQR 14-18) vs 24 (IQR 19-27), p = 0.05) with a significantly lower cognitive domain score (3 (IQR 2-6) severe disease vs 7 (IQR 7-8) mild disease, p = 0.02). CONCLUSIONS Neonatal tetanus is associated with long-term sequelae in those with severe disease. In view of these findings, prevention of neonatal tetanus should remain a priority.
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Affiliation(s)
- Huynh T. Trieu
- Hospital for Tropical Diseases, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
| | | | | | - T. T. M. Dao
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Pham Tam Dinh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Bridget Wills
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Phan Tu Qui
- Hospital for Tropical Diseases, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Catherine 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
A century ago, Emil von Behring passed away. He was the first to be honored by the Nobel Prize for Medicine in 1901 for the successful therapy of diphtheria and tetanus, which he had developed from the bench to the bed. He also contributed to the foundation of immunology, since his therapy was based on passive immunization with specific antisera. Being an ambitious character, he did not shy away from friction with his colleagues Paul Ehrlich and Elias Metchnikoff and his mentor, Robert Koch. Behring was not only an excellent translational researcher but also a successful entrepreneur and early proponent of public-private partnerships.
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Affiliation(s)
- Stefan H E Kaufmann
- Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany
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Tetanus vaccines: WHO position paper – February 2017. Wkly Epidemiol Rec 2017; 92:53-76. [PMID: 28185446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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15
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Zibners L. Diphtheria, pertussis, and tetanus: evidence-based management of pediatric patients in the emergency department. Pediatr Emerg Med Pract 2017; 14:1-24. [PMID: 28749121] [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] [Received: 11/01/2016] [Indexed: 06/07/2023]
Abstract
Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.
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Affiliation(s)
- Lara Zibners
- Honorary Consultant, Paediatric Emergency Medicine, St. Mary’s Hospital Imperial College Trust, London, UK; Nonclinical Instructor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Affiliation(s)
- A M Udosen
- Department of Surgery, University of Calabar, PmB 1278, Calabar, Nigeria.
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Brunelli G, Tesoro S, Trotta A, Dentini N, Peduto VA. Tetanus and Tako-Tsubo: is there a relationship? Minerva Anestesiol 2016; 82:495-496. [PMID: 26822817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Giulia Brunelli
- Department of Surgical and Biomedical Sciences, Institute of Anesthesia, Analgesia and Critical Care, University Hospital of Perugia, Perugia, Italy -
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Abstract
Tetanus is a potentially fatal infection. Approximately 100 cases are reported in Japan each year; however, little is known about its clinical course and outcomes in the current era of treatment. We herein report three cases of tetanus in elderly patients who survived after mechanical ventilation and intensive care. These patients, together with six other similar cases, had a median weaning period of 31 days and median length of stay of 77 days. In elderly patients, severe systemic forms of tetanus require prolonged mechanical ventilation and hospitalization. To improve prevention, tetanus vaccination should be promoted more aggressively among those who are susceptible to the disease.
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Affiliation(s)
- Hiroki Isono
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
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Toczyska I, Płusa T. [Shiga toxin and tetanus toxin as a potential biologic weapon]. Pol Merkur Lekarski 2015; 39:157-161. [PMID: 26449578] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Toxins produced by the bacteria are of particular interest as potential cargo combat possible for use in a terrorist attack or war. Shiga toxin is usually produced by shiga toxigenic strains of Escherichia coli (STEC - shigatoxigenic Escherichia coli). To infection occurs mostly after eating contaminated beef. Clinical syndromes associated with Shiga toxin diarrhea, hemorrhagic colitis, hemolytic uremic syndrome (HUS - hemolytic uremic syndrome) or thrombotic thrombocytopenic purpura. Treatment is symptomatic. In HUS, in which mortality during an epidemic reaches 20%, extending the kidney injury dialysis may be necessary. Exposure to tetanus toxin produced by Clostridium tetani, resulting in the most generalized tetanus, characterized by increased muscle tension and painful contractions of individual muscle groups. In the treatment beyond symptomatic behavior (among others spasticity medications, anticonvulsants, muscle relaxants) is used tetanus antitoxin and antibiotics (metronidazole choice). A common complication is acute respiratory failure - then it is necessary to implement mechanical ventilation.
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Affiliation(s)
- Izabela Toczyska
- Military Institute of Medicine in Warsawa, Poland, Department of Internal Diseases, Pneumonology and Allergology, Central Clinical Hospital of the Ministry of National Defense
| | - Tadeusz Płusa
- Military Institute of Medicine in Warsawa, Poland, Department of Internal Diseases, Pneumonology and Allergology, Central Clinical Hospital of the Ministry of National Defense
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Mustapha AF, Eegunranti BA, Fawale MB. Tetanus remains a formidable health challenge in Nigeria: The experience from a single Teaching Hospital in Osun State, Nigeria. Nig Q J Hosp Med 2015; 25:151-155. [PMID: 27295807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Tetanus, though an eminently preventable disease still ranks as a leading cause of death in Nigeria as well as in other developing countries. Reported mortality for severe tetanus varies from 20-60% and depends on the availability and quality of intensive care. Farmers and artisans are mostly affected. OBJECTIVES This retrospective study was carried out to determine the pattern of clinical presentation of tetanus, the immunization status, case fatality rate and factors influencing mortality. METHODS Case notes of patients (age > 10 and above) managed for tetanus from 2004-2008 at LAUTECH Teaching Hospital Osogbo were retrieved. Demographic, clinical data, laboratory investigation results and response to treatment were collated. The data obtained were analysed using the SPSS version 15 Statistical package. RESULTS Over the 5-year period,80 cases of tetanus were managed in the medical wards of LAUTECH Hospital Teaching Osogbo. However, the medical records of 12 of them could not be retrieved, leaving 68(85%) for analysis. This comprised of 45 males and 23 females. Tetanus was highest in the third decade of life. The commonest portal of entry was the lower limb (n = 43). Only one subject was fully vaccinated and received booster dose of vaccine. Thirty-one (31)out of the 68 patients died giving a case fatality rate of 51.5%. CONCLUSION The mortality of tetanus is still very high from this retrospective study. The rate of immunization against tetanus was dismally low. Active immunization should be given to all Nigerians particularly those in the vulnerable group.
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Stock I. [Tetanus and Clostridium tetani--a brief review]. Med Monatsschr Pharm 2015; 38:57-60. [PMID: 26376540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tetanus is an acute, often fatal, disease caused by an exotoxin (tetanospasmin) produced by the anaerobic, gram-positive spore-forming bacterium Clostridium tetani. It is characterized by generalized rigidity and convulsive spasms of skeletal muscles. In most industrialized countries, tetanus is a rare disease. However, in many tropical and subtropical countries with low vaccination coverage and poor medical care, it is still widely distributed. This applies in particular for neonatal tetanus. About 50 000 newborns and infants die each year from consequences from this severe illness. Management of tetanus involves neutralization of free circulating toxin, adequate antibacterial and symptomatic therapy as well as intensive care of the patient. For prophylaxis of the disease, active tetanus toxoid vaccination is the method of choice.
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Hertz MA, Sørensen SM. [Tetanus can still be found in Denmark]. Ugeskr Laeger 2014; 176:V06140334. [PMID: 25534221] [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: 06/04/2023]
Abstract
Tetanus (lockjaw) is caused by toxins produced by Clostridium tetani, usually transmitted through contaminated wounds. We describe a case of tetanus in an unvaccinated, previously healthy 78-year-old woman. Twelve days after minor trauma to the right palm, initially treated with tetanus vaccination without immunoglobulins, she developed hoarseness, dyspnoea and difficulties swallowing and opening her mouth. She got severe, painful muscle cramps of especially the truncal muscles requiring large doses of sedatives and complicating respiratory insufficiency. She was treated in intensive care for 33 days, but recovered completely.
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McCabe J, La Varis T, Mason D. Cephalic tetanus complicating geriatric fall. N Z Med J 2014; 127:98-100. [PMID: 25145370] [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: 06/03/2023]
Abstract
We report a case of cephalic tetanus which initially presented with acute lower motor neurone facial weakness. Tetanus is a rare diagnosis in the developed world but sporadic cases do occur. People born before 1960 in New Zealand are less likely to be immune. Judicious use of human tetanus immunoglobulin (TIG) and immunisation prevents the development of tetanus following injury and should always be considered in the elderly who are less likely to have immunity.
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Affiliation(s)
- Josie McCabe
- Department of Medicine, Christchurch Hospital, Christchurch, New Zealand.
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24
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Solov'ev AE, Kornienko GV, Kartyshova MA. [Observation of tetanus in a teenager]. Klin Khir 2014:71-72. [PMID: 25252421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
The prevalence of tetanus reflects a failure of immunization. Prompt diagnosis and prediction of severity are crucial for the prevention of early life threatening complications and the institution of appropriate management. The current symptomatic treatment of heavy sedation, paralysis and artificial ventilation for 3-5 weeks for moderate and severe tetanus, is, even in the best centers, still associated with unacceptably high mortality, due to the disease and complications of the therapy itself. It is especially inappropriate for the developing world where intensive care resources are minimal. New options reported to avoid artificial ventilation and sedation are dantrolene (Dantrium, Procter and Gamble Pharmaceuticals), baclofen (Lioresal, Novartis) and magnesium. Magnesium therapy has the advantages of controlling spasms and sympathetic over activity without sedation. This simplifies nursing care and minimizes the need for ventilatory support except in the very severe disease and the elderly. Magnesium is recommended as the first-line therapy in tetanus.
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Laine H, Vuorinen S, Simula S. [Pressure ulcer and tetanus in an elderly person]. Duodecim 2014; 130:174-177. [PMID: 24605433] [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: 06/03/2023]
Abstract
Clostridium tetani, the bacterium causing tetanus, can be found both in the soil and intestinal normal flora. While the majority of the Finnish population has adequate vaccination protection, part of the population exhibits weakened protection. We describe a case in which a patient developed tetanus as a consequence of pressure ulcer. The symptoms extended to the respiratory muscle region, resulting in respiratory insufficiency and cardiac arrest for the patient. The patient, however, recovered after successful resuscitation and extended intensive care as required by tetanus.
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Narang M, Khurana A, Gomber S, Choudhary N. Epidemiological trends of tetanus from East Delhi, India: a hospital-based study. J Infect Public Health 2013; 7:121-4. [PMID: 24284024 DOI: 10.1016/j.jiph.2013.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/24/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To study the demographic profile, prognostic indicators, and mortality of tetanus patients and treatment outcomes following intramuscular anti-tetanus immunoglobulin (ATG) alone or combined intrathecal and intramuscular ATG. DESIGN Retrospective study. SETTING Inpatients from a tertiary care hospital. SUBJECTS One hundred children under 12 years of age diagnosed with tetanus and admitted from January 2003 to December 2007 were included in the study. METHODS Case records of patients with neonatal tetanus (n=30) and post-neonatal tetanus (n=70) were evaluated retrospectively. The diagnosis of tetanus was based on World Health Organization (WHO) criteria. The outcomes of patients treated with either intramuscular ATG or both intrathecal and intramuscular ATG were separately compared in the neonatal and post-neonatal groups. RESULTS Our study revealed difficulty in feeding, trismus, spasms, rigidity, and opisthotonus posturing as the predominant clinical manifestations. The survival rate for children receiving tetanus immunoglobulin by the dual route was significantly higher than for children receiving the immunoglobulin via the intramuscular route. Seizures and tremors were poor prognostic factors associated with tetanus.
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Affiliation(s)
- Manish Narang
- Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India.
| | - Aman Khurana
- Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Sunil Gomber
- Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Nidhi Choudhary
- Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
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Brandon L, Nurdin NF, Byrne M, Moylett E. Clinical tetanus in an 11 year old boy. Ir Med J 2013; 106:313-314. [PMID: 24579413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- L Brandon
- Department of Paediatrics, National University of Ireland, Galway.
| | - N F Nurdin
- Department of Paediatrics, National University of Ireland, Galway
| | - M Byrne
- Department of Paediatrics, National University of Ireland, Galway
| | - E Moylett
- Department of Paediatrics, National University of Ireland, Galway
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Abstract
Tetanus is a very serious neuromuscular disease caused by a powerful exotoxin, tetanospasmin, from the Clostridium tetani bacillus. Its incidence in the developed world has diminished considerably since the introduction of primary vaccination. Tetanus is diagnosed clinically, through recognition of the characteristically inducible muscle spasms. Three clinical forms described in adults are generalised, localised and cephalic tetanus. Management of tetanus aims at removing the source of tetanospasmin, neutralising circulating toxin, and providing adequate supportive care for muscle spasms, respiration and autonomic instability. Tetanus is a forgotten disease in developed countries since many practicing primary care physicians have not seen a single case in their career. We present a case of tetanus and review briefly the pathogenesis, clinical features and therapy in order to educate the internist in recognising and adequately treating this disease.
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Abstract
Access to critical care is rapidly growing in areas of the world where it was previously nonexistent and where infectious diseases often comprise the largest disease burden. Additionally, with crowding, mass migrations, and air travel, infectious diseases previously geographically confined are quickly spread across the planet, often in shorter time frames than disease incubation periods. Hence, critical care practitioners must be familiar with infectious diseases previously confined to the developing world. This article reviews selected tropical diseases that are seen in diverse locales and often require critical care services.
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Affiliation(s)
- Srinivas Murthy
- Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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te Wierik MJM, Hahné SJM, van Ooik PC, van Lier AMC, Swaan CM. [Tetanus prophylaxis after an injury; check the need for vaccination and immunoglobulin]. Ned Tijdschr Geneeskd 2013; 157:A5906. [PMID: 24330787] [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: 06/03/2023]
Abstract
Tetanus can occur after an injury and is caused by the exotoxin of Clostridium tetani. Characteristics of generalised tetanus include spasms in the back and other muscles, trismus, risus sardonicus and difficulty in breathing caused by laryngospasms. Vaccination through the National Vaccination Programme of the Netherlands has resulted in 94% of the population being protected against tetanus; certain groups, however, have a low rate of vaccination. In the Netherlands, 5 patients were reported to have generalised tetanus in 2011. This figure is relatively high in comparison with previous years. Of these 5 patients, 3 did not receive post-exposure-prophylaxis (PEP) after their injuries, or received it incompletely. PEP may be comprised of 1 or more vaccinations with the tetanus toxoid and/or the administration of tetanus immunoglobulin. Patients who have sustained an injury should be evaluated in accordance with the guideline 'Tetanus' by the Landelijke Coördinatie Infectieziekten (National Coordination Centre for communicable disease control), and to assess whether PEP is indicated.
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Gilligan JEF, Lawrence JR, Clayton D, Rowland R. Tetanus and the evolution of intensive care in Australia. CRIT CARE RESUSC 2012; 14:316-323. [PMID: 23230882] [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: 06/01/2023]
Abstract
A review of two series of patients with tetanus from the Royal Adelaide Hospital provides a historical perspective on the evolution of intensive care in Australia. Nine consecutive severe cases presenting in 1957 constituted one of the first series published. Four patients died. The second series of 38 severe cases, among a total of 56 cases presenting between 1967 and 1985, included two deaths, comparing favourably with survival in other contemporary series. The specialty of intensive care evolved considerably during this time. Neuromuscular blockade introduced in the first series produced radical changes in management. Supportive measures that were not then widely practised, involving intermittent positive pressure ventilation, were used in the second series for up to 46 days and evolved into standard ICU practice. The option of using a tank respirator was rejected. Older patients were susceptible to complications commonly related to respiratory, cardiovascular and diabetic comorbidities, but most returned to their previous lifestyle. Severe tetanus often resulted from mild injuries in patients who were incompletely immunised. Four patients developed tetanus following surgical procedures. The use of nitrous oxide in the first series was abandoned owing to adverse effects on bone marrow function. Complications reported in early literature, such as fractures and myositis ossificans, presumably related to unrelieved spasm, are no longer seen. Clinicians are now likely to see the condition only if working with counter-disaster teams overseas.
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Affiliation(s)
- Mikael Alves
- Medical Intensive Care Unit, Hospital Saint-Antoine, Paris, France.
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Alagbe-Briggs OT, Tinubu SA. Tetanus--a case report with severe autonomic instability and: a review of the literature. Niger J Med 2012; 21:353-356. [PMID: 23304936] [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: 06/01/2023] Open
Abstract
BACKGROUND Tetanus is an infection that can be associated with a high mortality especially in developing countries. Critical care which may include artificial control of respiration is crucial in survival, but cardiovascular complications from autonomic instability remains an important cause of death. The objective of this report is to highlight this important cause of mortality despite artificial control of ventilation to prevent respiratory arrest. METHOD The medical record of the patient and relevant literature were reviewed. RESULT A 29-year old male following a wound on the lower limb presented with clinical features suggestive of tetanus. Incubation period was short and immunization history was uncertain. Basic treatment directed at removing source of infection and neutralisation of unbound toxin was however commenced. Following signs of imminent respiratory failure due to severe uncontrollable spasms, controlled mechanical ventilation was instituted in the critical care unit (CCU). However, the patient succumbed to cardiac arrest as a result of severe autonomic instability, despite aggressive cardiopulmonary resuscitation. CONCLUSION Cardiovascular arrest from severe autonomic instability remains an important cause of mortality in tetanus despite artificial ventilation. Early management with appropriate therapy is advisable to prevent its occurrence.
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Affiliation(s)
- O T Alagbe-Briggs
- Department of Anaesthesia and Intensive Care, Lagos State University Teaching Hospital, Ikeja, Lagos.
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Wasay M, Malik A, Fahim A, Yousuf A, Chawla R, Daniel H, Rafay M, Azam I, Razzak J. Knowledge and attitudes about tetanus and rabies: a population-based survey from Karachi, Pakistan. J PAK MED ASSOC 2012; 62:378-382. [PMID: 22755284] [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: 06/01/2023]
Abstract
OBJECTIVE To evaluate public knowledge regarding predisposing factors, fatality and prevention of Tetanus and Rabies and attitudes toward vaccination and post-exposure prophylaxis. METHODS A population-based, cross-sectional survey was conducted in all the 18 towns of Karachi, the largest metropolitan city of Pakistan, from December 2007 to January 2008. Men and women of more than 18 years of age were included in the study which used a self-reporting questionarre as its tool. RESULTS There were 1201 people interviewed by the study. The majority of respondents had known or heard about Tetanus (n = 973; 81%) and rabies (n = 699; 58%). There were 29 (2.5%) reported dog bites on the subjects themselves and 218(18%) respondents reported dog bites among their family members during the preceeding one year. Only three (11%) of these dog bite victims received some kind of vaccine or post-exposure prophylaxis. The majority of the participants were not aware of the fatality of these diseases and the importance of vaccination and post-exposure prophylaxis. Of the total respondents, 563 (47%) reported an injury or wound during the preceeding one year. Of them, 426 (76%) received a Tetanus injection. Out of the total study population, 1019 (85%) respondents did not know that Tetanus could be a fatal disease, and 844 (70%) did not know that Tetanus could affect and kill newborns. Literate people and males were more likely to have adequate knowledge on multivariate analysis. CONCLUSION Minor injuries and dog bites are a common occurrence in Karachi. Only a small proportion of these patients received post-exposure treatment. Most of the participants were not aware of the fatality of these diseases and the importance and affordability of vaccination in case of dog bites and minor trauma.
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Affiliation(s)
- Mohammad Wasay
- Department of Medicine, Emergency Medicine, and Community Health Sciences, Aga Khan University, Karachi
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fukutake T, Miyamoto R. [Clinical features of tetanus: a review with case reports]. Brain Nerve 2011; 63:1101-1110. [PMID: 21987566] [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: 05/31/2023]
Abstract
Tetanus is a CNS disorder characterized by muscle spasms that is caused by the exotoxin of an anaerobic bacterium, Clostridium tetani. This disease is killing tens of thousands of neonates in developing countries. Although the incidence and mortality of tetanus has dramatically dropped in developed countries due to effective vaccination, appropriate wound management, and recent advances in intensive care, treatments remain difficult. From among developed countries, Japan has had a relatively high incidence of tetanus, and prevention is the problem especially in the elderly. We analyzed the data from 12 patients admitted to our hospital during 1997-2010. Their age ranged from 50-82 years; median 72 years with male to female ratio 5: 7, and all patients lacked a reliable history of toxoid immunization. Five patients out of 12 had history of cancer and one each had diabetes mellitus, pulmonary emphysema and Sjogren syndrome. In some cases, the patients had been initially misdiagnosed with ENT disorders, dental problems, or psychosis. Therefore to date, observation of clinical symptoms such as difficulty in mouth opening is considered the most crucial for diagnosis. The shorter was a period from onset to generalized convulsion (onset time), the longer was a duration of hospital stay. A notable complication was intramuscular hemorrhage in the lumbar muscles, which occurred in 2 patients. No patients died due to ICU managements, in which the most useful were propofol for spasm control and sedation, and magnesium sulfate for autonomic overactivity. Retrospectively, the Tetanus Severity Score (TSS) for mortality proposed by Thwaites et al (2006) is considered a useful tool also for predicting the clinical outcome at discharge. Although tetanus has been traditionally classified into the generalized, local, and cephalic types, a simpler severity-based classification into "severe", "moderate", and "mild" types may be more practical with regard to disease management.
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Helbok R, Brenneis C, Beer R, Lackner P, Brössner G, Klien S, Seppi K, Schmutzhard E, Pfausler B. Intensive care management in very old adults: two cases with clostridium tetani infection. J Am Geriatr Soc 2011; 59:552-3. [PMID: 21391945 DOI: 10.1111/j.1532-5415.2010.03295.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Otero-Maldonado M, Bosques-Rosado M, Soto-Malavé R, Deliz-Roldán B, Bertrán-Pasarell J, Vargas Otero P. Tetanus is still present in the 21st century: case report and review of literature. Bol Asoc Med P R 2011; 103:41-47. [PMID: 22111470] [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: 05/31/2023]
Abstract
Tetanus is a very serious disease that can be fatal. Its incidence in the developed world has diminished considerably since the introduction of tetanus toxoid. More importantly, tetanus is one of the few infectious diseases that can be prevented. The recommendations for immunization are clear and readily available. In spite of the progress, we still see cases of tetanus in which the prognosis is poor. We present the case of a 67 year-old man that was admitted to our hospital with one of the most common manifestations of tetanus: trismus. Even though his treatment was established immediately, the hospital stay was long and made him susceptible to various medical complications and nosocomial infections. The incidence of tetanus in Puerto Rico is low but the mortality rate continues to be elevated in the high-risk group: patients older than 60 years of age. This is the reason for which we present this case. Our goal is to provide information with regards to epidemiology, pathogenesis, clinical manifestations, diagnosis and management of tetanus. In addition, it is equally essential to remind our colleagues the significance of adequate prevention of this potentially mortal and disabling disease.
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Affiliation(s)
- Mariely Otero-Maldonado
- Department of Infectious Disease, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Sood V, Aggarwal M, Aggarwal KC. Neonatal tetanus elimination in India-still a long way to go. Indian J Pediatr 2011; 78:491-2. [PMID: 21165724 DOI: 10.1007/s12098-010-0302-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 11/23/2010] [Indexed: 11/28/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Akdur O, Ozkan S, Durukan P, Koyuncu M, Ikizceli I, Metan G. A forgotten diagnosis in emergency department: tetanus. BRATISL MED J 2011; 112:469-471. [PMID: 21863620] [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 Tetanus is a serious and acute life-threatening disease caused by toxins of "Clostridium tetani". Although it is generally a disease of developing countries, its lower incidence is encountered also in developed countries. Since the principal treatment of this disease is known to be based on vaccination and wound care, the emergency physicians play a key role in its management. MATERIAL AND METHOD In the present study, we reviewed its uncommon clinical course along with demographic and clinical features of five cases that have presented with various complaints to our Emergency Department. Presenting signs, demographic features, injury history, and the time from the occurrence of injury to the beginning of symptoms were evaluated. RESULTS Four of five cases were female. The mean age of cases was 56.8 (34-73). Three of them had hand injury, one had foot injury, and the fifth case had facial injury. The initial symptoms included difficult jaw movement, back muscle spasm, and pain. Two cases died. CONCLUSION Tetanus cases may present to ED with different symptoms. Therefore, physicians should be aware of the early signs of tetanus. Careful and meticulous wound management of cases presented to ED following an injury should be considered a significant factor, which can help in reducing the tetanus cases (Tab. 2, Ref. 18).
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Affiliation(s)
- O Akdur
- Department of Emergency Medicine, Erciyes University Faculty of Medicine, Kayseri, Turkey.
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Adeniyi OF, Mabogunje CA, Okoromah CN, Renner JK. Neonatal tetanus: the Massey Street Children's Hospital experience. Nig Q J Hosp Med 2010; 20:147-152. [PMID: 21913519] [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: 05/31/2023]
Abstract
BACKGROUND Neonatal tetanus (NNT), a major cause of neonatal deaths in the developing world appears to be on the downward trend in recent years. At the Massey Street Children's Hospital (MSCH), a foremost paediatric centre in Lagos an unpublished review revealed that NNT constituted 15-20% of the neonatal admissions in the period 2003-2005. OBJECTIVE The aim of this study was to determine the current prevalence of the disease, describe the clinical characteristics of NNT cases seen at the hospital and proffer solutions that would contribute to the elimination of the disease. METHODS This was a retrospective study. The clinical record of 66 patients with NNT admitted during a 2 year period (2006-2008) was reviewed. The clinical characteristic of the patients, co-morbidities/complications and mortality in the children was determined. The immunization status, facility used for Antenatal care and delivery by the mothers was also noted. RESULTS NNT constituted 2.5% of neonatal admissions in the 2 year period. The mean age of the patients was 8.8 +/- 3.29 days. 36 (54.5%) of the patients died while 25 (37.9%) were discharged home. The overall case fatality rate (CFR) was 54.5%. Recurrent apnea was the commonest complication seen. 27 (40.9%) and 37 (56.1%) of the mothers had ANC and delivered at the TBA clinics respectively. Only 2 (3%) of the mothers attended government hospitals. CONCLUSION Though there is a reduction in the number of cases of NNT over the years (15-20% prevalence to 2.5%) the CFR at the secondary health facility still remains unacceptably high. The preference of mothers for TBA clinics rather than government hospitals is a major concern which needs to be addressed.
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Affiliation(s)
- O F Adeniyi
- Department of Paediatrics, Massey Street Children's Hospital, Lagos, Nigeria
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Benhaberou-Brun D. [Tetanus. Is it still a danger in 2010?]. Perspect Infirm 2010; 7:34-36. [PMID: 20653310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Indrawattana N, Sookrung N, Kulkeaw K, Seesuay W, Kongngoen T, Chongsa-nguan M, Tungtrongchitr A, Chaicumpa W. Human monoclonal ScFv that inhibits cellular entry and metalloprotease activity of tetanus neurotoxin. Asian Pac J Allergy Immunol 2010; 28:85-93. [PMID: 20527521] [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
Tetanus is a deadly disease of warm blooded animals and humans caused by an exotoxin called tetanospasmin or tetanus neurotoxin (TeNT) produced by anaerobic bacterium named Clostridium tetani TeNT is an A-B toxin; each molecule consists of a heavy chain (HC) containing cellular receptor binding domain and a light chain (LC) with zinc metalloprotease activity. TeNT produced in the infected tissue by the bacteria grown under anaerobic condition binds to ganglioside receptors of peripheral nerve, and endocytosed. The A subunit exits from the endosome and undergoes a retrograde transport via the nerve axon to the spinal cord. This highly toxic enzyme specifically cleaves one of the nerve cell SNARE proteins, i.e., synaptobrevin, resulting in inhibition of the release of neurotransmitters (glycine and GABA) from inhibitory interneuron causing spastic paralysis, the characteristic of tetanus. Current treatment mainstay of human tetanus is by passively administering anti-tetanus toxin produced from animals immunized with adjuvanted tetanus toxoid (TT). There are several obstacles in production and use of the animal derived therapeutic antibody especially the allergic reaction and serum sickness induced by the host immune response to the foreign protein. The animal antibody, mainly IgG, blocks nerve cell entry of the TeNT but does not neutralize the TeNT protease activity per se and cannot reverse the tetanus symptoms. In this study, fully human single chain antibody fragments (HuScFv) were produced from a human antibody phage display library. TT was used as antigen in a single round phage bio-panning to select phage clones that display TT bound-HuScFv from the library. HuScFv from 4 selected huscfv-phagemid transformed E. coli clones inhibited binding of the native TeNT to retinoic acid pulsed human neuroblastoma cells when used at the molecular TeNT:HuScFv ratio of 1:100. HuScFv from one of the 4 clones also inhibited the TeNT mediated cleavage of recombinant synaptobrevin. Further investigation is needed for identification of epitope specificity of these HuScFv and HuScFv effector mechanisms towards the TeNT. Cell penetrating version of the HuScFv that inhibited the TeNT zinc metalloprotease activity should be made. The HuScFv produced in this study either singly or in their suitable combination warrant developing further to a real use in humans as a surrogate of the animal antibody for treatment of tetanus.
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Affiliation(s)
- Nitaya Indrawattana
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok,Thailand.
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Affiliation(s)
- Thomas P Bleck
- Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL, USA
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Tadesse A, Gebre-Selassie S. Five years review of cases of adult tetanus managed at Gondar University Hospital, North West Ethiopia (Gondar, Sep. 2003-Aug. 2008). Ethiop Med J 2009; 47:291-297. [PMID: 20067144] [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: 05/28/2023]
Abstract
BACKGROUND Tetanus is a life threatening preventable infection relatively uncommon in the developed world but occurs frequently in developing countries with case fatality rate of 40-60%. We conducted the study as there is no recent review regarding adult tetanus in Ethiopia which looked at the predisposing factors, presenting features and case fatality rate. OBJECTIVE The study aims to evaluate clinical characteristics of adult tetanus as related to predisposing factors, presenting features and treatment outcome. METHODS This is a retrospective review of adult tetanus cases admitted to medical ward of Gondar University Hospital, North West Ethiopia, over a period of 5-years. RESULTS A total of 29 adults were admitted with the diagnosis of generalized tetanus during the study period. There were more male then female patients (sex ratio 1.9:1) with rural dwellers constituting the majority. The mean age of patients was 35 +/- 14 yrs (range, 18-70 yrs. Majority of patients (72.4%) sustained acute injury preceding symptom onset, often on lower extremity. Three rural mothers, who denied history of trauma, developed puerperal tetanus with in 2 weeks of delivery, genital tract thought to be the portal of entry. Almost all patients, who had sustained acute injury, did not seek medical help for their wounds and missed the chance to receive prophylaxis for tetanus. Over all, 48.3% had severe, 37.9% moderate, and 13.8% mild form of tetanus at presentation. The most common clinical presentation was trismus (100%), followed by stiff neck and back (93.1%) and neck rigidity (86.2).Over all mortality rate was 41.4%. Respiratory failure requiring ventilatory support (66.7%) was the major cause of death. CONCLUSION The study recommends a need for tetanus immunization in those who had acute injury and planning to educate individuals at risk to recognise symptoms early, and seek medical care to combat this fatal disease.
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Affiliation(s)
- Abilo Tadesse
- Department of Internal Medicine, Gondar University Hospital, Gondar, Ethiopia
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Trubuhovich RV. Some prehistory of New Zealand intensive care medicine. Anaesth Intensive Care 2009; 37 Suppl 1:16-29. [PMID: 19705630 DOI: 10.1177/0310057x090370s105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In taking 1960 as the foundation year for the practice of intensive care medicine in New Zealand, this paper briefly looks into the previous two centuries for some interventions in life-threatening conditions. With the help of descriptions in early 19th century journals and books by perceptive observers, the author focuses on some beliefs and practices of the Maori people during pre-European and later times, as well as aspects of medical treatment in New Zealand for early settlers and their descendents. Dr Laurie Gluckman's book Tangiwai has proved a valuable resource for New Zealand's medical history prior to 1860, while the recent publication of his findings from the examination of coroners' records for Auckland, 1841 to 1864, has been helpful. Drowning is highlighted as a common cause of accidental death, and consideration is given to alcohol as a factor. Following the 1893 foundation of the New Zealand Medical Journal, a limited number of its papers which are historically relevant to today's intensive care are explored: topics include tetanus, laryngeal diphtheria, direct cardiac massage, traumatic shock, thiopentone management for fitting and the ventilatory failure due to poliomyelitis.
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Mangilli LD, Sassi FC, Dos Santos SDS, de Andrade CRF. Oral sensorimotor function for feeding in patients with tetanus. Acta Trop 2009; 111:316-20. [PMID: 19481999 DOI: 10.1016/j.actatropica.2009.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 05/20/2009] [Accepted: 05/22/2009] [Indexed: 11/17/2022]
Abstract
Tetanus still remains a significant health problem in developing countries; it is a serious disease with a high mortality rate. The purpose of this study was to characterize the oral sensorimotor function for feeding in patients with tetanus. Thirteen patients clinically diagnosed with tetanus and admitted to an intensive care unit between December of 2005 and May of 2007 underwent a screening tool for dysphagia, involving the assessment of clinical features and 2 swallowing tests. Results indicate that the oral sensorimotor function for feeding in these patients is severely compromised, with the exception for the clinical feature of palate elevation and performance in the saliva swallowing test. The factor analysis indicated that the evaluation of tongue movement change in the oromotor examination is important in predicting alterations of cough/voice in the water swallowing test, thus suggesting that oral feeding might be unsafe. When looking at developing countries, the prolonged intensive medical and nursing care required by many patients with tetanus places extra demands on an already stretched healthcare budget. Intervention by a speech pathologist could mean that time in the ICU would be reduced as well as the number of re-admissions due to complications.
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Affiliation(s)
- Laura Davison Mangilli
- University of São Paulo School of Medicine, Rua Cipotania, 51, Campus Cidade Universitária, CEP 05360-160, São Paulo, SP, Brazil
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