Cases Of Tetanus Research Articles

JUST A GRAZE?

We describe a case of a diagnostically difficult stroke mimic, cephalic tetanus.1 Currently there are 12–15 cases of tetanus reported annually in the United Kingdom,2 but worldwide it accounts for...

Childhood tetanus from snakebite in Warri: a ten-year retrospective review

Background : Childhood tetanus from snakebite is a rare occurrence in Nigeria. It occurs more in adolescents and adults males. Aim : We report cases of tetanus in children following snakebite in Warri. Methods : Case notes of the children with tetanus from January 2000 to December 2009 at GN Chidren’s Clinic and Central Hospital Warri were used. Results : Only three cases were documented in 10 years and are presented below. Conclusion : Though tetanus from snakebites in children may be rare in our environment, there should be intensified efforts in eradicating the potentially fatal disease. Key words : Tetanus, children, snakebites, Warri, Nigeria

Tetanus: An unusual finding in dental practice

Tetanus is an infectious non-contagious disease caused by the bacillus Clostridium tetani, which enters the body through open wounds. Psychomotor dysfunction enables accidents among the elderly and vaccination coverage is low in this year range, hence contributing to high mortality rate. The aim of this paper is to show a case of tetanus in a geriatric patient referred for an oral and maxillofacial surgery practice. The patient presented signs and symptoms of the disease in the maxillofacial and neck regions, such as trismus and muscle spasms in the masticatory musculature, neck muscles and diaphragm. Symptoms shortly progressed to severe dysphagia and respiratory failure. Treatment involved intravenous antibiotics, tetanus immunoglobulin and muscle relaxant. The patient was discharged from the hospital after 26 days in a satisfactory condition.

Effect of Military Conflicts on the Formation of Emergency Medical Services Systems Worldwide

This article briefly reviews the evolution of medical support during wars and conflicts from ancient to modern times and discusses the effect warfare has had on the development of civilian health care and emergency medical services (EMS). Medical breakthroughs and discoveries made of necessity during military conflicts have developed into new paradigms of medical care, including novel programs of triage and health assessment, emergency battlefield treatment and stabilization, anesthesia, and other surgical and emergency procedures. The critical role of organizations that provide proper emergency care to help the sick and injured both on the battlefield and in the civilian world is also highlighted.

Traditional bonesetter’s gangrene of limb in children in Regional Hospital of Kaolack (Senegal)

Little published data exist on the morbidity and mortality associated with poor trauma care in developing countries. This report highlights our experience with iatrogenic limb gangrene related to fracture management by traditional bonesetters. Children with bonesetter’s gangrene were identified from a prospectively recorded paediatric surgery database at the Regional Hospital of Kaolack in Central Senegal. 21 children were treated for bonesetter’s gangrene during a 18-month period (January 2007 up to June 2008). The average age was 10 years (range, 5 to 15 years). Bonesetter’s gangrene was more common in boys (90.5%) and occurred almost exclusively in children from rural areas where access to health care was limited. 16 children underwent proximal extremity amputation. Complications included one case of tetanus. Bonesetter’s gangrene is a preventable complication that results from a failure of child health planners to recognize the importance of basic trauma care. Management of fractures should be considered an essential component of child health programs in developing countries.

Le tétanos nosocomial dans le service de référence de l’hôpital National Donka à Conakry (2001–2011)

Become almost non-existent in the developed countries, the hospital-borne tetanus always stays of current events in our country in spite of the forensic problem which it puts. The objectives of this study were to determine prevalence of this affection, to describe its clinical picture and to determine its lethality. It is about a retrospective study of a duration of 11 years realized in the service of the infectious diseases of Conakry. Among 8649 hospitalizations from 2001 till 2012 we brought together 239 cases of tetanus (2.7%) among which 60 hospital-borne tetanus (0.7%). Men represented 73% of these cases, with a sex-ratio M/F of 2.7. The age bracket of 20-40 years was the most affected with 32 cases (53.3%). A single patient had begun his vaccinal calendar which had remained incomplete. Both national hospitals of the CHU of Conakry and private hospitals were the biggest suppliers of this hospital-borne tetanus with respectively 22 and 27 cases (36.6 and 45%). Tetanus related to IM of quinine represented 26 cases (43.3%) whereas the hernial cure was found in 16 cases (26.6%). The average duration of invasion and incubation was respectively 1.5 days and 6 days for the dead (n = 45.7%) and 2 days and 10.5 days for the survivors. Three-quarters of 60 patients died. The fight against this type of tetanus passes inevitably by an improvement of the working conditions, a strict application of the rules of asepsis and the in-service training of the medical and paramedical staff.

Tetanus Following Root Canal Surgery

2400 years ago Hippocrates recognised Tetanus as a dreadful disease.It is caused by a straight slender gram positive anaerobic rod-Clostridium Tetani, the toxin of which interferes with acetylecholine/cholinesterase balance at peripheral motor end plate of central nervous system causing sustained tonic spasm. Children are routinely immunized these days everywhere against Diptheria,Pertisis,Tetanus,Poliomyelitis etc.But this does not apply with aged people who were not routinely immunized during their infancy making them vulnerable to these diseases including Tetanus. Majority of Tetanus cases follow wounds(war,accidents,post-operative) contaminated with soil,manure or other external sources.Following is a rare case where tetanus occured without so called wound i.e.Clostrdium Tetani infected pulp space in the root of the tooth following root canal surgery.As the pulp space becomes a closed chamber after filling it with inert material in R.C.T. so anaerobic infection can occur here as it occured in this case of 42 year old female school teacher.All wounds however trival from whatever cause should be considered tetanus prone.DOI: http://dx.doi.org/10.3329/kyamcj.v3i1.13663 KYAMC Journal Vol. 3, No.-1, June 2012 pp.265-268

A case of neonatal tetanus presented within 24 hours of life

Neonatal tetanus is still prevalent in developing countries such as India. Generally, neonatal tetanus is seen in babies of unimmunized mothers beyond the second day of life. A neonate presented to us on the 4th hour of birth with a periumbilical ulcer. The baby's antenatal and birth history was uneventful. The mother had been immunized against tetanus. At presentation, the baby was active, alert and sucking normally. A very small ulcer was noted below the umbilicus. Subsequently, the baby developed rigidity and a tonic spasm of its body with recurrent seizures from the 18th hour of its birth and by 21st hour. It also had a full blown clinical picture of neonatal tetanus including: masseter spasm; generalized rigidity; a high pitched cry: and intermittent opisthotonos posturing. An ulcer gradually enlarged to 5 × 4 cm and a swab from ulcer showed Clostridium tetani (both on Gram staining and culture). A review of the published literature did not reveal any case that had presented so early. Therefore, this is probably the first case of neonatal tetanus being reported within the 21st hour of birth.

デクスメデトミジン中止後に著しい交感神経過興奮状態を呈した破傷風の1例

デクスメデトミジン中止後に著しい交感神経過興奮状態を呈した破傷風の1例

A Case of Cephalic Tetanus in a Developed Country

Tetanus is a potentially life-threatening infection that results from contamination of skin wound by Clostridium Tetani spores. Although, it remains an important health problem in developing countries without strict national immunization programs, this condition is rare in the developed world. The most frequent presenting symptoms are trismus and dysphagia, due to the spasmodic contraction of the masticatory muscles. Then the disease usually diffuses with a descending pattern inducing a generalized contraction of the agonist and antagonistic muscles, which characterize a tetanic spasm. Mortality usually results from respiratory failure, cardiovascular collapse, or autonomic dysfunctions. Treatment usually requires the prompt admission to the intensive care unit to avoid the development of potential life-threatening complications. We report the case of a 78-year-old farmer, who was referred to us with progressive onset of lock-jaw and muscular stiffness of the facial region, that had occurred after he had scratched himself with a rose. The recognition of the presenting signs of cephalic tetanus allowed the prompt management of the infection. However, because of the rarity of this condition, the clinicians may be unfamiliar with the clinical presentation, and be unsuspecting of the diagnosis.

Seroprevalence of Anti-tetanus Antibodies in Women attending Omdurman Maternity Antenatal Clinic in Sudan

Seroprevalence of Anti-tetanus Antibodies in Women attending Omdurman Maternity Antenatal Clinic in Sudan

Infections with Spore-forming Bacteria in Persons Who Inject Drugs, 2000–2009

Since 2000 in the United Kingdom, infections caused by spore-forming bacteria have been associated with increasing illness and death among persons who inject drugs (PWID). To assess temporal and geographic trends in these illnesses (botulism, tetanus, Clostridium novyi infection, and anthrax), we compared rates across England and Scotland for 2000-2009. Overall, 295 infections were reported: 1.45 per 1,000 PWID in England and 4.01 per 1,000 PWID in Scotland. The higher rate in Scotland was mainly attributable to C. novyi infection and anthrax; rates of botulism and tetanus were comparable in both countries. The temporal and geographic clustering of cases of C. novyi and anthrax into outbreaks suggests possible contamination of specific heroin batches; in contrast, the more sporadic nature of tetanus and botulism cases suggests that these spores might more commonly exist in the drug supply or local environment although at varying levels. PWID should be advised about treatment programs, injecting hygiene, risks, and vaccinations.

Tetanus in a post operative patient—A case report

Tetanus is a preventable disease which commonly occurs with puncture or penetrating wounds, or contamination of cutaneous wounds. It may be secondary to surgical procedures such as gastrointestinal surgery on rare occasions. This article reports a fatal case of tetanus in a post operative patient in which the source of infection could not be ascertained. Active immunization of all persons against tetanus, adequate sterilization of surgical equipment and consumables as well as the operating rooms is advocated.

皮膚潰瘍を形成する乳癌からの発症が疑われた破傷風の 1 例

We report herein on a rare case of tetanus originating from ulcerated breast cancer. A 60-year-old homeless woman was admitted to our hospital because of lockjaw. On admission, a physical examination revealed tachypnea, trismus, opisthotonus and an ulcerated right breast. There was no other skin soft tissue damage. A diagnosis of tetanus was entertained from the lockjaw and opisthotonus. Tetanus globulin, tetanus toxoid, penicillin and respiratory support were initiated. Later, a right total mastectomy was performed, and the diagnosis of breast cancer was made, however, gram positive bacilli were not detected and Clostridiuum tetani (C. tetani) was not cultured. It is conceivable that the ulcerated breast was contaminated with C. tetani due to the patients living conditions.

Elimination of maternal and neonatal tetanus in Senegal: evolution of survey indicators of 2003-2009

This study aimed to estimate the evolution of the maternal and neonatal tetanus in Senegal from the tetanus vaccination coverage among pregnant women, the proportion of deliveries attended by trained medical personnel and the number of cases of tetanus declared by respective districts, helping to identify districts at high risk of neonatal tetanus (NNT). Data analysis of the epidemiological surveillance realized from 2003 to 2009 in 65 districts of Senegal. Data were collected from the reports of vaccination usage and from the Statistical Directories of the National Health Information Services of the Ministry of Health & Prevention. A district is at high risk when the incidence of NNT is ≥1 case per 1 000 Live births (LB). There were 153 reported cases of NNT in Senegal between 2003 and 2009. National incidence decreased from 0.08 to 0.03 case per 1 000 LB (p = 0,0008). The vaccination coverage of the pregnant women by at least two doses of tetanus vaccine (VAT2+) increased from 66% in 2003 to 78% in 2009. The percentage of districts that had reached a vaccination coverage ≥80% was 20% in 2003 compared to 60% in 2009 (p = 0.009). The proportion of deliveries attended by qualified medical staff evolved from 53% in 2003 to 67% in 2009 (p = 0,02). By 2009, the incidence of NNT was less than 1 case per 1,000 LBs in all districts. Assessing the elimination of maternal and neonatal tetanus in Senegal shows that progress has been made from 2003 to 2009. This was made possible through the organization of vaccination campaigns for women of childbearing age and the improvements in the conditions of deliveries.

Tetanus immunization: Perception of residents in a tertiary care teaching hospital in Western India

Background: Prevention of tetanus is far easier than its treatment where mortality is very high. Most cases of tetanus occur due to lack of proper vaccination against the disease and incomplete immunization on exposure. Residents in a tertiary care teaching hospital constitute the first contact physicians for patients. Aim: To assess the perception about Tetanus immunization among residents in a tertiary care teaching hospital of Pune city. Methodology: A pre tested questionnaire was used to assess the knowledge & recommendations about tetanus immunization among randomly selected 157 residents. Results: 73.25% residents were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years. Around 50% residents were not aware of the recommended number of doses of tetanus vaccine for adults over the age of 16 years and during pregnancy. Nearly 60% of the residents considered the wound after every injury to be tetanus prone. 75.8% of residents thought burn injuries to be prone to the development of tetanus while 13.4% and 36.9% of the residents did not consider animal bite and human bite to be tetanus prone respectively. 99.4% residents considered tetanus toxoid administration in wound with rusted iron. The knowledge regarding tetanus immunization in relation to the wound categories depending on the immunization status of the patients was very poor amongst the residents. Conclusion: Better awareness and adherence of tetanus prophylaxis recommendations is needed in residents who are the first tier of health care providers in teaching hospitals.

Trends in neonatal and post-neonatal tetanus admissions at a Nigerian teaching hospital

Tetanus accounts for high morbidity and case fatality rates in developing countries. This study therefore aimed to identify reasons for the persistence of this disease. Paediatric admissions at Ladoke Akintola University Teaching Hospital between 1 January 2006 and 31 December 2008 diagnosed with tetanus were studied. Data was analyzed with SPSS 18 and statistical significance was set at p < 0.05. Of the total 1,681 paediatric admissions, 30 (1.8%) had tetanus. Of the 878 neonatal admissions, 8 (0.9%) had tetanus, while 22 (2.7%) of the total 803 post-neonatal admissions had tetanus. Neonatal tetanus admissions were significantly higher in 2006 compared to 2007 and 2008 (7 [2.3%] versus 1 [0.2%] [χ²= 7.50, P=0.01]). Of the eight mothers whose neonates had tetanus, seven did not receive tetanus toxoids in pregnancy and five (62.5%) were secondary school dropouts. Post-neonatal tetanus cases admitted in the years 2006, 2007, and 2008 were 4, 12, and 6 children respectively. Most of these 22 children did not receive tetanus toxoid immunization in their first year of life. None of the 22 children received booster doses of tetanus toxoids after their first years of life. Mothers at risk of their babies having tetanus, such as secondary school dropouts, must be identified antenatally and vaccinated with tetanus toxiod. Their babies should also receive good care post-delivery. Completion of routine tetanus toxoid schedule in the first year and booster doses in the post-neonatal age should be ensured.

NEONATAL TETANUS

Objective: To determine the prevalence of neonatal tetanus and frequency of factor leading to neonatal tetanus in patientsvisiting to Nishtar Hospital, Multan and comparing this data with the past since 2002. Duration: January 2009 to December 2011. StudyDesign: Descriptive study (cross-sectional). Results: In this study 64 patients with neonatal tetanus were observed over a period of 03 yearsfrom January 2009 to December 2011. The ages of babies were from 3-28 days. Mean age was 7.89 + 1.23 days the total number of cases rosesignificantly from 0.8% of total admission in 2002 to 1.71% in 2011. The commonest risk factor was delivery of baby conducted at home (100%).2nd commonest factor was non immunized mothers, 95% of mothers were non immunized against tetanus in pregnancy. 5% were eitherpartially immunized (received one dose of T.T) or showed vaccine failure despite 2 doses of immunization. In 80% of the cases there wereunskilled birth attendants who conducted deliveries. Among tools which were used to cut umbilical cord, blades were 45% knives were 30%,and scissors were 25%. Ghee application on cord was found to be present in 30% of the cases. While Surma applied on cord was 40%. As far assex is concerned, 45% cases were females and 55% cases were males. Majority (70%) of cases were of normal birth weight (&gt;2.5kg) while30% cases were of low birth weight (&lt;2.5kg). Inability to take feed/lock jaw (95%), and fits (96%) were the two most common symptoms. Otherless common symptoms were fever (70%) and generalized stiffness (85%). All the patients were born at home by spontaneous vaginal delivery.Conclusions: The number of neonatal tetanus cases are increasing progressively despite the claims of wide coverage of Tetanus ToxoidVaccination of female population by EPI. In our setup the factors which lead to Neonatal Tetanus are; non immunization of mothers duringpregnancy, home delivery, delivery by non skilled birth attendants, application of ghee/surma on umbilical cord and cutting of umbilical cord byunsterilized tools (scissors, kitchen knife, blade). If proper immunization antenatal care and hygienic delivery practices are followed and allthese factors are overcome, disease can be controlled and mortality can be reduced.

Tetanus following ocular wooden foreign body in incompletely vaccinated patient: a case report

Tetanus is now encountered rarely in clinical practice. There were no reported cases of tetanus due to ocular injuries in Sri Lanka. We report of a case of tetanus following an ocular injury which can be at least partly attributed to the disruption of immunization programmes due to political unrest. A 13 year-old Sri Lankan Tamil schoolgirl who had a splinter prick injury to left orbit was treated for intraorbital abscess and orbital cellulites. She developed clinical tetanus while on intravenous antibiotics. Following intensive care and ventilatory support she achieved an uncomplicated recovery. Ocular injury is a rare cause of tetanus worldwide. Adequate debridement of orbital soft tissue injuries can be difficult and demanding. Even in countries with high immunization coverage, tetanus can still occur due to lapses in immunization with conflict and war.

Fatal Tetanus Complicating an Untreated Mild Open Head Injury: A Case-Illustrated Review of Cephalic Tetanus

Tetanus is now a rare disease in the Western world, but not so in developing countries. Cephalic tetanus, unlike some other local forms of the disease, is likely to be fatal. We describe the clinical presentation of a case of fatal cephalic tetanus complicating an unattended open non-severe head injury with a review of the literature on the disease. Few cases of cephalic tetanus complicating head injury are found in the world literature, and many were diagnosed late. Cephalic tetanus from open or compound depressed skull fracture is even more rare. Our patient was a young male with an uncertain tetanus immunization history who sustained mild head injury (scalp laceration) and an unattended open depressed skull fracture in a motorcycle crash. He developed cephalic tetanus seven days later, presented late to our service, and died while being prepared for surgical debridement of his cranial wounds. At the immediate post-trauma medical contact, in an across-the-street "clinic," he had received suboptimal care for his head wound and inadequate tetanus prophylaxis. Cephalic tetanus is a rare form of the disease. Although it is preventable easily by well-established medical and surgical treatment paradigms, it continues to catch many clinicians disastrously unaware.