Cases Of Tetanus Research Articles

Tendência temporal do tétano acidental no período de 1981 a 2004 em Pernambuco com avaliação do impacto da assistência em unidade de terapia intensiva sobre a letalidade

Despite reductions in the incidence of accidental tetanus cases in Brazil, there has not been any significant decrease in its mortality. In this case series, the mortality rates before and after establishing standard management practices for tetanus patients in the intensive care unit at the Oswaldo Cruz University Hospital are compared over the period from 1981 to 2004. Over these 24 years, 1.971 patients were admitted. Before establishing the intensive care unit management, the mortality rate was 35%. The Intensive care unit for attending to tetanus patients was established in 1997. From 1998 to 2004, the mortality rate fell to 12.6%: OR = 0.27 (95% CI = 0.18-0.39); p < 0.001. This trend was seen in all age groups and both sexes. The centralization of attendance for these patients into a single specialized service with early treatment in an intensive care unit has therefore been decisive in reducing the mortality rate. This service can count on the medical team's vast experience of tetanus management, with better treatment of symptoms that forestalls the serious complications from this disease.

Did we forget tetanus?

Currently, in our country (Republic of Serbia) tetanus is a rarely occurring disease, mainly affecting people older than 65 years of age. A small number of reported cases is mainly due to appropriate immunization. Therefore, each case of tetanus may be considered as failure of health care system to provide adequate immunization. A 71-year-old woman was injured in her garden. She sustained laceration in the left coccygeal region. The next day the wound was treated by a surgeon, but tetanus postexposure prophylaxis was not administrated. On the fifth day following the incident, the symptoms and signs of tetanus became apparent, and the patient died two days later. Postmortem examination revealed the wound that was not adequately treated, since there was a foreign body and a dressing inserted in the wound. Signs of acute (aerobic) infection were also present. Tetanus is a severe, potentially lethal disease that is absolutely preventable. Mistakes in immunization and surgical treatment of the wound can be considered as medical malpractice.

顔面神経麻痺を初発症状とした高齢者頭部破傷風の1例

顔面神経麻痺を初発症状とした高齢者頭部破傷風の1例

Cephalic Tetanus from Penetrating Orbital Wound

Tetanus is a neurologic disorder caused by tetanospasmin, a protein toxin elaborated by Clostridium tetani. Cephalic tetanus is a localized form of the disease causing trismus and dysfunction of cranial nerves. We report the case of a man who presented with facial trauma, complete ophthalmoplegia, exophthalmos, areactive mydriasis, and periorbital hematoma. An orbital CT revealed air bubbles in the right orbital apex. The patient was given a tetanus toxoid booster and antibiotherapy. After extraction of a wooden foreign body, the patient developed right facial nerve palsy, disorders of swallowing, contralateral III cranial nerve palsy, and trismus. Only one case of cephalic tetanus from penetrating orbital wound has been reported in literature 20 years ago. When a patient presents with an orbital wound with ophthalmoplegia and signs of anaerobic infection, cephalic tetanus should be ruled out.

Titration of high dose sedation is effective in severe tetanus: a case report

IntroductionTetanus is a fatal infectious disease. It could cause typical signs like pain, headache, stiffness, and spasms of facial muscles as well as trunk and skeletal muscles. The symptoms are risus sardonicus, trismus and opisthotonus. How to control the spasticity and rigidity of muscles is still a problem. Our object is to raise the feasibility of titration of high dose sedatives in the management of severe tetanus.Case presentationA 37-year-old woman was sustained a 2 cm wound in the right anterior part of chest. Then she developed progressive risus sardonicus, trismus and opisthotonus, elevated liver enzymes, creatine kinase, lactic acid and myoglobin. The patient was treated with continuous infusion of propofol (50-100 mg/h, 22 days) and midazolam (5-20 mg/h, 37 days) for sedation, vecuronium (1-6 mg/h, 25 days) for muscle relaxation. The symptoms of tetanus were controlled, and there were no side-effects appeared.ConclusionWe report one case of severe tetanus. In this case, several types of sedative were administrated and most of them were high doses. The patient recovered while no complications remained. This case report indicated that combination and high dose of sedation for severe tetanus were feasible. We recommend this treatment as the guidance of similar patients.

Tetanus in a Breast Cancer Patient with Adjuvant Chemotherapy

Tetanus is a neurologic disorder caused by a tetanoplasmin which is a neurotoxin elaborated by Clostridium tetani. It is characterized by increased muscle tone and spasm. Since a nationwide childhood vaccination program, tetanus has become a rare disease in Korea. Because many physicians have little experience, misdiagnosis or therapeutic delay may result in unexpected consequences. Although it has high mortality rate on attack, early detection, proper immunization and supportive care can increase survival rate. We report a case of tetanus due to puncture injury by splinter in a 69-year-old woman who has been treated with adjuvant chemotherapy of breast cancer. She was admitted to emergency room with difficulty of opening mouth for 3 days. After two days, we detected that the patient suddenly fell on her back with muscle spasm, so we diagnosed her with tetanus. She was given human tetanus immunoglobulin intramuscularly and supportive care. Forty days after admission, she was discharged without complications.

Tétanos néonatal et de la femme en âge de procréer à la clinique des maladies infectieuses de Dakar

Objectives This study had for aim to describe and compare the epidemiological, clinical and outcome features of tetanus in neonates (NT) and women of child bearing age (WCBAT) in Dakar. Patients and method This retrospective study was made on NT (3 to 28 days of age) and WCBAT (15 to 49 years of age) patient files, admitted in the Fann University Hospital Infectious Diseases Clinic from 2000 to 2007. Results One hundred and thirty-eight WCBAT (11.9%) and 103 NT (8.9%), for a total of 1156 cases of tetanus were admitted. A decrease of the annual rate of these populations was noted over this 8 year period. The majority (59.4%) of WCBAT was between 15 and 25 years of age and the mean age of NT was 9.3 days. Most of the patients in both groups came from suburban areas (78%). The tetanus immunization status was not updated for 92% of WCBAT. The most frequent portals of entry were cutaneous wounds for WCBAT (77.4%) and umbilical stumps for NT (85.4%). On admission, 64% of NT presented with severe tetanus (stage III on the Mollaret scale) compared to 11.6% for WCBAT. The death rate was significantly higher in NT (48.5%) than in WCBAT (26.8%); p = 0.0005. Conclusion To eliminate neonatal tetanus, the prognosis of which is worse in Dakar, an intensification of the large vaccination program is needed with supplementary vaccination campaigns including women of child bearing age in areas of risk.

Étude de l’immunité antitétanique chez les femmes enceintes durant l’année 2007 au service de maternité Souissi de Rabat

Summary The prevention against tetanus has considerably improved in the world. The eradication of neonatal tetanus is the one of the main aim of the WHO program. Even though the administration of tetanus toxoid has resulted in a decrease of the cases of tetanus in major industrialized countries, the situation in many developing countries is still alarming. In order to assess the impact of antitetanus vaccination, a prospective study was conducted from January 2007 to April 2007 in the emergency department of motherhood of Souissi for the assessment of the immune status of term parturient. We used immunochromatographic test for the detection of antitetanic antibodies. The results showed that 62% of cases (99 women) were immunized for tetanus, and 38% of the cases (61 women) were not. The strengthening of the immune status by the administration of booster doses of tetanus vaccine to teenagers and women of childbearing potential will enable the eradication of tetanus.

Tetanus in Equids: A Review of 76 Cases

Data on the clinical examination and treatment of 76 tetanus cases in equids was reviewed, aiming to verify factors that may assist veterinarians in establishing a prognosis for this disease. Overall mortality was 76.3%. Treatment was provided to 61 animals. Of those, 18 (29.5%) survived. Data analysis led to identification of the following indicators for fair to good prognosis: greater than 5 days' timespan between onset of signs of the disease and initial assistance (7 of 13 animals survived, 53.9%) and greater than 7 days of hospitalization (all of 17 animals survived, 100%). Conversely, indicators of poor prognosis included presence of dysphagia or aphagia at first examination (52 of 60 animals died, 86.7%), decubitus (all of 20 animals died, 100%), and hoof sole perforating lesions by nails (all of 8 animals died, 100%). Based on the high mortality rate of this disease, the importance of prophylaxis is reinforced.

Neonatal tetanus in Turkey; what has changed in the last decade?

BackgroundNeonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir.MethodsThe data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed.ResultsA total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate.ConclusionAlthough the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.

Autonomic nervous system instability, tetanic necrosis of the heart and myocardial TNFα expression in a tetanus fatal case

The cardiovascular manifestations of tetanus consist of disturbances of heart rate and rhythm, blood pressure instability, arrhythmias, myocardial dysfunction and sympathetic overactivity. It was suggested that either a sudden loss of catecholamine stimulation or myocardial damage caused by the direct action of the tetanus toxin, could be involved in cardiac dysfunction described in tetanus. However, histologic evidence of myocardial necrosis in tetanus was demonstrated in few cases. We report a fatal case of tetanus in which we investigated the cardiac morphology and the expression of TNFα to elucidate the heart involvement in this case. Since it is well known that myocardial damage caused by catecholamines can induce synthesis of cytokines by myocytes, cytokines, specifically those with known cardiodepressant properties such as TNF-α, could be an alternative mechanism involved in cardiac dysfunction in the setting of tetanus.

Tetanus antibody protection among HIV-infected US-born patients and immigrants.

IntroductionPublic health initiatives to immunize children and adults have effectively reduced the number of tetanus cases in the USA. However, in the Third National Health and Nutrition Examination Survey (NHANES III), immigrants from Mexico had a 67% nonprotective anti-tetanus antibody (ATA) level. Less work has been conducted among other vulnerable populations such as human immunodeficiency virus (HIV)-infected patients. The objective of this study was to measure ATA levels among the HIV immigrant population compared with US-born HIV-infected patients.MethodsA convenience sample of 158 HIV-infected individuals was recruited to determine the levels of ATA. A nonprotective level of ATA was defined as below 0.15 IU/ml.ResultsAmong the HIV-infected patients, 72% (114/158) were born in the USA. A total of 17% (27/158) lacked protective levels of ATA. A total of 6.1% (7/114) of those born in the USA lacked protection, compared to 45% (20/44) born outside the USA (p < 0.0001).ConclusionThe results illustrate that the country of birth is an important predictor of ATA protection, even among HIV-infected patients.

Evaluation for Tetanus Antibodies in Korean-Americans Living in the New York Area: A Pilot Study

Public health initiatives to immunize children and adults have effectively reduced the number of tetanus cases in the USA. However, in the third National Health and Nutrition Examination Survey (NHANES III), immigrants from Mexico had a 67% non-protective anti-tetanus antibody (ATA) level. Less work has been conducted among other immigrant populations to determine the extent of this observation. Objective To measure ATA levels among the Korean-American immigrant population. Methods A convenience sample of 50 Korean Americans born outside the USA was recruited to determine the levels of ATA. A non-protective level of ATA was defined as below 0.15 IU/ml. Results The mean age was 59.5 years and 82% were female. There were 43/50 (86% (95% confidence limits 76, 96)) patients with a non-protective ATA level. Those between the ages of 50-59 years (94% were seronegative) and 60 years-highest age (92% were seronegative) were among the least likely to be protected. Neither gender nor a self-reported history of past tetanus immunization or military service predicted protection to tetanus. Discussion In this pilot study we found that 86% of Korean immigrants did not have protective ATA levels, with patients in the 50-59 year age range as unlikely to be protected as the older subjects. Patient reported history was unreliable in determining whether an individual had protective levels. Conclusion The vast majority of sampled Korean American immigrants lack protective ATA levels and are in need of immunization. Additional study is needed to determine the risk of other immigrant groups to tetanus.

Maternal Tetanus at the University College Hospital in Ibadan Nigeria: A 15-Year Retrospective Analysis

Objective To determine the characteristics of women with maternal tetanus, pattern of presentation and outcome of management. Methods A total of 19 women were managed with maternal tetanus between 1990 and 2005 from the University College Hospital in Ibadan Nigeria. A retrospective study was performed. The medical records of all women managed as a case of maternal tetanus were retrieved from the central record department of the hospital. The pattern of presentation, characteristics of women, the duration of hospital admission, tetanus toxoid immunization, and outcome of care were measured. Results The records of 18 women managed were analyzed. The mean age at presentation was 25.2 ± 5.3 years. The patients were mostly single, nulliparous and had primary school education. The maternal tetanus cases seen mainly complicated induced abortion while 5 and 2 other cases were due to childbirth complication and leg wound respectively. The portal of entry of the remaining 3 cases could not be ascertained. None of the patient managed had complete immunization schedule. The average duration of admission was 11.2 ± 6.7 d. Five women had intensive care with 3 of them requiring ventilatory support. The case fatality rate was 66.7%. The only factor that significantly improved survival was presence of generalized spasm at presentation (P=0.006) Conclusion The occurrence of maternal tetanus is a reflection of low quality of health care delivery and lack or inefficient routine immunization coverage in any community.

Localized Tetanus in Lagos, Nigeria

Localized tetanus is rare in Nigerians, with an incidence of 1.8% in a previous report. We report six cases of localized tetanus out of total of 95 cases of tetanus seen at the Lagos University Teaching Hospital over a period of 3 years. All cases were seen and managed by one or both of the authors, the policy in the hospital being that all cases of tetanus in adolescents and adults are referred to and managed by the Neurology unit. The frequency of localized tetanus was 6.3% of all cases of tetanus. Two of the cases had partial immunization. The contribution of partial immunization to causation needs further study. The commonest site of involvement was the lower limb (in five of the cases). No case of cephalic tetanus was seen. Recognition of the existence of localized tetanus is important to ensure correct diagnosis and treatment.NQJHM Vol. 14 (3&4) 2004: pp. 217-219

Characteristics Of Tetanus Cases Seen Over A Ten Year Period In A Tertiary Health Facility In Benin City, Nigeria

Tetanus remains a great public health problem in developing sub-Saharan Africa and it is associated with high mortality. We evaluated the epidemiological characteristics and clinical profiles of tetanus cases seen in a tertiary health facility in Benin City, Nigeria between 1990 and 2000. All consecutive patients admitted in the Medical wards of the University Teaching Hospital, Benin City between 1990 and 2000 were recruited. It is a prospective study which analyzed all patients with tetanus within the study period. A total of 66 cases were admitted into the medical wards during this period, with a female preponderance (F/M = 1.4:1). The highest number of cases was in the age group 16-29 years. Majority was seen during the wet season and the commonest site of injuring was the lower limb. Injury from stepping on wood and cuts from cutlass accounted for most of the cases. The mean incubation period was 13.4+13.1 days and the mean onset time was 5.9+8.0 days. The mean duration of hospital stay was 21.8+13.3 days. The mortality rate was 27.4%. Severity of spasms, duration of hospital stay, incubation period, onset time, immunization status, socio-economic background and the type of initial care received affected mortality. Early diagnosis and emphasis on preventive strategies remain the bedrock of reduction of mortality in Sub-Saharan Africa. Keywords : Tetanus, Nigeria, sub-Saharan Africa, characteristics, mortality. Journal of Mining and Geology Vol. 5 (1&2) 2006: pp. 44-51

Intramuscular injections of quinine and tetanus at the Centre Hospitalier Universitaire of Brazzaville, Congo

Intramuscular injections are known for their iatrogenic complications. IM quinine is a routine procedure in Congo for drug resistant malaria management. In this short note, the authors evaluate tetanus relative to intramuscular injection of quinine among the cases of tetanus treated in the infectious diseases unit of "Centre Hospitalier Universitaire of Brazzaville". This study was conducted from January to December 2005 regarding 18 cases of tetanus among which 5 infected after intramuscular injection of quinine. Their level of severity was significantly higher with a high mortality rate (post intramuscular: 4 deaths out of 5; other cases: 3 deaths out of 13). Tetanus was generalized in 17 cases. A significant difference between the intramuscular and the non-intramuscular injection was observed regarding the pulse (p < 0.05), the level of severity (p < 0.005) and deaths (p < 0.005). Awareness-raising campaigns with populations and medical staff about the risks of intramuscular injections as well as vaccination schedule should be regularly implemented.

Generalized tetanus with otitic portal of entry after using intra-auricular traditional remedies in a 2 old child

A case of tetanus with uncommon way of contamination was found in the paediatric department of the Yopougon teaching hospital in Côte d'Ivoire. A two-year-old child, without vaccination against tetanus and suffering from a chronic otitis presented a generalized tetanus, after the use of traditional local remedies in his ear. Through this observation, the authors want to make population aware of the detrimental effects of traditional local auricular remedies and want to advise all physicians to make a serotherapy and/or a vaccination against tetanus to all children with chronic otitis in our area.

Epidemiology of Chronic suppurative otitis media in Nigerian children

Chronic suppurative otitis media is an important cause of morbidity and mortality in the tropics and is characterized by persistent or recurrent otorrhoea. This prospective study was carried out with the aim of determining the incidence and the associated epidemiological factors of the disease in this environment. The study was conducted at the general paediatric outpatient clinic over a one year period (2004-2005) amongst children aged 1month to 14 years with persistent ear discharge of 6 weeks or more. Fifty-three subjects were included in this study giving a hospital prevalence of 0.51%. The disease was most prevalent in children whose ages were six years and below. Higher proportions of subject were associated with low socioeconomic status, poor housing, indoor pollution, unilateral ear disease and central perforation of the ear drum. Complication rate was 5.7% with one case of otogenic tetanus and two cases of subperiosteal mastoid abscess. Mortality rate was 0%. In conclusion chronic suppurative otitis media is still an important cause of morbidity in children in the tropics. Further studies are required to confirm the various factors highlighted in this study as associated risk factors for the disease in this environment.

Tetanus caused by Ulcerated Giant Phyllodes Tumor

Tetanus is a rare infectious disease in western countries, however, it remains one of the most common and fatal disease in developing countries. Several diseases can mimic tetanus, and the diagnostic procedure is important to distinguish tetanus from other disease. Here we report the case of tetanus caused by ulcerated phyllodes tumor. This case suggests that the diagnosis and introduction of effective therapy should not be delayed, even if wound on the extremity surface is not clear.