Cases Of Tetanus Research Articles

Neonatal and post-neonatal tetanus in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria: A 10-year review

Introduction: Tetanus, a disease that is easily preventable by vaccination continues to be a public health problem in Nigeria and other developing countries. This study reviewed the socio-demographic and clinical characteristics of children admitted with tetanus in NAUTH over a 10-year period. Materials and Methods: This is hospital based 10-year retrospective study. Medical records of all the children admitted with tetanus in both neonatal and post-neonatal wards of NAUTH between January 2003 and December 2012 were retrieved and studied. Data was analyzed using SPSS version 16 and a P value < 0.05 was considered significant. Results: There were 26 cases of neonatal and post-neonatal tetanus. Three out of the 26 were from the neonatal group, while remaining 23 were from the post-neonatal group. All the patients in the neonatal group were males aged 2-10 days, with a mean of 5.66 ± 4.04 days. Fourteen (60.9%) of the post-neonatal group were males while nine (39.1%) were females. Their age ranged from 2 to 16 years with a mean of 9.8 ± 4.5 years. Eleven (47.8%) were aged 6 years and above, 9 (39.1%) were aged 5-10 years. Majority of the patients 21 (91.3%) among the post-neonatal group and all the patients in the neonatal group were from the rural area. Twenty-one (91.3%) of all post-neonatal patients were either not immunized at all or were not sure of their immunization status during infancy. Lower limb injury was the most common source of infection accounting for 56.5% of cases in the post-neonatal group while infected cord accounted for 66.6% of cases in the neonatal group. Thirteen (56.5%) of all the post-neonatal cases were discharged home, nine (39.1%) died while one was discharged against medical advice. Mortality was very high at 100% in the neonatal group. There was no statistical association between portal of entry and outcome. Conclusion: Tetanus remains a significant contributor to childhood morbidity and mortality in Nigeria. There is strong need to strengthen the present immunization coverage especially in the rural communities of our country.

The Socio-Economic Challenges in Post Neonatal Tetanus

Background: Tetanus has remained a major public health problem worldwide although it is a vaccine preventable disease. It is a major contributor to under-five morbidity and mortality globally. Its effect is worse in developing countries such as Nigeria. Aims and Objectives: To highlight the socio-economic challenges in the management of Post neonatal tetanus at the University of Port Harcourt Teaching Hospital, Nigeria. Study Design: A Retrospective Descriptive study. Place of Study: University of Port Harcourt Teaching Hospital. Methods: Report of the socio-economic challenges in the management of three consecutive cases of Post neonatal tetanus at the University of Port Harcourt Teaching Hospital from February to April 2015 was studied. Data on socio-economic variables were retrieved from case notes of the patients. Results: These were three patients, two females and a male. Their ages were 11 years old of the two females and 14 years old of the male. None was immunized with tetanus toxoid in infancy. All three children survived. They were all from low socio-economic class, two mothers were petty traders while one was unemployed, only one mother had complete secondary education. One mother was immunized in pregnancy, while one mother was married. Conclusions: The socio-economic challenges of tetanus are immense, but could be prevented by simple measures such as education of the girl child, immunization of all school children, raising community awareness among other measures, and strengthening the school health program.

Prognosis of neonatal tetanus in the modern management era: an observational study in 107 Vietnamese infants

Most data regarding the prognosis in neonatal tetanus originate from regions where limited resources have historically impeded management. It is not known whether recent improvements in critical care facilities in many low- and middle-income countries have affected indicators of a poor prognosis in neonatal tetanus. We aimed to determine the factors associated with worse outcomes in a Vietnamese hospital with neonatal intensive care facilities. Data were collected from 107 cases of neonatal tetanus. Clinical features on admission were analyzed against mortality and a combined endpoint of 'death or prolonged hospital stay'. Multivariable analysis showed that only younger age (odds ratio (OR) for mortality 0.69, 95% confidence interval (CI) 0.48-0.98) and lower weight (OR for mortality 0.06, 95% CI 0.01-0.54) were significantly associated with both the combined endpoint and death. A shorter period of onset (OR 0.94, 95% CI 0.88-0.99), raised white cell count (OR 1.17, 95% CI 1.02-1.35), and time between first symptom and admission (OR 3.77, 95% CI 1.14-12.51) were also indicators of mortality. Risk factors for a poor outcome in neonatal tetanus in a setting with critical care facilities include younger age, lower weight, delay in admission, and leukocytosis.

Effectiveness and cost of quick diagnostic tests to determine tetanus immunity in patients with a wound in French emergency departments.

BackgroundTétanos Quick Stick® (TQS) is a test for tetanus immunity screening for wounded patients in emergency departments (EDs), but represents additional costs compared with a medical interview on vaccination history. The study objective was to assess the effectiveness and cost of the TQS in French EDs.MethodsWe performed a model-based analysis that simulates screening of tetanus immunity and risk of tetanus based on prophylaxis administration. Strategies compared were: i) diagnosis of tetanus immunity by “TQS”; ii) “Medical Interview” (current practice). The study population was 1,658,000 French adults seeking ED care for a wound in 2012. Model parameters were estimated based on French national surveillance data, and published literature. Outcome measures were number of tetanus cases, life years gained and costs (2012 €) from a societal perspective.ResultsUse of TQS had negligible impact on health outcomes (0.02 tetanus cases/year in France vs. 0.41 for “Medical Interview”), but resulted in a decrease in annual costs of €2,203,000 (-42%). Base case and sub-group analysis showed that with the same effectiveness, the average cost per patient was: €13 with “Medical Interview” vs. €11.7 with TQS for the overall cohort; €28.9 with “Medical Interview” vs. €21 with “TQS” for tetanus-prone wounds; €15 with “Medical Interview” vs. €14.1 with “TQS” for patients aged ≥65 years; and €6.2 with “Medical Interview” vs. €7.8 with “TQS” for non-tetanus-prone wounds.ConclusionsUse of TQS is as effective and less costly than “Medical Interview” when applied in ED to wounded patients with tetanus-prone wounds or aged ≥65 years. However, it is more expensive in patients with non-tetanus-prone wounds.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0603-3) contains supplementary material, which is available to authorized users.

A systematic review of tetanus in individuals with previous tetanus toxoid immunization.

To assess the characteristics of tetanus in previously immunized individuals. A systematic literature search was undertaken using Ovid MEDLINE(R) and EMBASE databases for articles published between 1946 and September 3, 2013. The search strategy was developed using MESH terms for "tetanus", "immunization" and "vaccination". Inclusion criteria were articles in English or French that described at least one case of tetanus, immunization history and/or the results of anti-tetanus antibodies. Articles were reviewed for relevant references. 51 unique articles published from1946-2013 were included in the review. The articles described 359 cases of clinical tetanus in individuals with prior receipt of one or more doses of tetanus toxoid vaccine and/or levels of tetanus antibody titres generally considered protective. Of the 210 cases that reported patient status at discharge, 180 (85.7%) survived with only three cases reporting residual deficits. Tetanus spores are ubiquitous and this report clearly documents that tetanus cases can occur in individuals previously immunized with tetanus toxoid vaccine. Clinicians should not rule out tetanus when clinical symptoms suggest it, regardless of the vaccination history. When treated, the prognosis for tetanus is good. Further research is needed to assess the incidence of tetanus in partially- and fully-immunized populations and determine whether this is due to waning immunity of vaccine failure.

Neonatal Tetanus in Federal Medical Center, Ido-Ekiti, South West Nigeria in a five year Retrospective Study

Introduction: Neonatal Tetanus, though a preventable disease through simple measures, still remains a cause of neonatal mortality in Nigeria. Methodology: This was a review of all cases of neonatal tetanus in Federal Medical Centre, Ido- Ekiti between January 2007 and December 2012. It was performed using patients’ case notes and the diagnosis of tetanus was clinical in all cases. Results: There were six patients admitted during the five- year period. The mean age was 7.7 days. There were 5 females (83.3%) and 1 male (16.7%). The average number of days spent on admission in the hospital was 15.2 days with the minimum being 1 day and the maximum 33 days. The mean age at which the first spasm occurred was at 7.5 days. Only 1 (16.7%) was delivered in a health facility, 67.7% had fomentation done on their umbilical cords, 33.3% had septic umbilical cords only 1 (16.7%) was delivered in a health facility. Three of the patients were delivered in religious centres called mission homes. Five (83.3%) of the mothers were teenagers and unmarried, 2 (33.3%) had partial antenatal care, 4 (67.7%) had no antenatal care while none of them received up to 2 doses of tetanus toxoid vaccine. The case fatality rate was 50%. Conclusion: Teenage motherhood, poor antenatal care, inadequate immunization of mothers with tetanus toxoid vaccine and poor umbilical cord care are identified as risk factors for neonatal tetanus. It should be ensured that gender equality campaigns are strengthened, traditional birth attendants trained in issues of maternal and child health, and immunization campaigns for mothers and neonates improved.

Feline physiotherapy: part 2

Feline physiotherapy can be complex due to the range of conditions that feline patients may present with. Fractures are one of the most common orthopaedic conditions; a more complex condition is tetanus where the animal may present with a limb issue that is a secondary effect of an infection. Fractures can be complex at times due to the nature of how the fracture has occurred. This article explores the skills used by a physiotherapist to assist in fracture healing, pain reduction, range of motion of all limbs, muscle development and return of functional independence to the animal. To assist in doing this, a case study is included. To show the adaptation a physiotherapist is required to use with clinical decision-making, a second case study presents a complex case of tetanus, and the cat's road to recovery.

NEONATAL TETANUS IN MASHHAD (NORTH EAST OF IRAN) OVER A 17 YEAR PERIOD

Introduction: Neonatal tetanus is a highly fatal disease that can be prevented by immunization and improvement in obstetric practices. The aim of the present study was to assess the characteristics of cases of neonatal tetanus in two large tertiary hospitals (Ghaem and Imam Reza hospitals) of Mashhad -North East of Iran between 1984- 2001. Methods: all cases whose epidemiological and clinical characteristics were compatible with neonatal tetanus and were admitted into the NICU’s of these two hospitals between July 1984 to June 2001 were analyzed from their hospital records. Results: A total of 60 patients had been hospitalized with the diagnosis of neonatal tetanus during the study period. All of them were delivered out of hospital by untrained birth attendants and none of the mothers had been immunized against tetanus during pregnancy. 74% of infants died. Age younger than 7 days at the time of admission was associated with a high mortality rate. Conclusion: Although neonatal tetanus is a highly fatal disease yet. It can be prevented with appropriate health care practices and tetanus immunization of pregnant women

TETANUS – AN EVALUATION OF EPIDEMIOLOGIC DATA IN BRAZIL

Tetanus is an infectious preventable disease caused by Clostridium tetani that still occurs in large numbers in Brazil and has high mortality rates. Epidemiological data on morbidity and mortality of accidental and neonatal tetanus in Brazil from 2008 to 2011 were collected from the System of Information of Notifiable Diseases available on line. There were 1299 cases of accidental tetanus cases with 419 (32%) deaths. Men aged 20 to 59 years were most affected. High numbers of accidental tetanus areprobably related to more exposure to risk factors. The lack of specialcampaigns for tetanus revaccinations every ten years is another important factor. The fewer number of cases of neonatal tetanus (23) is related to the success of governmental vaccination program targeted to this age group. Despite low numbers, death rate is high, 65% among neonatal cases.

Epidemiology of tetanus in Jamaica, 1993–2010

Although tetanus is still endemic in Jamaica, the epidemiologic profile has not been evaluated. Admission registers at the main tertiary referral hospital were accessed to identify all patients diagnosed with tetanus from 1 January 1993 to 1 December 2010. There were 26 cases of tetanus (annual incidence of 0.57 cases per 1,000,000 population). Tetanus was more common in men (5.2:1) at a mean age of 59 ± 18.1 years. Persons in high-risk occupations (farmers, gardeners and construction workers) accounted for 52% of cases. Tetanus remains endemic in Jamaica, occurring more commonly in elderly men. Doctors should be educated about the importance of a high index of suspicion, an immunisation history and promoting booster shots in high-risk groups.

Validation on the elimination of neonatal tetanus programs through Lot Quality Assurance-Cluster Sample Survey in China

Field surveys were performed under WHO recommended validation procedures, using the Lot Quality Assurance-Cluster Sample(LQA-CS)method to validate the elimination status regarding neonatal tetanus in China. LQA-CS surveys were conducted in two areas under the highest risk of neonatal tetanus-Jiangmen prefecture in Guangdong and Hechi in Guangxi. Random sampling method was conducted on 96 survey clusters in each prefecture with 12 eligible live births(live birth born one year before the survey)for each cluster, by trained investigators. There were 1 153 eligible live births from 23 465 families surveyed in Jiangmen and 1 152 eligible live births from 21 623 families being studied in Hechi. All the indices on quality control were strictly followed. There was no neonatal tetanus case which met the criteria of neonatal elimination found in either of the areas. Data showed that neonatal tetanus had been eliminated in both Jiangmen and Hechi cities. Since both Jiangmen and Hechi were cities having the highest-risk in China, it was most likely that neonatal tetanus had also been eliminated in other prefectures at lower risk. Elimination programs on MNT was therefore considered validate in China when the study was carried out. However, the achievements needed to be maintained.

明らかな外傷を認めなかった破傷風の2例

Tetanus develops following inoculation of damaged human tissue with Clostridium tetani which transforms into a vegetative rod-shaped bacterium and produces the tetanospasmin. Usually we make a diagnosis of tetanus based on typical symptoms and history of trauma. But, when patients have no noticeable history of trauma, we have to diagnose tetanus on the basis of the clinical course and symptoms. We report herein on two cases of tetanus without a clear history of trauma. The first patient visited us with the chief complaints of pain in the neck and shoulder, and difficulty in opening the mouth. Based on these symptoms, we diagnosed tetani in the first stage and we started treatment, consisting mainly of human anti-tetanus immunoglobulin on the first day. The second patient also had typical symptoms of tetanus. However, he rejected the use of human anti-tetanus immunoglobulin on the first day. Because his symptoms worsened on the 2nd day, we insisted that he used it. On the 5th hospital day he developed partial opisthotonus of neck. However he recovered without tracheotomy or intratracheal intubation.

Jacksonian March Revisited? A Case of Local Tetanus with Generalized Spread

A 41 year-old male with no prior history of seizure disorder presented to the emergency department complaining of four “seizure” episodes which began a few hours prior to arrival. Within minutes of triage, one of the episodes was witnessed and inconsistencies with seizure activity including an absence of clonus, consciousness throughout the event and lack of a post-ictal state were noted. Further examination led to discovery of an untreated laceration on the patient’s left hand which had been sustained 1-week prior on a rusted metal fence. More extensive history also revealed recurrent episodes of muscle spasm in his left hand which preceding the generalized attacks. A presumptive diagnosis of wound tetanus with secondary, generalized manifestation was made and the patient was treated with local and intramuscular tetanus immunoglobulin as well as intravenous metronidazole and diazepam. The patient was admitted to the Neurologic Intensive Care Unit and, after 1 week of therapy, made a full recovery. While rare in the developed world, acute tetanus remains a disease associated with a significant morbidity and mortality (even in the United States). The high rate of lapsed adult immunization as well as the prevalence of insufficient effective antibodies even in those sufficiently immunized mandates vigilance on the part of the emergency physicians-particularly in patients with atypical neurological presentations.

Tetanus trismus in A 2 year old child: Case report

Tetanus is still a major cause of mortality and morbidity in developing countries. It occurs in children mainly in the unimmunized, due to parental ignorance and objection to vaccination. This potentially fatal disease caused by a neurotoxin, tetanospasmin released from wounds infected with Clostridium tetani, an anaerobic gram–positive bacillus. As tetanus becomes less common, cases are likely to be misdiagnosed or go unrecognized. In this case report, we present a case of tetanus in a partially immunized 2 year old girl who presented with trismus. She was treated with the recent recommendations and adequate supportive care. Detection of tetanus at a very early stage can favor lifesaving interventions. Trismus, infected wound and partially immunized/unimmunized status of a child were the key features leading to the prompt diagnosis and early treatment.

Tetanus in Italy 2001–2010: A continuing threat in older adults

Despite being a completely preventable disease, tetanus cases continue to occur in Italy and notification and hospitalization rates have been reported to be higher with respect to European and other industrialized countries. We examined statutory notification, hospitalization, mortality and seroprevalence data to describe tetanus epidemiology in Italy from 2001 to 2010. A total of 594 tetanus cases were notified, with an average annual incidence of 1.0/1,000,000 population. Most cases were unvaccinated or incompletely vaccinated. Eighty percent of cases occurred in subjects aged >64 years and a higher proportion of females with respect to males were reported in this age group. The annual number of hospital admissions was 1.4–1.7 times greater than the number of notifications in the same year. The mean annual number of reported deaths was 21. Seroprevalence data show progressively higher susceptibility levels with increasing age. Over 50% of persons aged 45–64 years and over two thirds of subjects ≥65 years had tetanus antibody levels <0.01IU/ml. Results show that tetanus is a continuing problem in Italy and, as in other countries, most cases occur in older adults, especially elderly women. The observed differences in notification and hospitalization rates suggest underreporting by physicians. In recent years, Italy has accounted for most cases reported annually in the European Union (EU) but different case definitions are used. In Italy, a confirmed case is one that meets the clinical case definition while the EU case definition classifies confirmed cases as those with laboratory confirmation of disease. The incidence of clinical tetanus in Italy is ten-fold higher than in other industrialized countries, like Australia and Canada, likely due to higher susceptibility levels in Italy. In view of the low prevalence of tetanus antibodies in adults ≥45 years, strategies to improve vaccine uptake in this population group need to be implemented.

Tetanus is still a deadly disease: a report of six tetanus cases and reminder of our knowledge

We analysed the data in the medical records of six patients admitted for tetanus in the intensive care unit (ICU) of the anaesthesia department in the Medical Faculty of Ataturk University from 1 January 2010 to 31 December 2012. All patients received the generalized form of treatment for tetanus in the ICU. The average age of the patients was 65.33 ± 13.45 years. Treatment modalities were administered to the patients in accordance with the literature. Four patients died despite all therapeutic interventions and two patients were discharged uneventfully. All those who died had chronic disease and infected wounds on their head, but only one patient had an infected wound on his leg. The surviving patients had no chronic illnesses but did have injuries on their legs. The presence of chronic disease increases tetanus-related mortality. More information about the disease must be made available in order to make it preventable with regular vaccinations.

Vaccine-Preventable Disease Among Homeschooled Children: Two Cases of Tetanus in Oklahoma

Homeschooled children represent an increasing proportion of school-aged children in the United States. Immunization rates among homeschooled children are largely unknown because they are usually not subject to state-based school-entry vaccination requirements. Geographic foci of underimmunized children can increase the risk for outbreaks of vaccine-preventable diseases. In 2012, 2 cases of tetanus were reported in Oklahoma; both cases involved homeschooled children without documentation of diphtheria-tetanus-acellular pertussis vaccination. We describe the characteristics of both patients and outline innovative outreach measures with the potential to increase vaccination access and coverage among homeschooled children.

Neonatal severe bacterial infection impairment estimates in South Asia, sub-Saharan Africa, and Latin America for 2010

Background:Survivors of neonatal infections are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified and yet important for program priority setting. Systematic reviews and meta-analyses were undertaken and applied in a three-step compartmental model to estimate NDI cases after severe neonatal bacterial infection in South Asia, sub-Saharan Africa, and Latin America in neonates of >32 wk gestation (or >1,500 g).Methods:We estimated cases of sepsis, meningitis, pneumonia, or no severe bacterial infection from among estimated cases of possible severe bacterial infection ((pSBI) step 1). We applied respective case fatality risks ((CFRs) step 2) and the NDI risk among survivors (step 3). For neonatal tetanus, incidence estimates were based on the estimated deaths, CFRs, and risk of subsequent NDI.Results:For 2010, we estimated 1.7 million (uncertainty range: 1.1–2.4 million) cases of neonatal sepsis, 200,000 (21,000–350,000) cases of meningitis, 510,000 cases (150,000–930,000) of pneumonia, and 79,000 cases (70,000–930,000) of tetanus in neonates >32 wk gestation (or >1,500 g). Among the survivors, we estimated moderate to severe NDI after neonatal meningitis in 23% (95% confidence interval: 19–26%) of survivors, 18,000 (2,700–35,000) cases, and after neonatal tetanus in 16% (6–27%), 4,700 cases (1,700–8,900).Conclusion:Data are lacking for impairment after neonatal sepsis and pneumonia, especially among those of >32 wk gestation. Improved recognition and treatment of pSBI will reduce neonatal mortality. Lack of follow-up data for survivors of severe bacterial infections, particularly sepsis, was striking. Given the high incidence of sepsis, even minor NDI would be of major public health importance. Prevention of neonatal infection, improved case management, and support for children with NDI are all important strategies, currently receiving limited policy attention.

TETANUS: A DIAGNOSTIC CHALLENGE IN THE WESTERN WORLD

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.

Vitamin C for preventing and treating tetanus

Tetanus is a severe disease that can be prevented by vaccination. In developing countries vaccination coverage is not always high. Cases still occur also in developed countries, particularly in elderly people owing to their reduced immuno protection. There are about 1 million tetanus cases per year globally. In animal studies, vitamin C has protected against various infections and bacterial toxins. In a study with rats, vitamin C protected against the purified tetanus toxin. To assess the prophylactic and therapeutic effect of vitamin C on tetanus. In May 2013 we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations ); and Ovid EMBASE for this third update. Controlled trials of vitamin C as a prevention or treatment for tetanus, whether or not these were placebo controlled, in any language, published or unpublished. Two review authors independently made inclusion decisions. Both review authors independently extracted data from trial reports and assessed methodological quality. Since one of the cells in a 2 × 2 table had no events, we calculated the odds ratio (OR) and its 95% confidence interval (CI) for case fatality rate by using the Peto-method. Another of the 2 × 2 tables had no empty cells and the inverse-variance method was used to calculate its risk ratio (RR) estimate and 95% CI. We also used the Fisher's exact test to calculate the exact 95% CI for the OR of the 2 × 2 table with the empty cell. One single trial was eligible for inclusion. This non-randomised, unblinded, controlled trial undertaken in Bangladesh involved 117 tetanus patients. Vitamin C at a dosage of 1 g/day was administered intravenously alongside conventional treatment. At recruitment, the participants were stratified into two age groups and the results were reported by age. There was a significant difference in the vitamin C effect between the two age groups (P = 0.01). In the tetanus patients aged 1 to 12 years (n = 62), vitamin C treatment was associated with a 100% reduction in case fatality rate (95% CI from -100% to -94%). In patients aged 13 to 30 years (n = 55), vitamin C treatment was associated with a 45% reduction in case fatality rate (95% CI from -69% to -5%). A single, non-randomised, poorly reported trial of vitamin C as a treatment for tetanus suggests a considerable reduction in mortality. However, concerns about trial quality mean that this result must be interpreted with caution and vitamin C cannot be recommended as a treatment for tetanus on the basis of this evidence. New trials should be carried out to examine the effect of vitamin C on tetanus treatment.