Tetanus- disease patterns observed in a specialist unit

Muhammad Abbas Raza; Muhammad Hasan Abbas

Author(s)

Muhammad Abbas Raza North Medical Ward, Mayo Hospital, Lahore, Pakistan

Muhammad Hasan Abbas South Surgical Ward, Mayo Hospital, Lahore, Pakistan

Abstract

An observational retrospective study was conducted in a specialized tetanus ward in a tertiary care hospital over one year period to see if tetanus has changed its face in our set up in modern times and to redefine prognostic factors.The result showed that tetanus remained a disease of younger age group (mean age 35.02 ± 16.02). Overall mortality was 29.9% affecting, men in majority (69.2%). Most of the patients were poor (90.7%), belonged to rural background (65.4%) and were manual workers. Illegal abortion remained an important etiology (33% of female patients). Bad prognostic factors included older age > 60 years (76.9% mortality Odds Ratio [OR] 7.81, 95% Confidence Interval [Cl] 2.30 to 26.51), major fits (84.5% mortality, OR 5.27,95% Cl 2.74 to10.12), short time from lock jaw to first fit (especially less than 2 days), an initial pulse rate > 110/m (50% mortality, OR 2.34, 95% Cl 1.75 to 3.13), pulse rate variation of more than 40/minute in a short period (63.2% mortality, OR 4.02, 95% Cl 1.74 to 9.26), profuse sweating (61.2% mortality, OR 3.70,95% Cl 2.84 to 5.51), aspiration pneumonia (85.7% mortality, OR 14.06, 95 Cl 4.45 to 44.41) and a higher temperature at presentation without accountable infections. Seventy-five percent mortality occurred in first 4 days. Final outcome was not primarily influenced by incubation period, nature of injury, sex or occupation.Tetanus has probably not changed its outlook in developing countries. It is possible to triage patients into low and high-risk group on reception.

Publication Details

Page(s) 249-254

DOI DOI not available

Published Journal: Journal of College of Physicians and Surgeons--Pakistan : JCPSP, Volume: 10, Issue: 7, Year: 2000

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Keywords

Tetanus, Mortality Prognosis

References

Bieck TP,Mandell GL .1995 .rinciples and practice of infectious diseases. , : .

.1998 .47(SS-2. Morb Mortal Wkty Rep CDCSurveiHSumm, : 1-13.

. .Managementof tetanus in the elderly. JAm BFam Pract\^2\, (1) : 43-9.

.1992 .Aggressive intensive care treatment of very elderly patients with tetanus is justified. Acta MedPort, 5(5) : 251-4.

. .Morb Mortal Wkty Rep CDC SurveiH Summed-. Tetanus surveillance United States, 46 : 15-25.

.1976 .Tetanus and the need for an improved treatment. JPakMedAssoc, 26(10) : 198-201.

GowersWR .1888 .A manualof diseases of the nervous system. , : .

Udwadia FE,Ledingham JGG .1996 .. Oxford Text Book of Medicine. 3rded. Oxford:OxfordUniversityPress-, : 624-30.

Newton-JohnHF .1984 .Review of 106 patients managed in one hospital. MedJAust, 140(4) : 194-200.

SandersRK .1996 .. TropDoct, 3 : 107-15.

surveillance-United States .1998 .. , 47(2) : 1-13.

States .1997 .. Morb Mortal Wkty Rep CDC SurveiH Summ, 46(38) : 897-901.

.1990 .A threat to elderly patients. Chest, 97 : 702-5.

CDC. Current Trends Tetanus - United States .1985 .Morb Mortal Wkty Rep CDC SurveiH Summ. , 602(39) : 607-11.

Lima VM,Resende MR,Campos EO . .Accidental tetanus: clinical and epidemiological profile of inpatients at a university hospital. , 32(2) : 166-71.

Hodes RM .1990 .TeferedegneB. Tetanus in Ethiopia: analysis of 55 cases from Addis Ababa. EAfr MedJ, 67(12) : 887-93.

Appignanesi R,D'ErricoMM R .1998 .Epidemiology of tetanus in the Marches Region of Italy,. Bull WHO, 76(1) : 47-54.

Chao CH,Yu KW,Liu CY,Wang LS .1991 .Wong -WW?Tetanus2:0 years of clinical experience. ChungHua . IHsueh Tsa Chih (Taipei), 48(2) : 110-5.

Palazon Sanchez EL,Silla Lopez A,PardoTalavera JC .1993 .Tetanus in the Murcia region: the clinico-epidemiological characteristics of 150 cases. Rev CHn Esp, 192(8) : 369-75.

Payda S,Akkiz H .1988 .Mortalitylowering effect of systemic corticosteroid therapy in severe tetanus. CHn Then, 10(3) : 276-80.

.1996 .Tetanus-still a topic of present interest: a report of 27 cases from a Belgian referral hospital. JIntern Med, 239(3) : 249-52.

. .Intensive care in tetanus: management, complications, and mortality in 100 cases. , 1 : 6175.

.1993 .Unusual and iatrogenic sources of tetanus. Ann ChirGynaecol, 82 : 1-25.

.1992 .Tetanus caused by occupational accidents. Scand J Work Environ Health, 18(5) : 323-6.

. .. TherUmsch, 52(3) : 193-200.

.1990 .Tetanus from ulcerated tumors. Ann Intern Med, 113 : 170-1.

Yen LM,Dao LM,Day NP,Hien TT .1994 .WhiteNJ. Role of quinine in the high mortality of intramuscular injection tetanus. Lancet, 344 : 786-7.

.1993 .The medical complications of drug addiction and the medical assessment of the intravenous drug user: 25 years later. Ann Intern Med, 119 : 1017-28.

.1999 .pregnancy-related mortality in Bangladesh. Lancet, 354 : 565.

Edwards C,Ikimalo J,Panezai S. .1995 .Induced abortion can predispose to tetanus [. Letters]B.r Med J, 311 : 748-749.

Udwadia FE,Jain MC,D'CostaR MC,Jain PK,Lail A,Udwadia ZF,Kapadia F . .KapurKC, etat. Hemodynamic studies during the management of severe tetanus. Z27/W1992, : 449-60.

.1979 .The involvement of the sympathetic nervous system in tetanus. Ktin Wochenschr, 57(8) : 383-9.

Ahmadsyah I,Salim A .1985 .Treatment of tetanus: an open study to compare the efficacy of procaine penicillin and metronidazole. BrMedJ, 291 : 648-50.

Blake PA,Feldman RA .1976 .Serologic therapy of tetanus in the United States,. JAMA, 235 : 42-4.

Bagree MM,Singh JD,Kanwar DL,Nagar RC .1982 .Therapeutic efficacy of human anti-tetanic globulina clinical study of 100 cases. Jpn J Burg, 12(1) : 26-9.