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Cheng D, Liang L, Miaomiao H, Guolei H, Wei S. Adult patients with tetanus in Anhui Province of China from 2013 to 2022: A retrospective study. Medicine (Baltimore) 2023; 102:e35274. [PMID: 37800818 PMCID: PMC10553034 DOI: 10.1097/md.0000000000035274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
Tetanus is a highly fatal infectious disease with an incubation period of 7 to 8 days. The aim of this study was to identify risk factors for death in tetanus patients, develop a nomogram model for predicting mortality risk. This retrospective study included tetanus patients who were admitted to the intensive care unit department between January 2013 and December 2022. The patients were divided into 2 groups based on their final outcome, namely death group and survival group. Risk factors associated with mortality were analyzed using univariate and multivariate logistic regression analysis. Finally, a nomogram model was developed using the rms package. A total of 91 patients were enrolled in this study, including 54 males and 37 females. The average age of the tetanus patients was 52.88 ± 16.56 years, with a mean incubation period of 8.51 ± 3.97 days. The foot was the most common injury site (42.86%), and metal product stabbing was the leading cause of injury (48.78%). Ventilator-associated pneumonia was the most frequent complication (21.98%). Univariate and multivariate logistic regression analyses revealed that Ablett classification (odds ratio [OR], 21.999; 95% confidence interval [CI], 4.124-117.352), white blood cell count (OR, 6.033; 95%CI, 1.275-28.552), and autonomic nervous dysfunction (OR, 22.663; 95%CI, 4.363-117.728) as independent risk factors for tetanus patients. The C-index of the nomogram model was 0.942, with an area under the curve of the receiver operating characteristic curve at 0.942 (95%CI, 0.871-0.905). Ablett classification, white blood cell count, autonomic nervous dysfunctions were associated with the prognosis of patients with tetanus. The nomogram model developed based on risk factors has high accuracy.
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Affiliation(s)
- Dai Cheng
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
| | - Li Liang
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
| | - Hu Miaomiao
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group CO., Ltd., Hangzhou, Zhejiang Province, China
| | - Han Guolei
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
| | - Sun Wei
- Department of Respiratory and Critical Care Medicine, The Second People’s Hospital of Fuyang City, Fuyang, Anhui Province, China
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Gou Y, Li SM, Zhang JF, Hei XP, Lv BH, Feng K. 6084 Cases of Adult Tetanus from China: A Literature Analysis. Infect Drug Resist 2023; 16:2007-2018. [PMID: 37038478 PMCID: PMC10082574 DOI: 10.2147/idr.s404747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Objective To describe the clinical characteristics, treatments, and outcomes of tetanus and determine the most appropriate focus for tetanus prevention and treatment to reduce morbidity and mortality in China. Methods Four databases, including the Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data, were searched from 1 January, 2000 to 30 October, 2022. Results In total, 151 articles including 6084 tetanus patients met the inclusion criteria. Additionally, 5925 patients had their gender recorded in detail, among which 66.67% (3950/5925) were male, and 33.33% (1975/ 5925) were female. The average age in the detailed records was reported in 4773 cases, with an overall average age of 46.69. The number of patients' places of residence was 580. Those from rural areas comprised the highest percentage with 88.62% (514 / 580). The causes of injury were recorded in 1592 cases in total; injuries caused by metals, wood, and wooden spikes accounted for the highest percentage with 54.52% (868/1592). Patient outcomes were recorded in 4305 cases, with a mortality of 9.34% (402/4305). The leading causes of death included treatment terminated by family members, asphyxia due to persistent spasms, respiratory failure, and autonomic dysfunction, family automatic abandonment and asphyxia accounted for the highest percentage, both 24.00% (54/225). Conclusion The overall success rate of tetanus treatment in China has dramatically improved, but the prevention and control of non-neonatal tetanus is still challenging. Focus should be placed on the prevention of adult tetanus and standardizing the use of sedative and spasmolytic drugs. Additionally, medical professionals should popularize tetanus prevention and treatment knowledge among the people and strengthen training in grass-roots hospitals.
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Affiliation(s)
- Yi Gou
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Sheng-Ming Li
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Jun-Fei Zhang
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Xiao-Ping Hei
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Bo-Hui Lv
- Department of Emergency Medical, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
| | - Ke Feng
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, 750000, People’s Republic of China
- Correspondence: Ke Feng, Department of Emergency Medical, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, People’s Republic of China, Tel +86 18709676586, Email
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Khan MAS, Hasan MJ, Rashid MU, Kha Sagar S, Khan S, Zaman S, Sumon SM, Basher A, Hawlader MDH, Nabi MH, Kakoly NS. Factors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh. PLoS Negl Trop Dis 2022; 16:e0010235. [PMID: 35231035 PMCID: PMC8887756 DOI: 10.1371/journal.pntd.0010235] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/05/2022] [Indexed: 01/22/2023] Open
Abstract
Background
Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh.
Methods
This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26).
Results
A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07–15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05–10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications.
Conclusion
Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.
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Affiliation(s)
- Md. Abdullah Saeed Khan
- Infectious Disease Hospital, Dhaka, Bangladesh
- Pi Research Consultancy Center, Dhaka, Bangladesh
- * E-mail:
| | | | - Md. Utba Rashid
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Soumik Kha Sagar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Olum S, Eyul J, Lukwiya DO, Scolding N. Tetanus in a rural low-income intensive care unit setting. Brain Commun 2021; 3:fcab013. [PMID: 33824951 PMCID: PMC8010432 DOI: 10.1093/braincomms/fcab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/04/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Abstract
Tetanus is a potentially severe but preventable infection. In resource-rich settings, vaccination programmes have reduced tetanus to a rare disease, though still carrying an overall mortality of some 13%. However, in low-income settings, tetanus remains common, and is a significant cause of mortality-though major World Health Organisation programmes are successfully targeting neonatal and maternal disease. Data concerning the frequency and outcomes of non-neonatal tetanus in low-income settings are very sparse. We aimed to utilize a unique intensive care unit-based dataset to elicit clinical and demographic features and mortality in a large cohort of tetanus patients admitted over an eleven-year period to a single hospital centre in a rural low-income setting in northern Uganda. A total of 268 patients with tetanus were admitted to the Intensive Care Unit at St Mary's Hospital, Lacor between 2005 and 2015; the records of 190 were retrievable and had sufficient information to be assessed. 29 were neonates (median age 7 days, IQR 0), 52 children (1-16yrs; median age 11 years, IQR 4.5) and 109 were adults (median age 42 years, IQR 23). There was no seasonal pattern in the frequency of admissions. Of the 190 patients, 69 had endotracheal intubation with intermitent positive pressure ventilation, and 57 patients had central line placement. The overall mortality was 51.5-72.4% in neonatal disease, 25% in children and 57.8% in adults. The requirements for neither central line insertion, nor endotracheal intubation, nor intermittent positive pressure ventilation were independently linked to mortality rates. By contrast with neonatal and childhood disease, there was a marked male preponderance in adult tetanus-94 males and 15 females (gender difference P < 0.001)-and although year-on-year breakdown suggested no obvious upward or downward trend over the span of our study in total numbers of tetanus admissions, a trend towards an increasing incidence of adult tetanus was apparent.These findings confirm that adult tetanus remains a major problem in rural low-income settings, particularly in males, and suggests that more resources should be devoted to vaccination programmes targeting men.
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Affiliation(s)
- Sam Olum
- Gulu University Faculty of Medicine, Gulu, Uganda.,St. Mary's Hospital Lacor, Gulu, Uganda
| | - Jacob Eyul
- Gulu University Faculty of Medicine, Gulu, Uganda.,St. Mary's Hospital Lacor, Gulu, Uganda
| | | | - Neil Scolding
- Gulu University Faculty of Medicine, Gulu, Uganda.,Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
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Abstract
RATIONALE Tetanus is usually caused by wound infection with Clostridium tetani after acute injuries. Skin cancer wound is a rarely reported cause of tetani infection. It is difficult to be diagnosed and mistaken for other brain lesions. PATIENT CONCERNS A 49-year-old man presenting with the only symptom of repeated convulsions was admitted to our department. He had an ulcerated skin cancer on the right buttock that had been excised in another hospital 1 month before admission, leaving the wound unhealed. He was suspected of having a metastatic brain tumor early, but exhibited a negative cranial CT-scan. DIAGNOSIS Tetanus was diagnosed when he was observed to have sudden convulsions after sensory stimulation such as noise, light, or touch. INTERVENTIONS Despite administration of a high dose of diazepam and phenobarbitone, continuous generalized rigidity with laryngospasm still occurred. Instead, when propofol was intravenously infused, the spastic convulsion completely stopped. Tracheotomy and mechanical ventilation were performed. OUTCOMES The patient gradually recovered in 2 weeks. LESSONS Tetanus is rarely infected through the wound of an ulcerated skin cancer. Early diagnosis can only be based on accurate assessment of clinical manifestations, and propofol infusion appears to be more effective in anti-convulsion management for patients with tetanus. Routine vaccination to prevent tetanus in patients with ulcerated skin cancer should be considered in the future clinical work.
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Affiliation(s)
- Jin Wang
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Ying Yang
- Department of Pediatrics, Futian Women and Children Health Institute, Shenzhen, China
| | - Chao Yang
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Wen Lv
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Shihai Xu
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Fei Shi
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Aijun Shan
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
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Jacobs Slifka K, Harris JA, Nguyen V, Luquez C, Tiwari T, Rao AK. A Case of Localized, Unilateral (Cephalic) Wound Botulism. Clin Infect Dis 2019; 66:S95-S98. [PMID: 29293932 DOI: 10.1093/cid/cix828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe a rare presentation of botulism originally presenting with exclusively unilateral cranial nerve deficits following a puncture wound to the face. Cephalic tetanus was initially suspected but laboratory testing confirmed botulism. Botulism caused by local diffusion of toxin from a contaminated head wound can be confused with cephalic tetanus.
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Affiliation(s)
- Kara Jacobs Slifka
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Von Nguyen
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolina Luquez
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tejpratap Tiwari
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Agam K Rao
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Park D, Kim JS, Heo SJ. Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea: A case report and brief literature review. Medicine (Baltimore) 2019; 98:e15652. [PMID: 31169668 PMCID: PMC6571262 DOI: 10.1097/md.0000000000015652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani. The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory failure, laryngeal spasm, seizure, chest pain, nausea/vomiting, opisthotonus, back pain, and rigid abdominal wall can also be observed during progression of the disease. However, there has been no report of periocular discomfort as an initial manifestation after endoscopic sleep surgery in a patient with tetanus. Here, we report a patient who underwent endoscopic sleep surgery with a concurrent diagnosis of tetanus infection presenting with atypical periocular discomfort as the initial symptom. PATIENT CONCERNS A 63-year-old man complaining of sleep apnea, snoring, and daytime sleepiness visited our department. He subsequently underwent sleep surgery (anterior pharyngoplasty with tonsillectomy, septoplasty, microdebrider-assisted inferior turbinoplasty, and an endoscopic sinus surgery) for the treatment of his newly diagnosed obstructive sleep apnea. After 3 weeks of surgery, he visited the outpatient clinic of our department with right side periocular discomfort. DIAGNOSES Four days after presenting with periocular discomfort, he was diagnosed with tetanus by presenting trismus, jaw pain, dysphagia, and ptosis at an emergency department of a different hospital. INTERVENTIONS Tetanus immunoglobulin and antibiotics were administered. OUTCOMES His symptoms then resolved after a month without sequelae. LESSONS Although periocular discomfort is atypical and is not uncommon after nasal and oral surgeries, care should be taken when patients present with periocular pain because it could be a rare initial symptom of tetanus.
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Affiliation(s)
- Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Jung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital
| | - Sung Jae Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
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Tadele H. Clinical Profile and Outcome of Pediatrics Tetanus: The Experience of a Tertiary Hospital in Ethiopia. Ethiop J Health Sci 2018; 27:559-564. [PMID: 29217961 PMCID: PMC5615017 DOI: 10.4314/ejhs.v27i5.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Tetanus is an acute vaccine preventable illness manifested by neuromuscular dysfunction due to a potent exotoxin, tetanospasmin produced by Clostridium tetani. It is a common health problem in developing countries like Ethiopia. The aim of this study was to assess clinical profile and outcome of Pediatrics tetanus in a referral hospital, South Ethiopia. Methods This is a retrospective cross-sectional study of medical records of 24 Pediatric tetanus patients who were admitted from July 2014 to June 2016 to the Pediatrics Department of Hawassa University Comprehensive Specialized Hospital, Hawassa-Ethiopia. Tetanus was diagnosed clinically. Data were entered and analyzed using SPSS statistical software. Results The median age at diagnosis was 8 years with 19 (79.2%)of the study subjects being males. There were 3 male neonatal tetanus cases with 2 deaths. From post-neonatal cases, only 8(38.1%) were fully vaccinated for infant Expanded Period of Immunization (EPI). Booster vaccination with TT (tetanus toxoid) was only given to 5(29.4%) of discharged patients. Trauma was common in above 5 years of age and documented in 19(79.2%) of patients. All tetanus cases were generalized type with mild, moderate and severe grades comprising 7(29.2%), 8(33.3%), 7(29.2%) and 2(8.3%) respectively. Case fatality rate was 29.2% (7) with more deaths in higher grades. Respiratory failure 6(85.7%), and aspiration pneumonia 1(14.3%) were causes of death. Conclusion In this study, case fatality rate was high. Hence, health promotion with scale-up of EPI for infant tetanus immunization and large scale studies to provide support for booster vaccination schedules are recommended.
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Affiliation(s)
- Henok Tadele
- Department of Pediatrics and Child Health, Hawassa University, Ethiopia
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Sun C, Zhao H, Lu Y, Wang Z, Xue W, Lu S, Shen H, Wang Y, Peng Q, Huang L. Prognostic factors for generalized tetanus in adults: A retrospective study in a Chinese hospital. Am J Emerg Med 2018; 37:254-259. [PMID: 29891121 DOI: 10.1016/j.ajem.2018.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND We evaluated factors associated with mortality in patients with moderate/severe generalized tetanus. METHODS This retrospective study included patients with moderate/severe generalized tetanus admitted to the Affiliated Hospital of Nantong University (China) between January 2005 and January 2017. Clinical data were extracted from medical records. Patients were divided into two groups based on outcome (survival or death). Factors associated with mortality were analyzed using univariate and multivariate logistic regression. RESULTS Seventy-five patients were included (57.3% male; age, 57.9 ± 18.4 years; APACHE II score, 10.6 ± 3.4; severe tetanus, 49.3%; mortality, 25.3%). Multivariate analysis identified severe tetanus (odds ratio [OR], 30.364; 95% confidence interval [CI], 2.459-374.896) and APACHE II score (OR, 1.536; 95%CI, 1.051-2.243) as positively associated with mortality, whereas high-calorie nutrition (OR, 0.027; 95%CI, 0.002-0.359) and dexmedetomidine use (OR, 0.035; 95%CI, 0.003-0.467) were negatively associated with mortality (all P < 0.05). CONCLUSION Tetanus severity and APACHE II score were associated with mortality in patients with generalized tetanus, whereas high-calorie nutrition and dexmedetomidine use reduced the odds of death. High-calorie nutrition and dexmedetomidine administration may improve prognosis in adult patients with moderate/severe generalized tetanus.
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Affiliation(s)
- Chenliang Sun
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Hongsheng Zhao
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China.
| | - Yang Lu
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China.
| | - Zhiwei Wang
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Wanjiang Xue
- Department of General Surgery, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Shu Lu
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Haoliang Shen
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Yiping Wang
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Qingyun Peng
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Lili Huang
- Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, PR China
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Lee HJ, Choi JH. Tetanus-diphtheria-acellular pertussis vaccination for adults: an update. Clin Exp Vaccine Res 2017; 6:22-30. [PMID: 28168170 PMCID: PMC5292353 DOI: 10.7774/cevr.2017.6.1.22] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/21/2016] [Accepted: 01/02/2017] [Indexed: 11/15/2022] Open
Abstract
Although tetanus and diphtheria have become rare in developed countries, pertussis is still endemic in some developed countries. These are vaccine-preventable diseases and vaccination for adults is important to prevent the outbreak of disease. Strategies for tetanus, diphtheria, and pertussis vaccines vary from country to country. Each country needs to monitor consistently epidemiology of the diseases and changes vaccination policies accordingly. Recent studies showed that tetanus–diphtheria–acellular pertussis vaccine for adults is effective and safe to prevent pertussis disease in infants. However, vaccine coverage still remains low than expected and seroprevalence of protective antibodies levels for tetanus, diphtheria, and pertussis decline with aging. The importance of tetanus–diphtheria–acellular pertussis vaccine administration should be emphasized for the protection of young adult and elderly people also, not limited to children.
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Affiliation(s)
- Hyo-Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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11
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Woldeamanuel YW, Andemeskel AT, Kyei K, Woldeamanuel MW, Woldeamanuel W. Case fatality of adult tetanus in Africa: Systematic review and meta-analysis. J Neurol Sci 2016; 368:292-9. [PMID: 27538652 DOI: 10.1016/j.jns.2016.07.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/13/2016] [Accepted: 07/11/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Tetanus is a continued public health neuroinfectious burden in Africa; it accounts for significant proportion of lengthy intensive care unit (ICU) and hospital admissions. OBJECTIVES This study aimed to describe the pooled case-fatality rates of adult tetanus at African hospitals along with relevant discussions and recommendations. METHODS A systematic review using advanced search strategies employing PubMed/MEDLINE and Web of Science inclusive of gray literature handsearch was conducted for facility-based studies on adult tetanus by combining the terms "tetanus", "Africa" spanning all previous years until January 15, 2016. PRISMA and MOOSE guidelines were followed. Studies from non-African countries and studies on neonatal and childhood tetanus were excluded. A meta-analysis with fixed- and random-effects model was performed to identify pooled migraine prevalence. Inter-study heterogeneity was analyzed employing I Oshinaike et al. (2012) (inconsistency). RESULTS Twenty-seven studies involving 3043 patients were included. Median age was 33.7years (IQR 30-36). Median female to male ratio was 0.5. The geographic distribution of the studies was as follows: 15 (55.5%) studies were from Nigeria, 7 (26%) from Ethiopia, and the remaining single-centered studies were from Ghana (1; 3.7%), Uganda (1; 3.7%), Senegal (1; 3.7%), Democratic Republic of Congo (1; 3.7%), and Tanzania (1; 3.7%). The majority (88%) of the studies were from tertiary specialized or teaching university hospital settings.Median duration of the study period was 6.5years (IQR 4-9.25). Pooled crude tetanus case-fatality rate was found to be 43.2% (95% CI 36.9%-49.5%) on random-effects meta-analysis and 45.5% (95% CI 43.7%-47.2%) on fixed-effects meta-analysis. There was considerable inter-study heterogeneity. A time-series observation did not reveal a trend of decreasing case-fatality rates. Leading causes of death were complications from dysautonomia, aspiration pneumonia, hypoxemia, and sepsis (in descending order). Longer incubation period and longer onset time were associated with lower fatality; the further the wound site from the head, the longer the incubation period. Mechanical ventilation was not available in 26% of the studies; where available, mechanical ventilation and ICU admission was not utilized among most of the cases as the patients could not afford ICU care costs. CONCLUSION Despite declining tetanus incidence rates, case-fatality is still high in African care facilities. High rates of tetanus case fatality indicate lower quality of medical care at hospital settings.Most common causes of death are complication arising from dysautonomia and respiratory arrest secondary to laryngospasm. These can be prevented by potent medications and mechanical ventilation; where resources are lacking, nursing in darker and quieter rooms have been proven to be efficacious in reducing the frequency of spasms.
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Affiliation(s)
- Yohannes W Woldeamanuel
- Advanced Clinical Consultation & Research Center, Addis Abäba, Ethiopia; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, USA; Department of Neurology, Addis Abäba University School of Medicine, Addis Abäba, Ethiopia; Propria Health Solutions Co., USA.
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Lee JH, Hwang YS, Cho JH. Generalized tetanus could be complicated with Guillain–Barré syndrome. Int J Infect Dis 2016; 48:20-1. [DOI: 10.1016/j.ijid.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/05/2016] [Accepted: 04/13/2016] [Indexed: 11/15/2022] Open
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Clinical profile of tetanus patients attended at Felege Hiwot Referral Hospital, Northwest Ethiopia: a retrospective cross sectional study. SPRINGERPLUS 2016; 5:892. [PMID: 27386340 PMCID: PMC4923016 DOI: 10.1186/s40064-016-2592-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/15/2016] [Indexed: 11/12/2022]
Abstract
Background Tetanus is an acute, often fatal, disease caused by an exotoxin produced by the bacterium Clostridium tetani. It is characterized by generalized rigidity and convulsive spasms of skeletal muscles. Tetanus remains a major public health problem in Ethiopia like other developed nations. The aim of the present study was to assess the clinical profile and outcome of tetanus patients in a referral hospital, Northwest Ethiopia. Methods This is a retrospective cross sectional study in which we collected, compiled and analyzed medical records of patients aged greater than 15 years who were admitted at Felege Hiwot Referral Hospital from Sep 2012 to Sep 2015. Tetanus was diagnosed using clinical observations. Data were entered, cleared, and analyzed using SPSS statistical software package. Results Among 110 tetanus cases 84 (76.4 %) were males. Trauma was the most common antecedent cause. Most of the patients had no history of tetanus toxoid immunization. Aspiration pneumonia at 34.5 % and dysautonomia at 11.8 % were found to be the most frequently observed complications. About 36 (32.7 %) patients were died due to tetanus and the most common immediate cause of death was respiratory failure at (83.3 %). Patients’ area of residence (p = 0.004), type of complications (p = 0.00) and severity of tetanus (p = 0.00) were found statistically associated with the type of treatment outcomes. Conclusions In the study, the case-fatality rate was found to be very high. Therefore, there is a need to universal tetanus immunization and health information dissemination.
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Dalal S, Samuelson J, Reed J, Yakubu A, Ncube B, Baggaley R. Tetanus disease and deaths in men reveal need for vaccination. Bull World Health Organ 2016; 94:613-21. [PMID: 27516639 PMCID: PMC4969990 DOI: 10.2471/blt.15.166777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 01/09/2023] Open
Abstract
With efforts focused on the elimination of maternal and neonatal tetanus, less attention has been given to tetanus incidence and mortality among men. Since 2007 voluntary medical male circumcision has been scaled-up in 14 sub-Saharan African countries as an effective intervention to reduce the risk of human immunodeficiency virus (HIV) acquisition among men. As part of a review of adverse events from these programmes, we identified 13 cases of tetanus from five countries reported to the World Health Organization (WHO) up to March 2016. Eight patients died and only one patient had a known history of tetanus vaccination. Tetanus after voluntary medical male circumcision was rare among more than 11 million procedures conducted. Nevertheless, the cases prompted a review of the evidence on tetanus vaccination coverage and case notifications in sub-Saharan Africa, supplemented by a literature review of non-neonatal tetanus in Africa over the years 2003–2014. The WHO African Region reported the highest number of non-neonatal tetanus cases per million population and lowest historic coverage of tetanus-toxoid-containing vaccine. Coverage of the third dose of diphtheria–tetanus–polio vaccine ranged from 65% to 98% across the 14 countries in 2013. In hospital-based studies, non-neonatal tetanus comprised 0.3–10.7% of admissions, and a median of 71% of patients were men. The identification of tetanus cases following voluntary medical male circumcision highlights a gender gap in tetanus morbidity disproportionately affecting men. Incorporating tetanus vaccination for boys and men into national programmes should be a priority to align with the goal of universal health coverage.
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Affiliation(s)
- Shona Dalal
- Department of HIV/AIDS, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Julia Samuelson
- Department of HIV/AIDS, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Jason Reed
- Office of the Global AIDS Coordinator, United States Department of State, Washington DC, United States of America
| | - Ahmadu Yakubu
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Buhle Ncube
- Department of HIV, TB and Hepatitis, Communicable Diseases Cluster, World Health Organization Regional Office, Harare, Zimbabwe
| | - Rachel Baggaley
- Department of HIV/AIDS, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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Acute dysphagia in an octogenarian: an unusual case of tetanus. Am J Emerg Med 2014; 32:691.e1-2. [DOI: 10.1016/j.ajem.2013.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/05/2013] [Indexed: 11/19/2022] Open
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Tetanus: pathophysiology, treatment, and the possibility of using botulinum toxin against tetanus-induced rigidity and spasms. Toxins (Basel) 2013; 5:73-83. [PMID: 23299659 PMCID: PMC3564069 DOI: 10.3390/toxins5010073] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/25/2012] [Accepted: 12/27/2012] [Indexed: 11/24/2022] Open
Abstract
Tetanus toxin, the product of Clostridium tetani, is the cause of tetanus symptoms. Tetanus toxin is taken up into terminals of lower motor neurons and transported axonally to the spinal cord and/or brainstem. Here the toxin moves trans-synaptically into inhibitory nerve terminals, where vesicular release of inhibitory neurotransmitters becomes blocked, leading to disinhibition of lower motor neurons. Muscle rigidity and spasms ensue, often manifesting as trismus/lockjaw, dysphagia, opistotonus, or rigidity and spasms of respiratory, laryngeal, and abdominal muscles, which may cause respiratory failure. Botulinum toxin, in contrast, largely remains in lower motor neuron terminals, inhibiting acetylcholine release and muscle activity. Therefore, botulinum toxin may reduce tetanus symptoms. Trismus may be treated with botulinum toxin injections into the masseter and temporalis muscles. This should probably be done early in the course of tetanus to reduce the risk of pulmonary aspiration, involuntary tongue biting, anorexia and dental caries. Other muscle groups are also amenable to botulinum toxin treatment. Six tetanus patients have been successfully treated with botulinum toxin A. This review discusses the use of botulinum toxin for tetanus in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection.
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Tetanus in Ethiopia: Unveiling the Blight of an Entirely Vaccine-Preventable Disease. Curr Neurol Neurosci Rep 2012; 12:655-65. [DOI: 10.1007/s11910-012-0314-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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