Publication: Complete elimination of tetanus is still elusive in developing countries: A review of adult tetanus cases from referral hospital in Eastern Nepal
Date
2007
Authors
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Publisher
Kathmandu University
Abstract
Aim: To analyse demography, clinical presentation, treatment, complications and outcome of patients with tetanus
over a 2-year period.
Materials and methods: A retrospective analysis of medical records of all patients with tetanus admitted to the
intensive care unit of B.P Koirala Institute of Health Sciences, Dharan, Nepal between July 2004 and June 2006.
Results: Tetanus accounted for 1.1 % of our ICU admission. Eight tetanus patients (mean age 52 years; M: F ratio
7:1) were admitted. The tetanus prone wounds of seven patients were managed at home. The most common
presenting complaints were trismus and stiffness of neck and back (87.5%). Elective intubation was followed by
tracheostomy in all the patients. Overall mean duration of ventilatory support was 12.5 days. Treatments given in
ICU were diazepam, magnesium sulphate, tetanus immunoglobulin, metronidazole, wound management and
supportive measures. Five patients (62.5%) developed autonomic instability and three patients had ventilatory
associated pneumonia (37.5%). Average ICU stay was 15.1 days while hospital stay was 20.1 days. Five patients
(62.5%) survived the course of disease. Two patients (25%) left the hospital against medical advice while the other
(12.5%) died in ICU.
Conclusion: Tetanus is a vaccine preventable disease. Tetanus prone wounds should be managed appropriately.
Respiratory compromise and autonomic instability are the main causes of morbidity and mortality. Early
recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with
tetanus.
Description
Joshi S 1, Agarwal B2, Malla G 3, Karmacharya B4
1&2 Assistant Professors, 4Senior House Officer, Department of Anaesthesiology and Critical Care, B.P Koirala Institute of Health Sciences, Dharan, Nepal, Assistant Professor, Department of Family Medicine (Emergency), B.P Koirala Institute of Health Sciences, Dharan, Nepal