Clinical profile and management of tetanus: A 5-year retrospective case series in a referral tertiary hospital in Metro Manila.
- Author:
Jesi Ellen Bautista
;
Gail Melissa I. Ramiro
;
Artemio A. Roxas Jr.
- Publication Type:Journal Article
- MeSH:
Tetanus;
Clostridium tetani;
Clostridium Infections
- From:
Philippine Journal of Neurology
2020;23(1):15-24
- CountryPhilippines
- Language:English
-
Abstract:
OBJECTIVE:To describe the profile, management, and outcome of adult patients admitted for tetanus.
METHODOLOGY:A search of the hospital and department database was conducted for patients with admitting or final
diagnosis of tetanus. Patients below 19 years old, with alternative diagnosis, incomplete or unavailable
records, transferred to another institution, and went home against medical advice were excluded. Data on
patient demographics, source of infection, symptom severity, and management were obtained. Data was
described using proportions and averages.
RESULTS:Thirty-two patients were included in the study. Twenty-seven were male with a mean age of 45.63 ± 13.39.
All cases had no history of tetanus vaccination. The most common focus of infection was acute injuries.
More than half of patients would be diagnosed within 72 hours of symptom onset. The most common
symptoms on presentation were trismus, rigidity, dysphagia, and spasms. On admission, Cole severity for
11 (34.4%) cases was mild, 17 (53.1%) moderate, and 4 (12.5%) severe. Prophylactic tracheostomy was
performed in 31 patients and 19 (59.4%) were placed on assisted ventilation. All cases were treated with
metronidazole. A benzodiazepine was started in all cases for spasm control. Baclofen, magnesium sulfate,
and antiepileptic drugs such as carbamazepine were also used. Twenty (62.5%) patients suffered from
complications, the most common of which was nosocomial pneumonia, which resulted in longer ICU and
hospital stays. Eleven patients exhibited progression in Cole severity: 8.6% at stage 1, 57.1% at stage 2, and
34.3% cases were at stage 3. Mortality rate was 19% with the proportion increasing with Cole severity.
CONCLUSION:We describe the presentation and course of patients admitted for tetanus in our institution. Most cases
were males and all cases had no vaccination history. Trismus was the most common presenting symptom.
Metronidazole was the antibiotic of choice and benzodiazepines were the mainstay for spasm control.
Majority of cases were mild to moderate in severity on presentation. Advanced disease stages were
associated with higher fatality rates. Complications were associated with longer ICU and hospital stay.
These findings suggest that prevention of progression of disease severity and complications must be the
focus of tetanus protocols to shorten hospital stay and decrease mortality rate. Promoting vaccination of
at-risk adults is recommended to lower the incidence of tetanus.
- Full text:Clinical profile and management of tetanus.pdf
