Pakistan Journal of Medical Sciences

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Volume 25

October - December 2009 (Part-I)

Number  5


 

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Tetanus: Presentation and outcome in adults

Nadeem Javeed Younas1, Ali Hassan Abro2, Kirpal Das3,
Ahmed Mahamed Saleh Abdou4, Abdulla Mohamood Ustadi5, Shahid Afzal6

ABSTRACT

Objectives: Tetanus is still a common clinical entity, especially in developing countries. The purpose of this study was to evaluate the presenting features as well as the outcome of tetanus in adult patients admitted to the hospital.

Methodology: This was a hospital based descriptive study conducted at the Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates from Jan. 2003 to Dec. 2008. The study was designed to include demographics, clinical information and outcome observed in the patients admitted with clinical diagnosis of tetanus. Patients with malignancy, immunosuppression (AIDS/Drugs), significant cardiac dysfunction and renal impairment were excluded. The patients were treated as per the standard protocol for the management of tetanus.

Results: A total of 44 patients were enrolled into the study. The mean age+SD of the patients were 26.3+5.8 years and all of the study patients were males. Thirty six (81.81%) patients gave the history of injury prior to onset of the symptoms, whereas eight (18.18%) patients were unable to recall any history of injury. All the study patients were laborers working in construction companies except for four who were gardeners. Body stiffness/spasm, difficulty in opening the mouth, difficulty in swallowing, body pain, neck pain and backache were the main presenting complaints. The patients with upper limb injuries had shorter incubation period and more severe disease with high frequency of autonomous nervous system insufficiency. Overall, hospital stay was 46.6+11.4 days. Forty (90.9%) patients required mechanical ventilation. The mean+SD ICU stay was 26.4+5.8 days and on weaning all the ventilated patients required tracheostomy. Eight (18.18%) patients died as a result of ventilator associated complications (Pneumonia) and autonomic nervous system dysfunction.

Conclusion: Tetanus still carries high morbidity and mortality rate despite the available advanced management facilities including ICU care. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients.

KEY WORDS: Tetanus, adults, features, outcome.

Pak J Med Sci    October - December 2009 (Part-I)    Vol. 25 No. 5    760-765

How to cite this article:

Younas NJ, Abro AH, Das K, Abdou AMS, Ustadi AM, Afzal S. Tetanus: Presentation and outcome in adults. Pak J Med Sci 2009;25(5):760-765.


1. Nadeem Javeed Younas, MRCP, FCPS,
Infectious Diseases Unit.
2. Ali Hassan Abro, MRCP, FCPS,
Infectious Diseases Unit.
3. Kirpal Das, MRCP, FCPS,
Department of Medicine.
4. Ahmed Mahamed Saleh Abdou, FRCPI,
Infectious Diseases Unit.
5. Abdulla Mohamood Ustadi,
M Sc Tropical Medicine,
Infectious Diseases Unit.
6. Shahid Afzal, MRCP,
Respiratory Unit.

1,2,4-6: Rashid Hospital Dubai, United Arab Emirates.
3: Jinnah Postgraduate Medical Center,
Karachi - Pakistan.

Correspondence

Dr. Nadeem Javeed
Ward-17, Rashid Hospital Dubai,
PO Box: 4545, United Arab Emirates.
Email: nadeemjaved786@hotmail.com
momal65@hotmail.com

* Received for Publication: May 13, 2009
* Revision Received: September 10, 2009
* Revision Accepted: September 16, 2009



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