A Retrospective Clinical Study Of Factors Affecting Tetanus

摘要

Tetanus is a devastating disease of muscle spasm and autonomic instability with a high mortality. Despite being easily preventable with a highly effective vaccine, tetanus remains a significant source of morbidity and mortality worldwide . Our aim of the study was to review the demographic and clinical presentations of tetanus and to study the route of entry, immunization status and outcome of the disease. This study included all cases diagnosed as tetanus in a period of 6 years from 1st January 2000 to 31st December 2005. Data of the patients was retrospectively collected from the Medical Records Department of Kasturba medical college hospital, Manipal. The data included details of the patients and clinical findings. The maximum incidence was noted in the age group above 30yrs of age and males were more than females. Incidence among patients of various occupations was higher among those involved in manual work - farmers (66.66%) Common clinical manifestations included trismus with the common site of injury was lower Limb. Mortality was found to be higher with increase in severity of the disease and short Incubation period. Poor adherence to immunization schedule in adult population,low level of care administered for minor injuries by the primary health care providers, without keeping in mind the possibility of tetanus and lack of awareness among general public about the immunization schedule and the disease, was probably the reason for a higher incidence of tetanus in this country compared to the west. Severe tetanus had a higher mortality than moderate tetanus. The mortality of patients with tetanus remained phenomenally high (23.33%), the reason for which had to be elucidated with further prospective studies. Introduction Tetanus is a devastating disease of muscle spasm and autonomic instability with a high mortality. Despite being easily preventable with a highly effective vaccine, tetanus remains a significant source of morbidity and mortality worldwide with an incidence of about 500,000 to one million cases per year with a higher incidence among neonates, women and elderly in adult population 12 . 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. The muscle stiffness usually involves the jaw (lockjaw) and neck and then becomes generalized. Aims And Objectives Review the demographic and clinical presentations of Tetanus Study the route of entry ,immunization status and outcome of the disease Materials And Methods This study includes all cases diagnosed as Tetanus in a period of 6 years from 1 st January 2000 to 31 st December 2005. Data of the patients was retrospectively collected from the Medical Records Department of Kasturba medical college hospital ,Manipal which is a tertiary- care hospital. The data was compiled in proforma which included details of the patients, symptom analysis, clinical findings, investigations and management.In total, 30 tetanus patients admitted to the Kasturba Hospital, Manipal, between January 2000 and December 2005. All patients were given antibiotics, benzodiazepine (diazepam 5 mg/kg body weight) and, when needed, chlorpromazine and muscle relaxants for control of tonic–clonic contractions. Mechanical ventilation was used when generalized spasms were not controlled. Tracheostomy and/or mechanical ventilation were also used in patients who had respiratory problems. Patients received passive immunisation with Human Tetanus Immunoglobulin (HIG) 3000-6000 IU, and active immunisation with Tetanus Toxoid.Patients were classified according to various factors and relation to mortality evaluated. Incubation period [a] – time period from time of injury to onset of symptoms. Period of onset – time period from onset of symptoms to time of full blown disease / onset of convulsions ,Severity of disease – mild, moderate and severe according to the Classifica