Clinical profile and prognostic indicators of tetanus in children
Abstract
Introduction: Tetanus is still a major health problem in developing countries. There is paucity of published data regarding pediatric tetanus in study area. This study was conducted to describe the clinical profile, management outcome and prognostic indicators of tetanus in children in our region.
Material and Methods: This was a 5 year retrospective study of 24 pediatric tetanus patients < 18 years of age (excluding neonatal tetanus) from January 2010 to December 2014 admitted in Pediatric Intensive care unit of Chhattisgarh Institute of Medical Sciences Bilaspur (C.G.). Mean, summation, percentage and frequency distribution were used where applicable.
Results: A total of 24 cases were evaluated. The male to female ratio was 1.4: 1. The majority of patients (79.1%) were < 10 years of age. The mean age of cases were 6.94 ± 3.02 years (age range2 ½ - 12 years). Only 25% children with tetanus had prior tetanus immunization. Post injury tetanus (41.6%) and Otogenic tetanus (37.5%) were the most common mode of infection. The average incubation period and period of onset were 7.5 ± 3.13 days and 3.2 ± 0.96 days respectively. Complication rate was 54.1%. Mortality rate was 33.3%. Incubation period < 5 days, onset time < 3 days, presence of autonomic dysfunction, need for mechanical ventilation and severity of tetanus were associated with higher mortality.
Conclusion: Otogenic tetanus is a common mode of infection in children. Emphasis should be given to maintenance of ear hygiene and appropriate tetanus immunization in children with chronic ear discharge.
Downloads
References
2. Vandelaer J, Birmingham M, Gasse F, Kurian M, Shaw C, Garnier S. Tetanus in developing countries: an update on the Maternal and Neonatal Tetanus Elimination Initiative. Vaccine 2003 Jul; 21(24):3442-5. [PubMed]
3. Singh J, Datta KK, Foster SO. Sensitivity of neonatal tetanus surveillance system in India. Indian Pediatr1997 May; 34(5):398-401. [PubMed]
4. Amare A, Yami A. Case-fatality of adult tetanus at Jimma University Teaching Hospital, Southwest Ethiopia. Afr Health Sci 2011 March; 11(1):36-40. [PubMed]
5. Dietz V, Milstien JB, Van Loon F, Cochi S, Bennett J. Performance and potency of tetanus toxoid: implications for eliminating neonatal tetanus. Bull World Health Organ 1996; 74(6):619-28. [PubMed]
6. Feroz AHM, Rahman MH. A Ten-year Retrospective Study of Tetanus at a Teaching hospital in Bangladesh. J Bangladesh Coll Phys Surg 2007 May; 25 (2):62-69. [PubMed]
7. Edlich RF, Hill LG, Mahler CA, Cox MJ, Becker DG, Horowitz JH. Management and prevention of tetanus. J Long Term Eff Med Implants 2003; 13(3):139-54. [PubMed]
8. Arnon SS. Tetanus (Clostridium tetani). In: Behrman RE, Kleigman RM, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders; 2007:1228-30.
9. Ablett JJL. Analysis and main experience in 82 patients treated in the Leeds tetanus unit. In: Ellis M, ed. Symposium on tetanus in Great Britain. Boston Spa UK: National Lending Library; 1967:1-10.
10. Joshi S, Agarwal B, Malla G, Karmacharya B. Complete elimination of tetanus is still elusive in developing countries: a review of adult tetanus cases from referral hospital in Eastern Nepal. Kathmandu Univ Med J 2007 Jul-Sep; 5(3):378-81.
11. Oyelami OA, Aladekomo TA, Ononye FO. A 10 year retrospective evaluation of cases of post-neonatal tetanus seen in a pediatric unit of a university teaching hospital in southwestern Nigeria (1985 to 1994). Cent Afr J Med 1996 Mar; 42(3): 73-5.
12. Mondal T, Aneja S, Tyagi A, Kumar P, Sharma D. A study of childhood tetanus in post-neonatal age group in Delhi. Indian Pediatr 1994 Nov; 31(11): 1369-72. [PubMed]
13. Lau LG, Kong KO, Chew PH: A ten-year retrospective study of tetanus at a general hospital in Malaysia. Singapore Med J 2001Aug; 42(8):346-50. [PubMed]
14. Younas NJ, Abro AH, Das K, Abdou AMS, Ustadi AM, Afzal S: Tetanus: Presentation and outcome in adults. Pak J Med Sci 2009 Oct-Dec; 25(5):760-765. [PubMed]
15. Sandford JP: Tetanus-Forgotten but not gone. N Engl J Med 1995 Mar; 332(12):812-3. [PubMed]
16. Wesley AG, Pather M. Tetanus in children: An 11 year review. Ann Trop Paediatr 1987 Mar; 7(1):32-37. [PubMed]
17. Peetermans WE, Schepens D. Tetanus - still a topic of present interest: A report of 27 cases from a Belgian referral hospital. J Intern Med 1996 Mar; 239 (3):249-52. [PubMed]
18. Harding - Goldson HE, Hanna WJ. Tetanus: A recurring intensive care problem. J Trop Med Hyg 1995 Jun; 98 (3): 179-84. [PubMed]
19. Sun KO, Chan YW, Cheung RT, So PC, Yu YL, Li PC. Management of tetanus: A review of 18 cases. J R Soc Med 1994 Mar; 87(3): 135-7. [PubMed]
20. Bleck TP. Management of tetanus: A review of 18 cases. R Soc Med 1994 Sep; 87(9): 569. [PubMed]
21. Bhatia R, Prabhakar S, Grover VK. Tetanus. Neurol India 2002 Dec;50(4):398-407. [PubMed]
22. Cook TM, Protheoze RT, Handel JM. Tetanus: A review of literature. Br J Anaesth. 2001Sep; 87(3):477-87.
OAI - Open Archives Initiative
