W E Peetermans1, D Schepens. 1. Department of Internal Medicine, University Hospital, Leuven, Belgium.
Abstract
OBJECTIVE: To study the clinical presentation, treatment and outcome of tetanus in a European population. DESIGN: A retrospective study. SETTING: A large university hospital with a regional as well as a referral service. SUBJECTS: All patients with tetanus from 1983 till 1993. RESULTS: Twenty-seven patients (13 men, 14 women; mean age 68.5 years) were studied. Seventeen out of 24 wounds (three patients had no history of a recent wound) were described as tetanus-prone. Ten patients had medical wound care, but none received tetanus immunoglobulins despite the absence of tetanus immunity. All patients had the generalized type of the disease. The classical symptoms of trismus, dysphagia and muscular rigidity were present in all patients. Treatment consisted of wound management, neutralization of tetanus toxin by immunoglobulins, antibiotics, treatment of muscle spasm and instability of the autonomic nervous system, and supportive care. Twenty-five patients were admitted to the intensive care unit for a mean duration of 25.7 days. Sixteen patients were artificially ventilated for a mean duration of 27.5 days. Three patients died, 11 patients had a complicated course caused by haemodynamic instability and 15 patients had pulmonary complications. CONCLUSIONS: Tetanus has not vanished. It remains a difficult-to-treat disease with a substantial morbidity and mortality rate. Prevention during wound management of tetanus-prone wounds was inappropriate in many patients. The elderly population may have the highest risk for tetanus since they may not have had tetanus toxoid immunization or regular booster injections.
OBJECTIVE: To study the clinical presentation, treatment and outcome of tetanus in a European population. DESIGN: A retrospective study. SETTING: A large university hospital with a regional as well as a referral service. SUBJECTS: All patients with tetanus from 1983 till 1993. RESULTS: Twenty-seven patients (13 men, 14 women; mean age 68.5 years) were studied. Seventeen out of 24 wounds (three patients had no history of a recent wound) were described as tetanus-prone. Ten patients had medical wound care, but none received tetanus immunoglobulins despite the absence of tetanus immunity. All patients had the generalized type of the disease. The classical symptoms of trismus, dysphagia and muscular rigidity were present in all patients. Treatment consisted of wound management, neutralization of tetanus toxin by immunoglobulins, antibiotics, treatment of muscle spasm and instability of the autonomic nervous system, and supportive care. Twenty-five patients were admitted to the intensive care unit for a mean duration of 25.7 days. Sixteen patients were artificially ventilated for a mean duration of 27.5 days. Three patients died, 11 patients had a complicated course caused by haemodynamic instability and 15 patients had pulmonary complications. CONCLUSIONS:Tetanus has not vanished. It remains a difficult-to-treat disease with a substantial morbidity and mortality rate. Prevention during wound management of tetanus-prone wounds was inappropriate in many patients. The elderly population may have the highest risk for tetanus since they may not have had tetanus toxoid immunization or regular booster injections.