A Ten-year Retrospective Study of Tetanus at a Teaching Hospital in Bangladesh

Abstract

Aims: To study the demographic, clinical features, treatment as well as outcomes of tetanus patients in the Bangladeshi population from 1994 to 2003. 
 Design: A retrospective descriptive study. Setting: A large public Medical college hospital with a regional as well as referral service. Materials and Methods: All cases of tetanus in adult patients from January 1994 to December 2003 were identified from the medical record at the hospital and these were then retrospectively reviewed. 
 Results: A total of 80 cases of tetanus were seen at the Faridpur Medical college hospital in the 10 years period with a mean of 8 cases per year. There were 55 male (68.75%) and 25 female (31.25%) patients. The mean age of the study population was 51.7±10.08 years. Most cases occurred in the age group of 60-69 years. Risk factor analysis revealed identifiable acute injury (puncture, prick/laceration) in 85%, CSOM (2.5%), surgery (2.5%), abortion (2.5%), skin ulcer (1.25%), burn (1.25%), child birth (1.25%), boil (1.25%). Thirty-two (40%) patients had medical wound care before hospital admission but none received tetanus immunoglobulin despite the absence of tetanus immunity. All the patients had the generalized type of disease. Body stiffness, trismus and dysphagia were the three commonest presenting complaints. All the patients with injury and wound (74/80) had their wound debrided. All the tetanus patients (80/80) received intravenous diazepam infusion as part of their management. Seventy two (90%) patients received intravenous crystalline penicillin. Sixty-five (81.25%) patients received intramuscular human antitetanus immunoglobulin and fourteen (17.5%) had tracheostomy performed. Inhospital complications were observed as respiratory (80%), cardiovascular (65%), gastrointestinal (57-5%), renal (33.37%), neurological (17.%) and others (22.5%). 
 There were eighteen deaths in hospital, accounting for overall mortality of 22.5% (18/80). Higher mortality were observed in age group above 50 years than the age group below 50 years (29.16% vs 12.5%, P<0.05), in female than the male (40% vs 14.54%, P<0.05), in farmer than nonfarmer (30.95% vs 13.15%, P<0.05), in patients who had short incubation period than those who had incubation period more than one week (53.33% vs 23.25%, P<0.05). 
 Conclusion: In general, tetanus remains in Bangladesh an important disease with substantial mortality that primarily affects unvaccinated or inadequately vaccinated individuals. 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. It is, however, highly preventable through both routine vaccination and appropriate wound management. Our case series show comparable pattern and outcome with other case series in the developing countries reported in the literatures.
 
 (J Bangladesh Coll Phys Surg 2007; 25 : 62-69)

A Ten Year Retrospective Study on Adult Tetanus at the Epidemic Disease (ED) Hospital, Mysore in Southern India: A Review of 512 Cases

“…About 474 (92.5%) patients were from the rural areas as compared to 38 (7.4%) patients from the urban areas, which reflected the high risk population in terms of the occupational and the general propensity to the risk of injury due to the poor environmental conditions. In the present study, 375 (73.2%) patients were above the age of 40 years and 137(26.7%) patients were below the age of 40 years, which was in sound agreement with the findings of the studies which were done in Malaysia and Bangladesh [13,17]. This could be attributed to a low immunity against tetanus, as they would have never received the vaccination.…”

“…The poor prognostic factors which were seen in this study included age more than 40 years, the presence of complications and a lack of tracheostomy due to the absence of a well equipped ICU facility. Most of the deaths were due to cardio-respiratory arrests, an observation which was similar to those which were seen in other studies [12,17].…”

“…As in other studies, a majority of the patients were daily wage workers or farmers (91.1%) [10][11][12][13][14]16,17]. This can be explained by the fact that most of the people who worked barefoot in the fields were at a higher risk of exposure to the tetanus spores.…”

“…About 40% of the patients who survived, stayed in the hospital for over 20 days or more [ [8,10,11] and with that of other studies which were done in the developing world [12][13][14][15][16][17]. This can be explained by the fact that men spend more time in farming activities and other field work and that hence they are more likely to be exposed to the Clostridium tetani spores which are ubiquitous in the soil and that the females are protected against tetanus by the TT immunization which is given during the antenatal period.…”

Neonatal Tetanus, Yet Not Gone: Infectious Disease Hospital Experience

“…Chalya et al 22 and Feroz & Rahman 23 in their studies observed that in some patients no portal of entry for the organism could be identified.…”