Clinical Patterns in Severe Tetanus

Kloetzel, Kurt

doi:10.1001/jama.1963.03060070027018

Cited by 28 publications

(16 citation statements)

References 6 publications

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“…Although about 70% of the new cases of tetanus have been reported to occur in patients aged 50 years and older in the developed countries [1,2], it has remained a disease of all age groups in the developing ones [7,11]. This is, of course, as in our cases, because of a lack of adequate immunization against tetanus.…”

Section: Discussionmentioning

confidence: 54%

Tetanus in the Elderly: Is It Different from That in Younger Age Groups?

Khajehdehi

Rezaian²

1998

Gerontology

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Our aims were to itemize the clinical features and the outcome of tetanus in the elderly, as well as any age and sex differences in its acquisition. Therefore, we compared the demographic and clinical data of 12 elderly (group 1) cases of tetanus with 69 middle-aged patients (group 2) and 12 children (group 3) suffering from the same disease. There was no significant difference between the site of entry and incubation period or in the clinical and paraclinical findings among the three groups of patients. Acute respiratory failure was found more commonly in group 1 than in groups 2 and 3 (p = 0.0167 and p = 0.0006, respectively). It was also more common in group 2 than in group 3 (p = 0.0140). A mild form of tetanus was more often detected in children than in middle-aged and elderly cases (p = 0.0213 and p = 0.0013, respectively). Severe tetanus was seen more often in group 1 than in groups 2 and 3 (p = 0.0167 and p = 0.0006, respectively). Despite this, the mortality rate was not statistically different among the three groups of patients. Females were affected much less frequently than males with a female:male ratio of 1:3 in all three age groups. Our results suggest that elderly patients are at higher risk of acquiring a more severe form of tetanus and the subsequent development of acute respiratory failure. In addition, the disease is more common in males of all age groups, and age and sex have no apparent effect on the outcome of patients with tetanus.

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Section: Discussionmentioning

confidence: 54%

Tetanus in the Elderly: Is It Different from That in Younger Age Groups?

Khajehdehi

Rezaian²

1998

Gerontology

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“…The management of severe tetanus remains still a difficult problem. The mortality rate reported by several authors [11,12,15,17,22,25,28,32] remains at the disturbingly high level of 20-58%. In a retrospective study on a series of 82 patients with tetanus Kerr et al [28] observed a combination of symptoms which were believed to be due to an overactivity of the sympathetic nervous system.…”

Section: Die Beteiligung Des Sympathischen Nervensystems Bei Tetanusmentioning

confidence: 98%

“…Seven out of 11 patients with severe tetanus had striking cardiovascular and other sympathetic disturbances [38]. Tachycardia above 140/min was exhibited by 65% of the patients, who finally died [32]. These cardiovascular symptoms are reported to initiate 2-10 days after the onset of trismus [7,12,16,23,24,28,30].…”

Section: Cardiovascular Disturbancesmentioning

confidence: 99%

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The involvement of the sympathetic nervous system in tetanus

1979

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Besides the characteristic disturbances of the motor nervous system symptoms indicating an overactivity of the sympathetic nervous system can complicate the course of severe cases of tetanus. These symptoms include fluctuating tachycardia and hypertension, electrocardiographic changes, sweating, constipation with development of paralytic ileus and metabolic disorders. These symptoms are comparable to these developing in patients with phaeochromocytoma. Elevated catecholamine levels in plasma and urine have been found in several patients with tetanus who developed these symptoms. The prolonged over-activity of the sympathetic nervous system is thought to contribute to the still considerably high mortality rate. Myocardial lesions observed at necropsy are comparable to those found in patients dying of phaeochromocytoma. These lesions are suggested to be associated with sudden death from arrhythmias or cardiac failure in patients with tetanus. For the protection of the organism against the overactivity of the sympathetic nervous system a treatment using the combination of beta-adrenergic receptor blocking agents and adrenergic neuron blocking agents has been introduced. A reduction of the mortality rate was achievable by this treatment. Experimental evidence is accumulating that the tetanus toxin affects not only the motor, but also the sympathetic and sensory neurons.

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“…Psychiatric disorders associated with long-term diazepam treatment for tetanus occur relatively often, but as yet they have been reported not to be alarming or deleterious (Kloetzel, 1963;FemiPearse, 1966 On the twenty-fifth day the EEG record revealed a generalized slow activity as well as intermittent delta rhythm in both frontotemporal regions. On the thirty-eighth day EEG was even more improved, attaining the borderline of a normal pattern, and corresponding well with the clinical improvement.…”

Section: Introductionmentioning

confidence: 99%

Transient psychological syndrome following diazepam therapy for tetanus

Malatinský¹,

Procházka²,

Kadlic³

1975

Postgraduate Medical Journal

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SummaryTwo cases of transitory reversible pathopsychological changes associated with diazepam therapy in tetanus are described. The psychopathology developed owing to an abrupt discontinuance of diazepam or to a sudden reduction of its dosage. The reinstitution of diazepam in low doses and the administration of regulators of cerebral metabolism resulted in a progressive normalization of the psychological state.It is suggested that the described syndrome was caused by two aetiological factors; the toxinfectious factor giving rise to the primary cerebral dysfunction, and the prolonged action of high doses of diazepam with a sudden withdrawal, playing a role as precipitating factor. EEG findings showed widespread abnormality which corresponded with the clinical diagnosis. Even the normalization in EEG correlated well with the disappearance of psychiatric symptomatology.To avoid such undesirable psychic side effects, a gradual discontinuance of the drug is recommended.

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Clinical Patterns in Severe Tetanus

Cited by 28 publications

References 6 publications

Tetanus in the Elderly: Is It Different from That in Younger Age Groups?

Tetanus in the Elderly: Is It Different from That in Younger Age Groups?

The involvement of the sympathetic nervous system in tetanus

Transient psychological syndrome following diazepam therapy for tetanus

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