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.

Post Neonatal Tetanus as Seen in Rivers State University Teaching Hospital, Nigeria: Prevalence, Clinical Profile and Outcome

“…Also interesting is the fact that there were no cases of otogenic tetanus in our study, contrary to the study in India, [35] where it was the commonest portal of entry. There were also documented cases of otogenic tetanus occurring in other studies in Nigeria.…”

“…In concordance with other studies, [26,27,33,39] although not statistically significant, the CFR was higher among children with severe and very severe disease and those with short incubation period of less than 7 days. [35] Studies in Pakistan, [40] India [35] and Ethiopia [33] reported that the presence of complications especially autonomic instability in patients with PNT was associated with higher case fatality rates as also observed in this study. Also worrisome is the higher CFR observed in the first 7 days of admission as also seen in other studies in Nigeria [27] and outside the country.…”

“…The commonest portal of entry observed in this study was post traumatic injuries, followed by broomstick injury. Post traumatic injury was also the most frequently documented portal of entry in other studies in Nigeria, [27,29,31] India, [35] and Ethiopia. [33] Probably because children are prone to injuries while playing especially outdoors in the sand, where their wounds can be easily contaminated with the spores of clostridium tetani.…”

“…The CFR in this study was however lower than the 50% reported in Asaba, [26] 35.7% in Sagamu, [27] Nigeria and 40% and 33.3% in different health facilities in India. [35,39] The differences observed may be due to the methodologies used in these studies and the severity of tetanus among the participants. For example, Angurana et al [39] in their study, included only patients with severe and very severe tetanus according to Ablett's classification, admitted into Paediatric intensive care unit.…”

“…[36] It is however interesting to note that broomstick injury as a portal of entry was only documented in studies carried out in the south-south geopolitical region of Nigeria and not in other parts of the country [26][27][28][29][30] or in other countries. [33,35] One can only ponder at this stage if this behaviour of using broom to flog children is peculiar to this geopolitical zone of the country or if it was erroneously omitted in studies from other parts of Nigeria. Further research maybe needed to clarify this observation.…”