Multicenter Study of Tetanus Patients in Fujian Province of China: A Retrospective Review of 95 Cases

Abstract

Background. Tetanus is a life-threatening disease in developing countries and is accompanied by a high mortality rate. Although China is the world’s largest developing country, there have been few clinical studies on tetanus in China. The purpose of this study was to investigate the epidemiology, incidence, and management of tetanus in Fujian Province and to understand the current treatment and prognosis of tetanus patients. Methods. This was a retrospective, multicenter observational study of patients who presented with a clinical diagnosis of tetanus at 5 general hospitals in Fujian from January 2008 to December 2018. Data were analyzed using a computer software system. Results. A total of 95 patients were recruited, including 6 newborns. The average age of the adult tetanus patients was 55.53±15.39 years old. None of the patients knew their previous history of tetanus immunization. The rate of having received human tetanus immunoglobulin (HTIG) was 9.47%. A total of 73 (76.84%) patients were cured, 17 (17.89%) patients had an unknown prognosis, and 5 (5.26%) patients died. Age, severity of illness, and complications all increased the total duration of hospitalization. Compared with endotracheal intubation, tracheotomy increased the length of stay in the ICU (Intensive Care Unit) but did not affect the total hospital length of stay for mechanical ventilation. Conclusions. With the promotion of nationwide immunization against tetanus and the development of critical care medicine, morbidity and mortality rates of tetanus in Fujian are low. It is important to increase awareness among local physicians and staff in charge of tetanus immunization programs and with regard to neonatal tetanus and drug-induced tetanus. The prevention and treatment of tetanus in developing countries should arouse widespread concern in society.

Factors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh

“…Hence it is considered to be less suitable for prognostic stratification. Nevertheless, similar to other studies [ 22 ], we noted that nearly 50% of patients presented with severe and very severe disease.…”

“…One important finding of our study is that more than half of the patients were farmers and lived in rural areas. Similarly, many previous studies [ 16 , 19 – 22 ] observed a high proportion of farmers among tetanus patients. As C .…”

Neonatal tetanus

“…C. tetani is susceptible to several antimicrobials: penicillins, cephalosporins, metronidazole, macrolides, tetracyclines, and imipenem [21][22][23] . It is recommended that specific antimicrobial therapy should be given with one of these modalities: per os or IV metronidazole (< 7 days of age, 15 mg/kg/day in divided doses; > 7 days, 30 mg/kg/day in divided doses, for 10-14 days); or IV penicillin G (100,000 U/kg/day administered at 6-hour intervals, for 10-14 days).…”

“…Clinical experience has demonstrated that mortality rate was lowest in those treated with combined therapy of diazepam, phenobarbital sodium, and/or chlorpromazine 21) . Omphalectomy has also been used to eliminate the toxin production 21) .…”

Obstetric tetanus in an immunized patient

“…The disease is mediated by spores that enter the human body on contact with broken skin or mucosa. Once in an anaerobic environment within the body, the spores produce tetanospasmin, the tetanus neurotoxin responsible for the associated symptoms: muscle spasms, stiffness, fever, muscle aches, and dysphagia, among others [1] .…”