Tetanus: a review of the literature

Cook, T. M.; Protheroe, Richard; Handel, J

doi:10.1093/bja/87.3.477

Cited by 326 publications

(405 citation statements)

References 91 publications

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“…Set against this clinical picture in the prodromal stadium, patients in developing countries are more likely to present with progressed and unambiguous symptoms i.e. severe spasms of the facial musculature (risus sardonicus) and opisthotonus [2]. …”

Section: Discussionmentioning

confidence: 99%

“…Although these cases are usually associated with good outcome, rare cases with involvement of the cranial nerves (cephalic tetanus) have a high risk of progressing to generalized tetanus with a high mortality [2]. In tetanus neonatorum, the early symptoms include suckling and feeding problems, vomiting and seizures.…”

Section: Discussionmentioning

confidence: 99%

“…In tetanus neonatorum, the early symptoms include suckling and feeding problems, vomiting and seizures. These often rapidly progress into generalized spasms, opisthotonus or even septic complications [1,2]. …”

Section: Discussionmentioning

confidence: 99%

“…trismus (lockjaw) and opisthotonus [2]. Importantly, the onset of a generalized tetanus infection is not always associated with the clinical signs described above.…”

Section: Introductionmentioning

confidence: 99%

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Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

et al. 2009

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IntroductionThe low incidence of tetanus in developed countries has resulted in a decreased vigilance of this disease. This raises concern, as the prodromal stadium of a generalized tetanus infection may lack the characteristic paroxysmal muscle spasms. Tetanus can rapidly progress into life-threatening muscle spasms accompanied by respiratory insufficiency and/or autonomic dysfunction. This emphasizes the need for early diagnosis and treatment.Case presentationA 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration. Due to parental concerns about the boy's refusal of fluids, a pediatrician was consulted. At that time of presentation he showed signs of trismus and muscle rigidity. Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection. After sedation, endotracheal intubation and ventilation, passive immunization and initiation of antimicrobial treatment, he was immediately transferred to a pediatric intensive care unit (PICU) for further treatment. The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved.ConclusionTetanus infection remains a rare but potentially lethal disease in developed countries. As the full scope of classical symptoms may be absent at first presentation, tetanus should always be considered in non-immunized patients with an acute onset of dysphagia and trismus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…trismus (lockjaw) and opisthotonus [2]. Importantly, the onset of a generalized tetanus infection is not always associated with the clinical signs described above.…”

Section: Introductionmentioning

confidence: 99%

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Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

et al. 2009

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“…In addition, malaria reduces placental transfer of antibodies to the fetus. 8 Even in developed countries, such as the United States and the United Kingdom, serological surveys have shown that 49-66% of people over 60 years of age have inadequate immunity. Indeed, 70% of tetanus cases and 80% of deaths in these countries occur in people over 50 years of age.…”

Section: Pathophysiologymentioning

confidence: 99%

Tetanus in developing countries: a case series and review

Gibson

Uwineza

Kiviri

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Few anesthesiologists have expertise in the diagnosis and treatment of tetanus, a disease that remains prevalent in developing countries. We report on a series of four cases of tetanus cases recently encountered in Rwanda. We review the clinical epidemiology, pathophysiology, diagnosis and the treatment of tetanus, and provide implications for anesthesiologists and critical care physicians. Clinical features We report four cases, two involving adults who were inadequately vaccinated and experienced injuries, and two involving neonates, both of whom underwent umbilical cord transection using unsterilized equipment. All patients required tracheal intubation, and were mechanically ventilated when equipment was available. One adult and one neonate succumbed to the disease. These cases highlight the difficulties of diagnosis and management of complicated diseases in the resourcechallenged health care setting of developing countries. Conclusions The differential diagnosis of tetanus may be confusing, and survival depends on the rapidity of treatment with antitoxin, as well as adequate supportive care. High doses of sedatives and muscle relaxants, as well as prolonged mechanical ventilation, are usually necessary. Mortality remains high, usually resulting from late respiratory failure and cardiovascular collapse, associated with autonomic instability. Anesthesiologists and critical care physicians have an important role to play in the management of these patients. Increased involvement in humanitarian health organizations, immigration from developing countries, and emergence of high risk groups in developed countries will likely result in more exposure of anesthesiologists to the complexities of this disease. RésuméObjectif Tre`s peu d'anesthe´siologistes sont experts du diagnostic et du traitement du te´tanos, une pathologie qui demeure pre´valente dans les pays en voie de de´veloppe-ment. Nous rapportons une se´rie de quatre cas de te´tanos survenus re´cemment au Rwanda. Nous passons en revue l'e´pide´miologie clinique, la physiopathologie, le diagnostic et le traitement du te´tanos, et proposons des pistes inte´-ressantes pour les anesthe´siologistes et les me´decins en soins critiques. É léments cliniques Nous rapportons quatre cas dont deux impliquent des adultes mal vaccine´s et qui ont subi des blessures, et deux concernent des nouveaux-ne´s, tous deux ayant subi une coupe transversale du cordon ombilical a`l'aide d'instruments non ste´rilise´s. Tous les patients ont ne´cessite´une intubation trache´ale et ont e´te´venti-le´s me´caniquement lorsque le mate´riel e´tait disponible. Ces cas soulignent les difficulte´s rencontre´es lors du diagnostic et de la prise en charge de pathologies complexes dans le contexte des soins de sante´manquant de ressources des pays en voie de de´veloppement. Conclusions Le diagnostic diffe´rentiel du te´tanos peut porter a`confusion, et la survie de´pend de la rapidite´du traitement avec de l'antitoxine ainsi que de soins d'accompagnement adapte´s. En ge´ne´ral, des...

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Cranial Nerve VII Palsy as the First Sign of Cephalic Tetanus After an Earthquake

Gleeson

Etienne²

2011

Arch Neurol

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Tetanus: a review of the literature

Abstract: Under anaerobic conditions found in necrotic or infected tissue, the tetanus bacillus secretes two toxins: tetanospas

Cited by 326 publications

References 91 publications

Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

Tetanus in developing countries: a case series and review

Cranial Nerve VII Palsy as the First Sign of Cephalic Tetanus After an Earthquake

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