Two years’ study of Tetanus cases in a Paediatric Intensive Care Unit

Abstract

Objective:To study the demographic and clinical features, outcome, complications and treatment cost of tetanus patients admitted in Paediatirc Intensive Care Unit (PICU) of Civil Hospital Karachi (CHK).Methods:It is a descriptive observational study conducted at Civil Hospital Karachi from July 2013 to June 2015. Patients of tetanus admitted in PICU during the study period were enrolled. Data was collected from the file records of patients and included the demographic profile, clinical presentation, grade of severity, length of stay, complications and outcome. It also included the cost of treatment. Descriptive statistics were applied to describe the results.Results:During the study period, 23 cases of tetanus were admitted in P.I.C.U. twelve were male and 11 female. Majority of cases (13) belonged to age group 2-6 years. Seventeen cases were unvaccinated and 6 had received only BCG & OPV. None was appropriately vaccinated for age.There were 9 cases of post injury tetanus, 6 of them were males, 5 cases of otogenic tetanus and 9 cases had no clinically identifiable portal of entry. Eleven cases belonged to grade III severity of Ablett classification and 6 had grade IV severity. Mortality in our case series was 26%. Autonomic instability was seen in 17 patients and all of them needed ionotropic support. The estimated cost of per day treatment of a tetanus patient with mechanical ventilation was approximatly 31, 979/Pak Rs and without mechanical ventilation was 20,000/Pak Rs.Conclusion:Tetanus is an entirely preventable disease with a high mortality. Treatment is very costly as compared to vaccination which is free of cost. Complete vaccination and proper wound care is the only option to reduce the ongoing burden of tetanus.

Clinical profile and outcome of pediatrics tetanus: the experience of a tertiary hospital in Ethiopia

“…This could be due to disappearance of protection from infant tetanus immunization and tendency of boys to engage in outdoor and rough competitive games. This is in agreement with other similar studies done in developing countries( 8 , 14 – 17 ).…”

Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital

“…We found that only one third of children who presented with tetanus had received three doses of tetanus toxoid but none of the children received booster dose. A study from Pakistan showed much worse results about the vaccination status showing that none of patients was vaccinated for tetanus 13. Majority of our children were not immunized or partially immunized, which is similar to reports by other workers and a study by Oyedeji et al showed exactly similar ratio of completely vaccination and partially or totally unvaccinated children 1,5,9.…”

Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

“…Although uncommon, with prolonged tetanus, associated cardiomyopathy repeated exposure to catecholamines may be present. A perioperative assessment of renal and electrolyte balance required the presence of myoglobinuria and renal dysfunction [ 21 , 25 ]. In our case, 3 weeks postoperative course was uneventful, and the patient showed an excellent clinical recovery and discharged on postoperative day 16.…”

“…This can be explained by the high chance of ignoring pediatric trauma and lack of provision of tetanus prophylaxis. The most common cause of death was the respiratory failure secondary to uncontrolled spasm (laryngospasm and diaphragm spasm); this may have been due to poor escalation of muscle relaxants and lack of pediatric intensive care unit (ICU) care [1,7,20,21].…”