Tetanus not forgotten

Introduction

Tetanus still lingers with us although we have fairly good immunization programme in the country. There are no cases of neonatal tetanus in our hospital for the past 10 years.

Materials and methods

Retrospective study was done on 12 cases of generalised adult tetanus diagnosed clinically and admitted to our hospital from Jan 1995 to Nov 1997.

Management

Three cases were treated conservatively in the medical ward. Nine cases were admitted directly to ICU from the A&E Dept. Of the cases admitted to ICU, three were on conservative treatment: isolation in semi dark room, invasive monitoring, anti-tetanus toxoid, human hyperimmune antite-tanus globulin, titrated diazepam infusion, i.v. crystalline penicilline and metronidazole, and wound desloughing. Six needed ventilatory support: two underwent tracheostomy, and only one needed labetalol infusion. Proper nutrition was taken care of in all the patients.

Observation

Conservative management in the medical ward was satisfactory and all patients were discharged well. Patients admitted to ICU: 88.88% are above the age of 50 years, males more than females, average incubation period was 10 days, all patients had outdoor injuries, average stay was 14 days, 55.55%had autonomic dysfunction, 66.66% had nasocomial infection, there were two deaths (22.22%): one due to severe uncontrolled autonomic dysfunction with bradycardia, another due to septicaemia.

Conclusion

Tetanus is still a problem in elderly age group in our humid climate. Autonomic dysfunction is among the major complications. Titrated diazepam infusion without ventilation had satisfactory results.