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Tetanus in the ICU: increasing incidence in the past 5 years
Critical Care volume 10, Article number: P142 (2006)
Since 1973 the total number of cases of tetanus in our ICU is 30, almost all before 1990 (22 cases). Since 2000, six cases have taken place. The aim of the present study was to describe the characteristics of infection by Clostridium tetani in this period.
We retrospectively analysed the data of tetanus from 2000 to 2005. Clinical features, treatment and comorbidities were recorded.
Six cases of tetanus were described in this period: two cases of cephalic tetanus and four of generalized tetanus. Study patients had a mean age of 64 years (three were male), and period of the year was one case in spring, three in summer, two in autumn. The mean incubation period (from inoculation to first symptom) was 7 days in cephalic tetanus and 15 days in generalized tetanus, and the mean period of onset (from first symptom to first spasm) 10.5 days in cephalic tetanus and 14.5 days in generalized tetanus. The mean ICU length of stay was 28.2 ± 13 days, and the mean hospital length of stay was 43 ± 21 days. Mean days under mechanical ventilation were 21 ± 10 days. Clinical manifestations included trismus and generalized spasm in all cases, facial nerve paralysis in both cases of cephalic tetanus and abdominal pain in one case of generalized tetanus. All patients were treated with metronidazol, antitetanus immunoglobulin and toxin. Sedatives (midazolam and propofol) and neuromuscular blocking agents (cisatracurio and vecuronium) were used. Tracheostomy was performed in all cases as soon as possible. Complications included ventilator-associated pneumonia in four cases, infection of the urinary tract in two cases, asystole in one case, acute renal failure in one case, and seizures in one case. All patients were discharged from the ICU. One of them died in the hospital.
Tetanus is a rare disease in the ICU, but with low mortality. Strategies to fight tetanus include the training of the intensivist in earlier diagnosis and adequate interventions (attention to the airway and to ventilation is paramount at the time of presentation). Tetanus is entirely preventable worldwide. Revaccinating the population with antitetanus toxin might be considered in our setting.
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Casado, R., Chico, J., de Lange, S. et al. Tetanus in the ICU: increasing incidence in the past 5 years. Crit Care 10, P142 (2006). https://doi.org/10.1186/cc4489
- Acute Renal Failure
- Facial Nerve
- Nerve Paralysis