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Tracheostomy and tetanus

Riaz Aziz, Soledad Colombe, Gibonce Mwakisambwe, Solomon Ndezi, Jim Todd, Samuel Kalluvya, Halinder S Mangat, Reed Magleby, Arndt Koebler, Bernard Kenemo, Robert N Peck, Jennifer A Downs
BACKGROUND: Tetanus is a vaccine-preventable, neglected disease that is life threatening if acquired and occurs most frequently in regions where vaccination coverage is incomplete. Challenges in vaccination coverage contribute to the occurrence of non-neonatal tetanus in sub-Saharan countries, with high case fatality rates. The current WHO recommendations for the management of tetanus include close patient monitoring, administration of immune globulin, sedation, analgesia, wound hygiene and airway support [1]...
August 2018: PLoS Neglected Tropical Diseases
Mikio Nakajima, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
PURPOSE: This study was performed to elucidate the current clinical features and outcomes of tetanus using a national inpatient database in Japan. MATERIALS AND METHODS: We used the Japanese Diagnosis Procedure Combination inpatient database to retrospectively investigate patients with tetanus from July 2010 to March 2016. We examined the patients' characteristics; the proportions of patients requiring tracheal intubation, mechanical ventilation, and tracheostomy; and the discharge status...
April 2018: Journal of Critical Care
Suresh Kumar Angurana, Muralidharan Jayashree, Arun Bansal, Sunit Singhi, Karthi Nallasamy
Objectives: To evaluate pediatric intensive care unit (PICU) needs, outcome and predictors of mortality in post-neonatal tetanus. Materials and methods: Review of 30 consecutive post-neonatal tetanus cases aged 1 months to 12 years admitted to a PICU in north India over a period of 10 years (January 2006 to December 2015). Results: Chronic suppurative otitis media was the commonest portal of entry. All received tetanus toxoid, human tetanus immunoglobulin (HTIG) and appropriate antibiotics; 7 (23...
February 1, 2018: Journal of Tropical Pediatrics
Ioannis Papadiochos, Sofia Papadiochou, Vassilis Petsinis, Lampros Goutzanis, Charikleia Atsali, Nikolaos Papadogeorgaki
Although the incidence of tetanus disease has radically declined in developed countries, both dental practitioners and oral and maxillofacial surgeons should be knowledgeable about its diagnosis since initial manifestations of the disease, such as trismus and dysphagia, are observed in the orofacial region. This study reports on a case of generalized tetanus diagnosed in a middle-aged man. Before the tetanus diagnosis, the patient had sought medical advice from seven different health care professionals, including a dentist and an oral and maxillofacial surgeon...
October 2016: Journal of Oral & Facial Pain and Headache
Sophie Ch Wen, Catherine Webb, Fiona Miles, Elizabeth Wilson
AIM: To review management of children admitted with tetanus to Starship Children's Hospital from 2000 to 2013. METHODS: Retrospective chart review of children aged 0-15 years admitted to Starship Children's Hospital with tetanus from 2000 to 2013. Follow-up of immunisation status was via the National Immunisation Register and/or phone contact with patient's primary health care provider. RESULTS: Four cases of tetanus occurred, all in unimmunised children...
December 2016: Journal of Paediatrics and Child Health
Bjørn Brandsæter, Ingeborg S Aaberge, Oona Dunlop
Tetanus vaccination is part of the Norwegian childhood vaccination program. An elderly woman injured her arm and leg after a minor fall on her outdoor stairs. Two weeks later she presented with trismus. This developed into tetanic spasms, obstructed airways and the need for a tracheostomy. She died 14 days later due to pneumonia and multi-organ failure. ELISA for tetanus toxoid IgG was negative, probably because the patient was born before the introduction of tetanus vaccination in the Norwegian childhood vaccination program...
2015: IDCases
Ken Miya, Nobutake Shimojo, Yasuaki Koyama, Yuki Enomoto, Keiichi Hagiya, Yuichiro Yamasaki, Tomofumi Nishino, Satoru Kawano, Taro Mizutani
Tetanus is an infectious disease caused by Clostridium tetani, which manifests systemic convulsion and autonomic instability associated with high case fatality. Despite proper medical intervention, management of those symptoms is often difficult. We report a case of 67-year-old man with tetanus in which a concomitant use of dexmedetomidine, an adrenaline α-2 receptor agonist, and propofol, a GABA(A) receptor binding agent, was successful in the management of systemic convulsion and autonomic instability without necessitating conventional anticonvulsant, neuromuscular blocking agents, or tracheostomy...
December 2015: American Journal of Emergency Medicine
Kuenza P Wangmo, Margie Teng, Richard Henker, Stephen Kinnear, Jampel Tshering, Nancy E Wang
Tetanus is a life-threatening disease that continues to have a high prevalence in developing countries. Severe muscle spasms often require patients to receive tracheostomy, high-dose sedatives, and sometimes prolonged neuromuscular blockade. Magnesium sulfate (MgSO4) infusion has great promise as an adjunct treatment for severe tetanus, as it may allow clinicians to decrease the dose of other sedative medications. Although the mechanism of action of MgSO4 is not well understood, it appears to attenuate both the muscle spasms and autonomic instability associated with severe tetanus infections...
June 2014: Wilderness & Environmental Medicine
Mehmet Aksoy, Erkan Cem Celik, Ali Ahiskalioglu, Muhammet Ahmet Karakaya
We analysed the data in the medical records of six patients admitted for tetanus in the intensive care unit (ICU) of the anaesthesia department in the Medical Faculty of Ataturk University from 1 January 2010 to 31 December 2012. All patients received the generalized form of treatment for tetanus in the ICU. The average age of the patients was 65.33 ± 13.45 years. Treatment modalities were administered to the patients in accordance with the literature. Four patients died despite all therapeutic interventions and two patients were discharged uneventfully...
January 2014: Tropical Doctor
J M Al-Kaabi, E M Scrimgeour, A Louon, B M Al-Riyami
OBJECTIVE: Although tetanus is now uncommon in Oman (The Expanded Program on Immunization was introduced in 1981), patients continue to present from time to time at an average rate of 6 cases per year. Worldwide, the mortality rate for tetanus remains high (ranging from 15-20% in developed countries). At the Sultan Qaboos University Hospital, Muscat, Oman, prolonged Intensive Care Unit treatment and multi-disciplinary management is invariably required for tetanus patients. This study was carried out to evaluate our results over the past decade...
October 2001: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
S Joshi, B Agarwal, G Malla, B Karmacharya
Aim: To analyse demography, clinical presentation, treatment, complications and outcome of patients with tetanus over a 2-year period. Materials and methods: A retrospective analysis of medical records of all patients with tetanus admitted to the intensive care unit of B.P Koirala Institute of Health Sciences, Dharan, Nepal between July 2004 and June 2006. Results: Tetanus accounted for 1.1 % of our ICU admission. Eight tetanus patients (mean age 52 years; M: F ratio 7:1) were admitted. The tetanus prone wounds of seven patients were managed at home...
July 2007: Kathmandu University Medical Journal (KUMJ)
Amanuel Amare, Yilma Melkamu, Desalew Mekonnen
BACKGROUND: Tetanus remains a major health problem in the developing world. The aim of this study was to evaluate the clinical presentation, risk factors, complications, treatment, outcome and predictors of death in patients with tetanus. METHODS: Patients aged ≥ 13 years admitted to Tikur Anbessa Hospital from June 2001 to May 2009 with the diagnosis of tetanus were included in this retrospective study. RESULTS: Data from 68 patients were analyzed; majority (77...
June 15, 2012: Journal of the Neurological Sciences
Erin E Simmonds, Amy J Alwood, Merilee F Costello
OBJECTIVE: To describe the use of magnesium sulfate in a case of generalized tetanus in a dog. CASE SUMMARY: A 1.5-year-old golden retriever was presented for a digital wound on the right thoracic limb and clinical signs associated with generalized tetanus. Initial case management consisted of wound debridement, treatment with metronidazole, tetanus immunoglobulin, methocarbamol, airway management via tracheostomy, and nursing care. Sedation to control severe muscle spasms became insufficient despite increasing doses of benzodiazepine, methocarbamol, and barbiturate continuous rate infusions...
October 2011: Journal of Veterinary Emergency and Critical Care
Huynh Thi Loan, Janet Parry, Nguyen Thi Ngoc Nga, Lam Minh Yen, Nguyen Thien Binh, Tran Thi Diem Thuy, Nguyen Minh Duong, James I Campbell, Louise Thwaites, Jeremy J Farrar, Christopher M Parry
Healthcare-associated pneumonia (HCAP) is a common complication in patients with severe tetanus. Nursing tetanus patients in a semi-recumbent body position could reduce the incidence of HCAP. In a randomised controlled trial we compared the occurrence of HCAP in patients with severe tetanus nursed in a semi-recumbent (30°) or supine position. A total of 229 adults and children (aged ≥1 year) with severe tetanus admitted to hospital in Vietnam, were randomly assigned to a supine (n=112) or semi-recumbent (n=117) position...
February 2012: Transactions of the Royal Society of Tropical Medicine and Hygiene
Phillipo L Chalya, Joseph B Mabula, Ramesh M Dass, Nkinda Mbelenge, Stephen E Mshana, Japhet M Gilyoma
BACKGROUND: Tetanus is still a major health problem in developing countries and it is associated with a high morbidity and mortality rate. There is paucity of published data regarding the management of tetanus in Tanzania, especially the study area. This study was conducted to describe our own experiences with tetanus outlining the clinical characteristics and treatment outcome of tetanus patients in our environment and to identify predictors of outcome of these patients. METHODS: This was a ten-year period retrospective study of patients who presented with a clinical diagnosis of tetanus at Bugando Medical Centre between January 2001 and December 2010...
July 8, 2011: World Journal of Emergency Surgery: WJES
A Amare, A Yami
BACKGROUND: Tetanus remains a major health problem in Ethiopia like in most other developing countries. OBJECTIVES: To assess the clinical presentation, complications and outcome of tetanus patients. METHODS: In this retrospective study, patients (age > 13 years) who were admitted to Jimma University Teaching Hospital from 1996 to 2009 were included. RESULTS: Data from 171 patients were analyzed (129 males, 42 females, mean age 33 years)...
March 2011: African Health Sciences
Ayotunde James Fasunla
OBJECTIVES: Severe tetanus is one of the indications for admissions into the intensive care unit requiring muscular paralysis, tracheostomy and mechanical ventilatory support. This study aimed to evaluate tetanus patients managed with tracheostomy and to determine associated complications. METHODS: This was a 16-year review of patients who were managed for tetanus with tracheostomy in an intensive care unit between 1999 and 2009. The data collected from the medical records including demographic data, clinical presentations, tetanus immunization history, suspected portal entry of infection, duration of ICU admission, endotracheal intubation, tracheostomy, and complications...
2010: International Journal of Preventive Medicine
Rana Imran Sikendar, Bader us Samad, Safdar Ali, Mohammad Iqbal Memon
BACKGROUND: Tetanus is a life threatening disease. Reported mortality for tetanus is 15-39%. Conventional treatment includes heavy sedation and artificial ventilation. Complications resulting from long term heavy sedation and artificial ventilation contribute to 60% of the total mortality caused by tetanus. In this study magnesium sulphate was used to reduce the need for sedation and artificial ventilation. Objectives of this prospective study were to determine the role of magnesium sulphate in post traumatic tetanus...
April 2009: Journal of Ayub Medical College, Abbottabad: JAMC
Menelaos Karanikolas, Dimitrios Velissaris, Markos Marangos, Vassilios Karamouzos, Fotini Fligou, Kriton S Filos
INTRODUCTION: Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial. CASE PRESENTATIONS: Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity...
2010: Journal of Medical Case Reports
S Joshi, B Agarwal, G Malla, B Karmacharya
AIM: To analyse demography, clinical presentation, treatment, complications and outcome of patients with tetanus over a 2-year period. MATERIALS AND METHODS: A retrospective analysis of medical records of all patients with tetanus admitted to the intensive care unit of B.P Koirala Institute of Health Sciences, Dharan, Nepal between July 2004 and June 2006. RESULTS: Tetanus accounted for 1.1 % of our ICU admission. Eight tetanus patients (mean age 52 years; M: F ratio 7:1) were admitted...
July 2007: Kathmandu University Medical Journal (KUMJ)
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