Intraoperative Diagnosis and Use of Glidescope^t^mVideo Laryngoscope for Cephalic Tetanus

This case report describes the clinical characteristics and management of a 38-year-old man with cephalic tetanus. He presented with a massive facial infection after a dental procedure. After induction of anesthesia, cephalic tetanus was clinically diagnosed during induction based on the presence of a new facial nerve palsy and nuchal rigidity even after the administration of succinylcholine. The first attempt at intubation was unsuccessful with a Macintosh laryngoscope due to persistent nuchal rigidity and lockjaw despite the use of succinylcholine. Consistent with other reports, intubation was remarkably uncomplicated when the video laryngoscope was used. Postoperatively, the Clostridium tetani infection progressed to generalized tetanus and responded to supportive care. This case highlights the difficulties of diagnosis, and supports the utility of the Glidescopetm video laryngoscope in this unusual pathological condition.

Maternal Tetanus at the University College Hospital in Ibadan Nigeria: A 15-Year Retrospective Analysis

Objective To determine the characteristics of women with maternal tetanus, pattern of presentation and outcome of management. Methods A total of 19 women were managed with maternal tetanus between 1990 and 2005 from the University College Hospital in Ibadan Nigeria. A retrospective study was performed. The medical records of all women managed as a case of maternal tetanus were retrieved from the central record department of the hospital. The pattern of presentation, characteristics of women, the duration of hospital admission, tetanus toxoid immunization, and outcome of care were measured. Results The records of 18 women managed were analyzed. The mean age at presentation was 25.2 ±5.3 years. The patients were mostly single, nulliparous and had primary school education. The maternal tetanus cases seen mainly complicated induced abortion while 5 and 2 other cases were due to childbirth complication and leg wound respectively. The portal of entry of the remaining 3 cases could not be ascertained. None of the patient managed had complete immunization schedule. The average duration of admission was 11.2 ± 6. 7 d. Five women had intensive care with 3 of them requiring ventilatory support. The case fatality rate was 66. 7%. The only factor that significantly improved survival was presence of generalized spasm at presentation （P=0.006） Conclusion The occurrence of maternal tetanus is a reflection of low quality of health care delivery and lack or inefficient routine immunization coverage in any community.

Tetanus of the Child after Extraction of <i>Tunga penetrans</i>in Brazzaville: One Case

Tetanus has become rare even exceptional in the West. On the contrary, it is common in developing countries such as Congo because of low immunization coverage. Its diagnosis, which is essentially clinical, is easy but necessitates a fine semeiological analysis under certain circumstances. We are reporting here a case of tetanus involving an 8-year-old unvaccinated, indigenous aboriginal boy that was caused by the extraction of a Tunga penetrans. The symptomatology of abdominal contractures led to an exploratory laparotomy. The evolution was favorable.

Influence of Age on the Clinical and Prognostic Features of Tetanus in Mali

Background: The regression of post-vaccination immunity with age exposes elderly subjects to certain infectious diseases, in particular tetanus. The aim was to compare the clinical and prognostic features of tetanus according to the age of patients. Methodology: Analytical study of the files of patients hospitalized for tetanus in the Infectious Diseases Department at Point “G” University Teaching Hospital from 2013 to 2019 with retrospective collection. According to age, three groups of patients were formed: group I (<18 years), group II (18 - 59 years) and group III (≥60 years). The study variables were socio-demographic, clinical and prognostic. The One-way ANOVA and Chi-square statistical tests were applied with a significance level p = 0.05. Results: In total, 202 cases of tetanus were recorded or 7.3% of admissions. The mean age was 41.9 ± 15.6 years (range, 6 and 85 years) with a sex ratio of 19.2. According to the age grouping, group II was predominant (79.2%) followed by group III (14.9%) with respective mean ages of 39.2 ± 10.6 and 67.3 ± 6.5 and sex ratio of 39 and 29. Workers (33.3%), farmers (25.8%), traders (19.7%) and drivers (7.1%) represented the most important occupations most at risk. Clinically, bad general condition (p < 0.001), trismus (p = 0.001), dysphagia (p = 0.009) and complications during hospitalization (p = 0.028) were seen more frequently in group III patients compared to younger ones. From a prognostic point of view, patients in group III were at greater risk to develop a severe form of tetanus (p = 0.021) with higher mortality compared to other age groups (p < 0.001). Conclusion: Tetanus is more prevalent in men. Complications and mortality increase with age. It is important to include booster immunization of adults in existing national programs in order to reduce disease-related morbidity and mortality in this age group.

Neonatal Tetanus at Pediatric Teaching Hospital in Bangui

Background: Despite the Maternal and Neonatal Tetanus (MNT) elimination initiative, neonatal tetanus still persists in some parts of the world. Objectives: To determine hospital prevalence and describe epidemiological, clinical, therapeutic and outcome aspects of neonatal tetanus at the Pediatric Teaching Hospital in Bangui. Methodology: It was the review of hospitalized newborns’ files in the neonatal unit at Pediatric Teaching Hospital in Bangui between January 2016 and December 2019. Newborns discharged with tetanus diagnosis, and whose files were usable were included. The variables studied were: for the newborn: age, sex, birth weight, the reason for transfer, diagnosis, cause and time of death, place and method of delivery;for the mother: age, antenatal care, tetanus vaccine status, parity and geographical provenance. Epi Info 7 software, version 7.1.3.3 was used for data analysis. The chi2 test with the significance level set at p < 0.05 and the odds ratio were used. Résultats: Forty-eight (48) out of 5796 newborns had neonatal tetanus (0.8%). They were newborns to mothers with an average age of 18.8 years of which 68.8% (n = 33) were primipara and 87.5% (n = 42) not vaccinated against tetanus. Childbirth happened at home in 91.7% (n = 44), and the blade was used for sectioning the umbilical cord in 39.6% (n = 19). Newborns were referred from rural area in 47.9% (n = 23). A single antenatal care contact was done in 68.7% (n = 33). Tetanus was classified as severe according to the Dakar prognosis score between 4 and 6 in 89.6% of cases (n = 43). The death occurred in 58.3% (n = 28). Conclusion: The high frequency of neonatal tetanus as well as its severity requires pregnancy follow-up strengthening and childbirth monitoring in order to its elimination. But primary prevention relies on improving individual and general hygiene conditions.

Diphtheria and Tetanus Antibody Persistence in Indian Pre-school Children and Response to a Booster Dose of DT Vaccine.

Despite effective vaccines, diphtheria (D) resurged recently in the former socialistic block, and tetanus (T) still occurs in less privileged countries. We studied the antibody persistence for D and T in Indian pre-school children who had received four doses of DTP vaccine and subsequently, the response to a booster dose. Anti-D and anti-T IgG antibodies prior to and one month after a DT vaccine were measured by ELISA in 223 healthy children of 4-6 years who had previously received four doses of the triple vaccine. Adverse reactions were monitored for one month. While 30% and 14% of subjects were susceptible to D and T, respectively, 98% and 100% of them attained seroprotection post-vaccination. Both responses were significant. Local, but not systemic reactions except fever were rather common. A high proportion of the Indian pre-school population is susceptible to D and T, despite of receiving four doses. The current policy of giving the fifth dose at this age is appropriate.

Epidemiological and Clinical Characteristics of Non-neonatal Tetanus Patients in Guangxi,China:An 11-year Retrospective Study(2011–2021)

Tetanus is the only non-communicable disease among vaccine-preventable infectious diseases.It is caused by an infection with Clostridium tetanus bacterium and is characterized by continuous tonic contraction and paroxysmal spasms of skeletal muscles throughout the body[1].

Epidemiological, Clinical and Outcome Aspects of Care-Related Tetanus in Dakar, Senegal

Introduction: Tetanus portals of entry are numerous. Amongst these, the carerelated portals of entry are rarely reported. The aim of the study was to describe the epidemiological, clinical and outcome aspects and identify the factors associated with death from care-related tetanus. Patients and Methods: This is a retrospective study of descriptive and analytical purposes. Data were collected from the medical records of patients admitted to the Infectious and Tropical Diseases Department of the National University Hospital Center (CHNU) of Fann in Dakar for care-related tetanus during the period ranging from 1 January 2009 to 31 December 2016. Care-related tetanus was defined as any case of tetanus occurring after a surgical procedure, including circumcisions performed even outside a health facility. Results: In eight years, 50 cases of care-related tetanus were recorded. Care-related tetanus accounted for 6.7% of hospitalized tetanus cases. The mean age of patients was 21 ± 22 years, with a male predominance (sex ratio: 6.14). The procedure had been performed in most cases, either in a health facility in 22 patients (44%) or at home in 16 patients (32%), and occurred after circumcision. In 62% of cases the portal of entry was urological, followed by orthopedic surgery (14%) and visceral surgery (10%). The procedures performed were dominated by circumcision (31 cases), limb amputation (3 cases) and inguinal hernia repair (2 cases). Tetanus was immediately generalized on admission in all patients. Eighty-four percent (84%) of patients were admitted with Mollaret stage II. Cardiovascular (11 cases), infectious (10 cases) and respiratory (9 cases) complications were the most frequent. The hospital case fatality rate was 24%. Factors associated with death were female gender (p = 0.03), age between 15 - 60 years (p = 0.02), incubation time Conclusion: Care-related tetanus remains a concern in poor income countries, particularly in Senegal. The drop of these cases will require better immunization coverage of the population. It is also appropriate to raise the awareness of health care providers and surgeons and to promote capacity building for better prevention of cases through sero-immunization of patients at risk before the procedure and rigorous asepsis.

Characteristics, Management, and Outcomes of Tetanus Cases in a Referral Center in Senegal, between 2010 and 2017

Tetanus is an infection caused by Clostridium tetani. The disease has been described from the earliest medical literature. Despite this old knowledge, the existence of a vaccine, and the progress made in pathophysiology and treatment, tetanus remains a real public health problem, particularly in developing countries. Tetanus in children and adults is still a frequent cause of hospitalization in the Infectious and Tropical Diseases Department (SMIT) of the Fann National University Hospital (CHNU). We conducted this study with the main objective of carrying out a situational analysis of tetanus at SMIT from 2010 to 2017. We recorded 706 cases of tetanus in a total of 8123 hospitalized patients. The median age of the patients was 23 years [1 - 90 years]. The sex ratio (M/F) was 4/1. More than half (58.78%) came from suburban areas. The population was most frequently made up of students (24%) or manual workers (22.1%). At least one comorbidity was present in 107 patients (15.15%). The absence of a vaccination record was found in 99.56%. The main portal of entry was integumentary (83.3%), post-circumcision (5.7%) and otogenous (4%). Tetanus was generalized in 93.9% of cases. The main signs of tetanus found were trismus and dysphagia. Patients were most frequently classified as stage II (78.7%). Antibiotic therapy was based on metronidazole (51.41%). Anti-tetanus serotherapy was carried out by sub-occipital administration in 97.6%. Tracheostomy was performed in 48 patients. Complications occurred in 226 patients (32.01%). The main complications were respiratory (53.98%), infectious (45.13%) and cardiovascular (41.59%). The average delay in hospitalization was 3.6 ± 3.4 days. The mean length of hospital stay was 11.9 ± 8.2 days. The hospital case-lethality rate was 18.98%. Despite the decline in cases over the years in our country, tetanus remains a public health problem because of its prevalence, severity, and lethality.

Tetanus in a post operative patient—A case report

Tetanus is a preventable disease which commonly occurs with puncture or penetrating wounds, or contamination of cutaneous wounds. It may be secondary to surgical procedures such as gastrointestinal surgery on rare occasions. This article reports a fatal case of tetanus in a post operative patient in which the source of infection could not be ascertained. Active immunization of all persons against tetanus, adequate sterilization of surgical equipment and consumables as well as the operating rooms is advocated.

Safety Evaluation of a Potent Tetanus Vaccine (250 Lf) in Guinea Pigs (Cavia procellus)

A subacute toxicity study of a potent tetanus toxoid (250 Lf) was carried out in guinea pigs.The toxoid was injected subcutaneously at the nape of the neck at dose levels of 1.0, 1.5.and 2.0 ml in Groups Ⅱ. Ⅲ. and Ⅳ, respectively.In the controls (Group Ⅰ) 2.0 ml of aluminum phosphate suspension was given in each injection.Periodic evaluations of body weight, food/water intake, general observable behavior, hematology.and blood chemistry in toxoid-injected guinea pigs were similar to those in control guinea pigs.Thus, the toxoid did not cause any side effects up to four times the dose proposed for humans.1990 Academic Press, Inc.

Tetanus in Cat： From Neglected Wound to Neuromuscular DisordermCase Report

Tetanus is caused by the bacterium, Clostridium tetanL and can infect both domestic animals and man. The disease is rarely diagnosed in cats, as a consequence of their increased resistance to the neurotoxin, tetanospasmin. Mortality in animals is generally high （80%）. To date these authors have not been able to locate any reports of mortality rates specific to cats. Clinical diagnosis is based on clinical signs and a history of an untreated penetrating wound. This case report describes the development of moderate generalized tetanus in an approximately six month old female stray cat, found with an untreated wound on the side of its neck. This report describes clinical signs, treatment and recovery of the animal.

Teratogenicity Studies of a New Potent Tetanus Vaccine in Rabbit (Oryctolagus cuniculus)

Glaxo Laboratories, Bombay, have prepared a potent tetanus vaccine of 250 Lf as a substitute of the previous 5 Lf tetanus vaccine. The safety evaluation of the vaccine has been reported, but the teratogenic potential was not studied. In the experiment reported herein we have studied the teratogenic action of the vaccine in the progeny of rabbits. No congenital anomalies were observed.

Seroimmunity to Tetanus and Diphtheria among Immunocompetent Adult Patients Admitted to a Tertiary Hospital for Any Reason

Ignoring the importance of receiving booster doses of vaccines in vast majority of adults could result in their lack of immunity against tetanus and diphtheria. In this prospective cohort study all immunocompetent adults ≥ 40 years old who were admitted for any reason during the time period of the survey were enrolled and antibody levels against tetanus and diphtheria were measured. 84 patients (48%) were 40 - 60 years old and 93 (52%) subjects aged older than 60 years. In general, anti-tetanus antibody titer was <0.1 IU/mL (non-immune range) in 83 people (46.9%). For anti-diphtheria antibody, 74 (41.8%) were considered non-immune. Of all people whose tetanus antibody level was <0.1, 19 had a complete history of childhood diphtheria and tetanus immunization and 64 had unknown vaccination history. Among people with diphtheria antibody levels < 0.1, 18 (24.3%) had complete history of childhood vaccination and 56 (75.6%) had unknown history.

The association between area of residence and sufficient antenatal tetanus vaccination in women ages 15-49 in Afghanistan:an analysis of the 2015 DHS dataset

Background:Neonatal tetanus(NT)is a deadly nervous system disorder that is endemic to Afghanistan.Administering sufficient doses of tetanus toxoid containing vaccine(TTCV)during pregnancy can pass antibodies to the fetus and therefore prevent NT.Using survey data,we investigated the association between area of residence(urban or rural)and sufficient antenatal TTCV coverage among women aged 15-49 years in Afghanistan during their most recent pregnancy in the past 5 years that resulted in a live birth.Mother’s education level was also assessed as a potential effect modifier.Methods:Secondary analysis was performed on data from the 2015 Afghanistan Demographic and Health Survey(AfDHS).The 2015 AfDHS was a nationally representative survey with participants selected in a stratified two-stage sample design from urban and rural areas across Afghanistan’s 34 provinces.Data were analyzed on 19,737 women ages 15-49 that had a live birth in the 5 years preceding the survey.The relationship between area of residence and sufficient antenatal TTCV was assessed in a multivariable logistic regression model,adjusting for several confounding variables.Results:55.1%(95%CI=51.6-58.5%)of urban women and 53.9%(95%CI=49.7-57.9%)of rural women had sufficient tetanus vaccination coverage in their most recent pregnancy.In multivariate analysis,there was strong evidence for greater odds of sufficient antenatal tetanus vaccination in rural areas(OR=1.62;95%CI=1.18-2.24,p=0.003).There was no effect modification on this association by mother’s education level.Conclusions:Women in rural areas of Afghanistan have greater odds of receiving sufficient antenatal tetanus vaccination than women in urban areas.Further study into factors contributing to this urban-rural disparity is needed.Targeted antenatal tetanus vaccination strategies for urban and rural women will be necessary as Afghanistan continues to work towards NT eradication.

Difference of the Pain during the DPT (Diphtheria-Pertussis-Tetanus) Vaccination

Background: The objective of this study is to determine whether analyze of the infant’s pain associated with diphtheria-pertussis-tetanus (DPT) immunization is useful for vaccination in children. It is not known whether the immunization pain can be prevented with the adequate choice of DPT vaccines among several manufacturers in Japan. Further, it is not clear whether the difference of the reaction during vaccination between gender and age. Design: Three manufacturer’s Japanese DPT vaccines were used in this study. The parents assessed their infant’s pain on a modified visual analogue scale (MVAS), the start of the crying and total crying time during the immunization. Results: The A manufacturer’s DPT vaccine was significantly lower on the proportion of crying, the duration of crying and MVAS score than the other two manufacturer’s DPT vaccines. The proportion of crying, the duration of crying and MVAS score was lower in the boy than in the girl. On the other hand, it had not found the difference of their reactions with age. Conclusions: Our studies have found that the adequate choice of DPT vaccine decreased vaccination pain. The studies also indicate that some tendencies with vaccinations were shown in children. To consider these tendencies was useful in performing less painful vaccination.

Comparative Pertussis Antibody Response of Nigerian Children to Diphtheria, Pertussis, Tetanus (DPT) and Pentavalent Vaccines

Background: In Nigeria Pentavalent vaccine had replaced Diphtheria-Pertussis- Tetanus [DPT] vaccine in the prevention of pertussis since 2012. Aims and Objectives: The aim of this study was to compare the anti-pertussis immunoglobin G (IgG) response of children who received DPT with those who received the pentavalent vaccine. Subjects and Methods: This study was carried out in Akpabuyo LGA of Cross River State from April to June 2016. It was a cross-sectional survey of anti-pertussis IgG levels in children aged 6 months to 5 years who received DPT and those who received pentavalent vaccine. IgG antibody levels were determined using enzyme-linked immunosorbent assay. The protective level was set at >11 DU according to manufacturer’s cut off point. Results: Seventy eight out of 230 children [33.9%] who had received DPT had protective levels of anti-pertussis IgG compared to 74 out of 192 children [38.5%] who had received pentavalent vaccine. The difference was not statistically significant [p = 0.61]. The median IgG antibody level in those who received DPT was 8.0 DU (interquartile range (IQR) 4.0 - 13.0) compared with 9.0 DU (IQR) 4.0 - 15.0 in those who received pentavalent vaccine [p = 0.18]. No single factor investigated predicted the development of protective levels of antibody in the multivariate analysis. Conclusion/Recommendation: There was no difference in the antipertussis antibody response between DPT and pentavalent vaccines recipients. Further study is needed to elucidate factors that could be responsible for low anti-pertussis antibody response in this population.

临床药师防治新生儿破伤风及撤药综合征的循证用药实践

目的:探讨临床药师参与新生儿破伤风及撤药综合征的循证用药思路及监护要点。方法:临床药师参与1例新生儿破伤风及撤药综合征的药物治疗过程,对在家分娩的新生儿是否需预防破伤风和新生儿撤药综合征药物治疗进行证据检索。结果:临床药师建议预防用1500~3000 U破伤风抗毒素,并在确诊新生儿撤药综合征后给予苯巴比妥5 mg/(kg·d)维持治疗。临床医师采纳用药建议,患儿惊厥控制后停用苯巴比妥。患儿生命体征平稳出院,出院后3个月随访未再发生惊厥。结论:临床药师在针对临床治疗经验少和治疗方案有争议的用药问题上,充分结合最佳证据给予临床治疗依据,在促进新生儿临床安全、合理用药中发挥了一定作用。

咪达唑仑+机械通气治疗重症破伤风的疗效分析

目的探讨重症破伤风患者采用咪达唑仑+机械通气治疗的临床效果。方法随机选取2018年7月—2023年7月济南市第三人民医院收治的50例重症破伤风患者为研究对象,按照不同治疗方法分为参照组和研究组,每组25例。参照组采用硫酸镁等常规治疗,研究组在参照组基础上采用咪达唑仑+机械通气治疗。对比两组治疗总有效率、疼痛情况和并发症。结果研究组治疗总有效率[96.00%(24/25)]高于参照组[68.00%(17/25)],差异有统计学意义(χ^(2)=4.878,P<0.05)。治疗后,研究组疼痛评分(1.25±0.33)分低于参照组的(3.19±0.38)分,差异有统计学意义(t=19.273,P<0.05)。研究组并发症总发生率低于参照组,差异有统计学意义(P<0.05)。结论临床治疗重症破伤风患者,实施咪达唑仑药物联合机械通气疗法可提升重症破伤风患者的临床疗效,并有效缓解患者的疼痛程度,安全性较高。

吸附破伤风疫苗加强免疫后7天抗体水平变化

目的 明确吸附破伤风疫苗加强免疫后早期破伤风抗体(tetanus antibody, TAB)水平变化情况。方法 对2019—2021年在晋江市罗山街道社区卫生服务中心就诊的1978年以后出生的已完成含破伤风类毒素疫苗(tetanus toxoid-containing vaccine, TTCV)免疫规划5年以上的269例受试者加强免疫1剂破伤风类毒素(tetanus toxoid, TT),观察免疫后7 d TAB水平变化。结果 269例受试者中,加强免疫前TAB<0.01 IU/mL和0.01~0.09 IU/mL的受试者分别占29.4%和70.6%;加强免疫后7 d, TAB≥0.01 IU/mL的受试者达82.9%,TAB≥0.10 IU/mL的受试者达37.2%;加强免疫前后,不同TAB水平的受试者比例差异有统计学意义(χ2=123.05,P<0.001)。加强免疫后7 d,男、女性受试者中TAB≥0.10 IU/mL的受试者分别占35.6%和38.7%;12~<21岁、21~<31岁和31~42岁组受试者中TAB≥0.10 IU/mL的受试者分别占55.3%、36.8%和20.3%。结论 已完成全程TTCV免疫规划5年以上人群TT加强免疫后7 d约1/3的受试者可以获得有效免疫保护。