Tetanus after application of traditional topical treatment to a severe burn.

A 2-year-old child was accompanied by his parents to the pediatric emergency room for refusal to eat, trismus and generalized contractures four days after the application of a traditional topical treatment (Cassava leaves) on lesions of a severe thermal burn. A temperature of 38̊C, a heart rate of 114 beats/min, and a blood pressure of 90/60 mm Hg were recorded. The tetanus vaccination was not up to date. The diagnosis of tetanus was immediately suggested. Antitetanus serum (immunoglobulin), an antibiotic (amoxicillin and clavulanic acid), and a myorelaxant (benzodiazepine) were administered. Local treatments were also performed. The child died within 24 hours.

[Severe PERM syndrom mimicking tetanus]. / PERM syndrome sévère mimant un tétanos.

We report the case of a 55-year-old man without significant medical history admitted to the ICU for a progressive paralysis mimicking life-threatening tetanus. Evolution with classical tetanus treatment was negative, with the need for ventilator support and worsening condition being life threatening. Uncommon evolution revealed a rare glycin antibody-associated hyperekplexia (progressive encephalomyelitis with rigidity syndrome). Patient dramatically improved with immunosuppressive therapy including plasmatic exchanges, cyclophasmid and high dose corticoid infusions. Intensivists should be aware of this very rare syndrome whose treatment is the opposite of tetanus while presentation is very close. Optimal and treatment could lead to prolonged survival.

Amputation and disability following snakebite in Nigeria.

Snakebite is an important cause of amputation and disability in rural communities throughout the tropics. However, the details of the causes, types and estimates of disability are lacking. This report describes 16 snakebite victims who had amputations, including two who had above-knee amputations. The patients presented with limb swelling (16), gangrene (15), ischaemia (4) and three had possible compartment syndrome. All the patients used ineffective time wasting remedies that were potentially harmful as first-aid. The median delay to hospital following bite was 2.5 days. In order to prevent disability, efforts should be made to: reduce delay before hospital presentation; improve the knowledge of first-aid; provide effective antivenoms; improve wound and clinical care in communities; and improve facilities.

[Generalized tetanus with otitic portal of entry after using intra-auricular traditional remedies in a 2 old child]. / Tetanos généralisé à porte d'entrée otitique, suite à l'utilisation de topiques traditionnels intra-auriculaires chez un enfant de 2 ans.

A case of tetanus with uncommon way of contamination was found in the paediatric department of the Yopougon teaching hospital in Côte d'Ivoire. A two-year-old child, without vaccination against tetanus and suffering from a chronic otitis presented a generalized tetanus, after the use of traditional local remedies in his ear. Through this observation, the authors want to make population aware of the detrimental effects of traditional local auricular remedies and want to advise all physicians to make a serotherapy and/or a vaccination against tetanus to all children with chronic otitis in our area.

Neonatal tetanus in Turkey; what has changed in the last decade?

BACKGROUND: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. METHODS: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. RESULTS: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. CONCLUSION: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.

Tetanus complicating snakebite in northern Nigeria: clinical presentation and public health implications.

BACKGROUND: There is inequality in vaccination coverage, and adult farmers in tropical rural communities could have missed tetanus toxoid as campaigns target children. Snakebite is not uncommon and partly because of lack of effective antivenom, management in inaccessible areas could be complicated with tetanus in unimmunized victims. PATIENTS AND RESULTS: Four snakebite victims who developed tetanus were seen in northern Nigeria. Three were bitten while farming and patients took 10-25 days before presenting to hospital. All patients had incised bite sites and applied local medicinal herbs and in one case, a black 'snake' stone. Bites were by the cobra (Naja nigricollis) and carpet viper (Echis ocellatus) in the extremities and victims had swollen limbs and bleeding with incoagulable blood. Three of the patients were given anti-tetanus serum (ATS) after development of tetanus symptoms in a primary facility and only one recalled receipt of one dose of tetanus toxoid prior to bite. Patients had trismus, rigidity, backache, spasms and one had autonomic dysfunction and was managed with antispasmodics, ATS, wound care, antibiotics and supportive measures. Two patients with envenoming and severe tetanus received antivenom, but died. One of the two surviving patients developed osteomyelitis with prolonged hospital stay, while the other recovered with residual disability. CONCLUSION: Tetanus could follow snakebite in inaccessible rural agricultural communities with inadequate health care provision. Clinical presentation is typical but late and is confounded by snakebite complications leading to considerable morbidity and mortality. The cases highlight the triple problems of inadequacy, inaccessibility and inequality in health care and calls for measures aimed at improvement.

Tétanos asociados a acupuntura: a propósito de un caso / Tetanus associated with acupucture: a purpose of a case

Se describe el caso de un paciente femenino de 32 años de edad, con antecedente de inserción de guías de acupuntura en región pre-auricular quien ingresó al departamento de Medicina Interna Hospital Central de la F.A. Dr. Carlos Arvelo" con dolor y contractura muscular generalizada. Se apreciaron lesiones micronodulares en pie y aumento del tono muscular en cuello, maseteros, abdomen, región dorso lumbar, cuadriceps, así como opistótonos a la estimulación del raquis. Se planteó el diagnóstico de tétanos. Se realiza una discusión clínica del caso

Neonatal tetanus in the southeast of Turkey: risk factors, and clinical and prognostic aspects. Review of 73 cases, 1990-1999.

Although neonatal tetanus (NT) can be prevented by immunization of expectant mothers and by good hygiene and asepsis during delivery, it is still a common cause of neonatal mortality in developing countries. The objective of this study was to determine indicators in NT. We reviewed the clinical records of 73 neonates admitted to the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, Turkey, with the diagnosis of NT. Delivery had occurred at home by untrained traditional birth attendants in all cases. None of the mothers had immunization with tetanus toxoid during pregnancy. The median age of infants at presentation was 7.3 days and the mean age at onset of symptoms was 5.6 +/- 2.8 days. The overall mortality was found to be 52 percent. Mortality was significantly associated with an incubation period of 4.3 days or less and fever. The incidence of NT in Turkey is on the decline due to widespread tetanus toxoid use in pregnant women, but in some regions, especially in the so-called rural poor areas, there is still risk of preventable diseases. Hygienic deliveries and immunization of pregnant women are very important for the prevention of NT deaths, and universal prenatal care, including education programs on appropriate perinatal and cord care, can significantly reduce NT incidence and mortality in developing countries.

Epidemiologia del Tetanos Neonatales en Bolivia / Epidemiology the neonatal tetanus in Bolivia

En Bolivia se dan las condiciones culturales, sociales y ambientales para que se presenten casos de Tetanos neonatal y son alarmante algunas practicas de la medicina tradicional. Este trabajo enfoca el problema sobre la base informativa de los registro de 157 establecimiento de salud de los 9 Departamentos del pais del trienio 1986 y 88, identificando, segun sus caracteristica ambientales, las regiones de mayor riesgo de infeccion que corresponden sobre todo a los llanos sub-tropicales y tropicales, no observandose casos sobre los 2.000 metros de altitud. El Tetano neonatal es un serio problema de salud, siendo la tasa promedio de incidencia anual 0.43 x 10.000 h.: la mayor parte de los 430 casos registrados en los tres anos, provenian del area rural, de partos atendidos por el personal no capacitado con madres no inmunizadas. La letalidad es muy alta y sobre pasa el 50 por ciento. Un hecho llamativo fue la ausencia de adecuados registros en los Centros de atencion de Salud que hace dificil cualquier conclusion

Risk factors of neonatal tetanus in Senegal.

A case-control study for evaluating the risk factors of neonatal tetanus was conducted in a rural area of Senegal under demographic surveillance (Niakhar). Some 45 neonatal tetanus deaths that occurred in the study area between March 1983 and March 1986 were investigated. They were matched with 187 controls. Neonatal tetanus accounted for one-third of all neonatal deaths; mortality from neonatal tetanus was 16/1000 livebirths. The effect of various demographic, socioeconomic, epidemiological and behavioural factors was investigated in a multivariate analysis using linear logistic regression. There was no difference associated with socioeconomic factors between cases and controls. Factors associated with the skill and behaviour of birth attendant and mother were highly significant and were associated with high odds ratio (OR) and included whether the hands of the person cutting the cord were washed with soap (OR = 5.22; p = 0.001); whether the person who dressed the cord was skilled (OR = 4.71; p = 0.012); whether the age of the mother was less than 18 years (OR = 7.03; p = 0.027) and whether the birth attendant arrived before delivery (OR = 4.15, p = 0.023). Conversely, the type of tool used to cut the cord did not have a significant effect (p = 0.239). Data analysis suggests that a main source of Clostridium tetani may be the hands of the birth attendant and that the main mode of contamination may be the dressing of the wound stump. Results suggest that teaching mothers and birth attendants simple hygienic principles and basic techniques may have a significant impact on neonatal tetanus mortality.

Tetanus after induced abortion--a case report.

A case of tetanus occurring after induced abortion is reported. The patient gave a history of low grade fever with chill and rigors, headache, neck pain and Trismus. She subsequently developed respiratory distress. However, incorrect information from the patient resulted in the delay to locate and eradicate the source of infection. Early referral to an intensive care unit for ventilatory assistance was the most appropriate step to save the patient. Complications which occurred during the course of the disease were sometimes difficult to overcome. These complications were probably related to the duration of stay in the intensive care unit. Their incidence could be reduced by more meticulous patient care.