ABSTRACT
Tetanus is a serious and potentially fatal systemic disease, caused by the bacterium Clostridium tetani. It is estimated that 1 million cases occur worldwide annually. Immunization programs have drastically decreased tetanus in developed countries, and the sporadic cases have been linked to injecting drug users (IDUs), immunosuppressed individuals, or those older than 65 without complete vaccination. Regrettably, it is still endemic in under-developed countries. In Spain, an average of 10 cases are notified each year, especially affecting those older than 65. The present article describes a case of a 48-year-old Spanish woman, an ex-convict and IDU with infection antecedents of Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV), who was admitted to the Emergency Department of a University Hospital with cervical rigidity and trismus. In a few hours, a neurological and respiratory deterioration was observed, resulting in admittance to the intensive care unit under the suspicion of a generalized tetanus infection. The treatment included hemodynamic support and respiratory therapy, antibiotics, muscle relaxants, sedatives, and tetanus immunoglobulin. Her stay in the ICU lasted 47 days. The clinical suspicion, the antecedents of risk, and the verification of the vaccination records should provide early guidance for diagnostics and the establishment of a treatment in these cases.
ABSTRACT
La atención a las heridas de riesgo tetanígeno en los servicios de urgencias suele incluir la administración de gammaglobulina y/o vacuna antitetánica. La prueba de detección rápida de anticuerpos frente a tétanos (Tetanus Quick Stick [TQS]) podría mejorar la práctica clínica habitual al identificar a las personas no inmunizadas. Nuestro objetivo es analizar la validez de la prueba diagnóstica TQS y su coste-beneficio según la literatura disponible. Realizamos una búsqueda en las bases de datos WoS, PubMed, EMBASE y SCOPUS. Tras aplicar criterios de inclusión y exclusión, se recuperaron 20 artículos, la mayoría de ellos europeos y redactados por servicios de urgencias. El rango de los test de sensibilidad oscila entre el 55-100%, el de especificidad entre el 66,6-100%, el VPP: 81,1-100% y el VPN: 42,9-100%. La mayoría de estudios avalan el coste-beneficio de la aplicación del TQS. Creemos que el uso del TQS en urgencias sería recomendable y un ejemplo de buena práctica clínica
Standard procedure when treating tetanigenic risk wounds in an emergency room setting, usually includes administering a dose of gamma-globulin or/and a tetanus vaccine. The rapid detection test (Tetanus Quick Stick [TQS]) can better the current procedure of detecting people who are not immunized. Our objective was to review and analyse the validity of the TQS test, and determine the cost-benefit with the data available. We searched the following data bases for information: WoS, PubMed, EMBASE & SCOPUS. After reviewing articles and applying inclusion/exclusion criteria, we included 20 articles mostly European and written by Emergency room services. Sensitivity ranged from 55%-100%, specificity from 66.6%-100%, PPV: 81.1%-100%, NPV: 42.9%-100%. Most of the tests supported the cost-benefit analysis of the TQS test. We determined that in emergency room situations, it would be beneficial to use the TQS test, and an example of good clinical practice
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Tetanus/diagnosis , Early Diagnosis , Reproducibility of Results , Tetanus/immunology , Emergency Medical Services , Cost-Benefit Analysis , Tetanus/prevention & control , Tetanus Toxoid/immunology , Wounds and Injuries/immunologyABSTRACT
Standard procedure when treating tetanigenic risk wounds in an emergency room setting, usually includes administering a dose of gamma-globulin or/and a tetanus vaccine. The rapid detection test (Tetanus Quick Stick [TQS]) can better the current procedure of detecting people who are not immunized. Our objective was to review and analyse the validity of the TQS test, and determine the cost-benefit with the data available. We searched the following data bases for information: WoS, PubMed, EMBASE & SCOPUS. After reviewing articles and applying inclusion/exclusion criteria, we included 20 articles mostly European and written by Emergency room services. Sensitivity ranged from 55%-100%, specificity from 66.6%-100%, PPV: 81.1%-100%, NPV: 42.9%-100%. Most of the tests supported the cost-benefit analysis of the TQS test. We determined that in emergency room situations, it would be beneficial to use the TQS test, and an example of good clinical practice.