Tétanos secundario a mordedura y arañazo de gato en una paciente previamente vacunada / Tetanus after cat scratch and bites in a previously immunized patient

Tetanus is declining due to vaccination, professional labor management and appropriate wound care. Tetanus cases have been reported despite immunization. We report the case of a previously healthy 21 years old female patient that presented a mild generalized tetanus requiring admission after mild and recurrent cat scratch and bites. She had received six vaccine shots during childhood, and a booster dose five years earlier after a rabbit bite. Symptoms appeared seven weeks after the last contact, and included headache, muscle spasms and mild opisthotonus. Laboratory evaluation, including CSF analysis and microbiological investigation, as well as imaging studies were all normal. The patient received 6,000 IU of human antitoxin immunoglobulin. No autonomic manifestations or respiratory compromise were registered. Symptoms resolved rapidly and she was discharge after seven days with an order to complete a tetanus toxoid immunization schedule with three doses. Conclusions. Tetanus is possible in urban settings with a declining epidemiologic curve of disease in previously immunized patients. Severity of disease is modulated by previous vaccination.

El tétanos está en declinación gracias a la vacunación, manejo profesional del parto y el cuidado apropiado de las heridas. Se han reportado casos a pesar de la inmunización. Presentamos el caso clínico de una mujer previamente sana de 21 años que presentó un tétanos generalizado leve, luego de repetidas mordeduras y arañazos de su gato. Había recibido su esquema completo de seis dosis de vacuna antitetánica en la infancia y un refuerzo hacía cinco años luego de una mordedura por conejo. Los síntomas aparecieron siete semanas después del último contacto e incluyeron cefalea, espasmos musculares y opistótonos leve. La evaluación de laboratorio, incluyendo un estudio del LCR e imágenes fueron normales. La paciente recibió inmunoglobulina humana antitetánica. No hubo manifestaciones autonómicas ni compromiso respiratorio. Los síntomas regresaron rápidamente y se dio de alta a los siete días con indicación de completar tres dosis de vacuna antitetánica. Conclusiones: El tétanos es posible en ambientes urbanos con una curva epidemiológica en descenso en pacientes previamente inmunizados. La gravedad del cuadro es modulada por la vacunación previa.

Tétanos generalizado: caso clínico y revisión del tema / Generalized tetanus: clinical case report and review of the literature

Tetanus is a severe and potentially mortal disease, which affects the Nervous System, caused by the bacteria Clostridium tetani. It's endemic in developing countries, presenting in Chile with a rate of 0,02 cases per 100.000 habitants, but the antitetanic vaccine has reduced its incidence in developed countries. We present here a case report of a patient with generalized tetanus from our hospital. The clinical presentation was characterized by generalized increased muscle tone and trismus, and the patient was hospitalized in the Intensive Care Unit. The neurologic manifestations were important for a period of 3 weeks, but then they started decreasing until the patient was discharged, without complications and being able to sit and walk with assistance. In relation to this case, we will review the actualizations in the subject of Tetanus. The recommended treatment includes support therapy, prevention of complications, antibiotics, muscle relaxants and anti-tetanospasmin immunoglobulin; all therapies that our patient received partially. The disease has a mortality that reaches the 50 percent in some series, but the ones who survive have a good prognosis and full recovery. This is why the presentation of this case is important, being an infrequent disease that must be diagnosed timely and be treated adequately.

Introducción: El tétanos es una enfermedad grave y potencialmente mortal, que afecta al sistema nervioso y causada por la bacteria Clostridium tetani. Es endémica en países en desarrollo, teniendo en Chile el año 2007 una tasa de 0,02 casos por cien mil habitantes. La vacuna con el toxoide antitetánico ha disminuido ostensiblemente su incidencia en países desarrollados. Caso clínico: Se presenta el caso clínico de un paciente de 18 años con tétanos generalizado ingresado a nuestro hospital. Clínicamente se manifestó con un aumento del tono muscular generalizado y trismo. Se hospitalizó en la Unidad de Cuidados Intensivos. Los síntomas y signos neurológicos tuvieron una máxima intensidad de aproximadamente cuatro semanas; posteriormente fueron disminuyendo sin presentar complicaciones severas. Al alta el enfermo lograba sentarse y caminar con ayuda. Discusión: A propósito de este caso se hace una revisión de la literatura y actualización de esta grave enfermedad. El tratamiento recomendado incluye terapia de soporte, prevención de complicaciones, antibioterapia, relajantes musculares e inmunoglobulina antitetánica; terapias que este paciente recibió. Si bien esta enfermedad tiene una letalidad promedio de un 50 por ciento, los pacientes que sobreviven tienen buen pronóstico y recuperación completa. Por ello, la presentación de este caso clínico es importante, sobre todo siendo una condición poco frecuente, que debe diagnosticarse con prontitud y, así, recibir el tratamiento adecuado.

Tétano: quando a imunoprevenção falha / Tetanus: when vaccine prevention fails

O tétano é doença adquirida do sistema nervoso central pela contaminação de feridaspelo bacilo Gram positivo Clostridium tetani, presente em fezes de animais, solo, poeirae objetos enferrujados. O tétano, apesar de passível de imunoprevenção, ainda persistenos países em desenvolvimento, devido à cobertura vacinal incompleta e ao tratamentoinadequado de lesões traumáticas. Este trabalho descreve a evolução de pacienteatendido no Hospital Risoleta Tolentino Neves, com manifestações clínicas de tétano,caso em que a adequada abordagem terapêutica garantiu a cura. Alerta para a persistênciado tétano como doença grave e para a importância da observação do esquemavacinal e da correta abordagem de feridas.

Tetanus is a central nervous system disease, acquired by contamination of wounds by Clostridium tetani, a Gram positive bacillus present in animal feces, soil, dust and rusty objects. Although vaccine-preventable, the disease persists in developing countries, due to incomplete vaccine-coverage and inadequate treatment of traumatic injuries. This paper describes a case of a patient treated at Hospital Risoleta Tolentino Neves, with typi-cal clinical manifestations of tetanus, in whom the institution of an appropriate treatment contributed effectively to his healing. This case report highlights the persistence of tetanus in Brazilian context and aims to draw attention to the importance of observation of the immunization schedule and the correct approach to wound treatment.

Clinical classification of tetanus patients

The authors propose a clinical classification to monitor the evolution of tetanus patients, ranging from grade I to IV according to severity. It was applied on admission and repeated on alternate days up to the 10th day to patients aged > or = 12 years admitted to the State University Hospital, Recife, Brazil. Patients were also classified upon admission according to three prognostic indicators to determine if the proposed classification is in agreement with the traditionally used indicators. Upon admission, the distribution of the 64 patients among the different levels of the proposed classification was similar for the groups of better and worse prognosis according to the three indicators (P > 0.05), most of the patients belonging to grades I and II of the proposed classification. In the later reclassifications, severe forms of tetanus (grades III and IV) were more frequent in the categories of worse prognosis and these differences were statistically significant. There was a reduction in the proportion of mild forms (grades I and II) of tetanus with time for the categories of worse prognostic indicators (chi-square for trend: P = 0.00006, 0.03, and 0.00000) whereas no such trend was observed for the categories of better prognosis (grades I and II). This serially used classification reflected the prognosis of the traditional indicators and permitted the comparison of the dynamics of the disease in different groups. Thus, it becomes a useful tool for monitoring patients by determining clinical category changes with time, and for assessing responses to different therapeutic measures.

A Case of Maternal Tetanus in Korea

Tetanus is uncommon in Korea due to the introduction of vaccination programs and advances in public health. A case of maternal tetanus occurred on the 9 day postpartum in a 29-yr-old woman, who had not received a 10-yr-booster of tetanusdiphtheria toxoid after receiving the primary series of tetanus-toxoid-containing vaccine. There has hitherto been no reports on maternal tetanus in Korea. This case illustrates that tetanus remains a medical problem, principally among nonand underimmunized adults. The only way to fully prevent this disease is to ensure adequate immunization in all adults.

Tetanus- a community health problem in Hazara division

Prevalence, pattern, and prognosis of tetanus was studied in 100 admitted patients in Civil Teaching Hospital, Abbottabad between January 1992 to October, 1995. Tetanus was found to be more common in men and was more prevalent in summer. Survival of our tetanus patients was comparable with various centres equipped with intensive therapeutic supports, Prevention campaign need to be enforced to enhance mainly status of the community

Tétano simulando abdome agudo / Tetanus simulating acute abdomem

Foi apresentado o caso clínico de um paciente com tétano, internado com dor abdominal sugestiva de abdome agudo. Relatou-se o quadro clínico inicial, a operaçäo e a evoluçäo clínica e, concluiu-se que a suspeita do tétano como diagnóstico diferencial de dor abdominal facilitaria o diagnóstico precoce diminuindo a morbidade dessa afecçäo.

Botulinum toxin A for trismus in cephalic tetanus

O tétano cefálico é uma forma localizada de tétano. Da mesma maneira que nas formas generalizadas, o trismo é componente clínico, proeminente, leva a grande dificuldade na alimentaçäo, na deglutiçäo da saliva e para a higiene da boca. Essas dificuldades frequentemente precedem os problemas respiratórios e as pneumonias aspirativas, que se constituem em complicaçöes que ameaçam a vida dos pacientes. Drogas relaxantes musculares de outro tipo que as drogas curarizantes trazem pouco benefício para o trismo. A neurotoxina tetânica (tetanospasmin) e a toxina botulínica compartilham muitas semlhanças, como estrutura química símile, origem de microorganismos relacionados (clostridium tetani e Clostridium botulinum, respectivamente) e, presumivelmente, os mesmos mecanismos de açäo no neurônio. A diferença entre as duas reside na sua peculiar neuroespecificidade, atuando em diferentes neurônios. Injeçäo de doses reduzidas da toxina botulínica em músculos envolvidos em distonias focais ou outras desordens com espasticidade muscular localizada tem se mostrado eficaz em abolir as contraçöes. Descrevemos o uso da toxina botulínica A com sucesso no tratamento do trismo num paciente sofrendo de tétano cefálico. Acreditamos que esta forma de tratamento possa ser de valor no sentido de diminuir o risco de complicaçöes pulmonares nos pacientes com tétano

Tétano pós-cirúrgico: relato de caso / Postoperative tetanus

Os autores apresentam caso de tétano pós-cirurgico com evoluçäo benigna a atençäo para a possibilidade de, em determinadas situaçöes, este tipo de tétano dever-se à contaminaçäo por fontes diferentes daquelas relacionadas à intrvençäo cirúrgica

Betamethasone in tetanus patients: an evaluation of its effect on the mortality and morbidity.

The effect of betamethasone on the outcome in moderate to severe tetanus was studied in a randomised, double blind, placebo controlled study in 22 patients. The mortality rate was reduced by 36.1% with the addition of corticosteroids to the regime of treatment. Betamethasone did not alter the duration of intensive care in those requiring it, but reduced the need for tracheostomy and ventilation. The mean daily dose of diazepam required was not significantly different between the two groups and there was no increase in the incidence of infections in the betamethasone group.

Le tetanos chez l'enfant : aspects epidemiologique; clinique et therapeutique : a propos de 784 cas

Toxi-infection tres meurtriere; le tetanos demeure une calamite chez l'enfant dans les pays en voie de developpement. A partir de 784 cas observes sur 10 ans a la clinique de pediatrie de Cotonou; les auteurs font le point sur l'epidemiologie; les aspects cliniques et therapeutiques du tetanos. La frequence est de 2;36 pour cent des hospitalisations. Le tetanos atteint surtout les nouveau-nes et les enfants de 5 a 10 ans provenant des milieux socio-economiques defavorises. A defaut de l'arsenal therapeutique moderne rencontre dans les pays developpes la seule solution pour les pays en developpement pour reduire l'incidence du tetanos est la vaccination. Ceci explique la baisse reguliere de la prevalence du tetanos depuis l'institution du programme elargi de vaccination

Tétano: uma revisäo / Tetanus: a review

Os autores fazem uma revisäo dos casos de tétano registrados no Hospital Universitário Federal de Juiz de Fora (HU/UFJF), no período de agosto de 1972 a abril de 1990, procurando ainda, abordar as atuais perspectivas terapêuticas da doença.

Tratamento do tétano severo com síndrome de hiperatividade adrenérgica controlada com labetalol: apresentaçäo de um caso / Treatment of severe tetanus with adrenergic hiperactivity syndrome controled with labetalol: report of a case

Caso de tétano severo com síndrome de hiperatividade adrenérgica, tratado na UTI do Departamento de Pediatria do Hospital do Servidor Público Estadual - SP. Os distúrbios cardiovasculares foram controlados pela administraçäo de labetalol, droga anti-hipertensiva com efeito alfa e beta bloqueador

Chlorpromazine versus diazepam in the treatment of tetanus

This is a comparative study which deals with the management of tetanus by chlorpromazine versus diazepam. Fifty tetanus cases were studied. The males [62%] were more affected than females [38%]. All ages were nearly affected. Most of the admitted cases were of severe degree the main clinical signs were risus sardonicus [92%], trismus [100%], convulsions [96%] and rigidity [98%]. Besides anti-tetanic serum and pencillin or ampicillin therapy, the patients were classified in a randomised rotational manner into either chlorpromazine or diazepam therapy. In chlorpromazine group, risus sardonicus subsided after an average of 10 days, mean [9.9 + 1.6 days], trismus subsided after an average of 7 days means [6.9 + 1.6 days], convulsions subsided after an average of 6 daysmean [6.1+1.3 days], and rigidity subsided after an average of 13 days mean [12.4+1.5]. The case fatality rate was 36%. In the diazepam group, risus sardonicus subsided after an average of 10 days, mean [9.5+1.6], trismus subsided after an average of 6 days, mean [6.4+0.5 days], convulsions subsided after an average of 4 days, mean [4.2+0.8days] and rigidity subsided after an average of 11 days, mean [11+3.4 days], the case fatility rate was 28%