Tetanus: presentation and outcome in adults

Tetanus is still a common clinical entity, especially in developing countries. The purpose of this study was to evaluate the presenting features as well as the outcome of tetanus in adult patients admitted to the hospital. This was a hospital based descriptive study conducted at the Infectious Diseases Unit, Rashid Hospital Dubai, United Arab Emirates from Jan. 2003 to Dec. 2008. The study was designed to include demographics, clinical information and outcome observed in the patients admitted with clinical diagnosis of tetanus. Patients with malignancy, immunosuppression [AIDS/Drugs], significant cardiac dysfunction and renal impairment were excluded. The patients were treated as per the standard protocol for the management of tetanus. A total of 44 patients were enrolled into the study. The mean age+SD of the patients were 26.3+5.8 years and all of the study patients were males. Thirty six [81.81%] patients gave the history of injury prior to onset of the symptoms, whereas eight [18.18%] patients were unable to recall any history of injury. All the study patients were laborers working in construction companies except for four who were gardeners. Body stiffness/spasm, difficulty in opening the mouth, difficulty in swallowing, body pain, neck pain and backache were the main presenting complaints. The patients with upper limb injuries had shorter incubation period and more severe disease with high frequency of autonomous nervous system insufficiency. Overall, hospital stay was 46.6+11.4 days. Forty [90.9%] patients required mechanical ventilation. The mean+SD ICU stay was 26.4+5.8 days and on weaning all the ventilated patients required tracheostomy. Eight [18.18%] patients died as a result of ventilator associated complications [Pneumonia] and autonomic nervous system dysfunction. Tetanus still carries high morbidity and mortality rate despite the available advanced management facilities including ICU care. The incidence of tetanus can be reduced significantly by an effective immunization program and proper wound management of the patients

Typhoid fever with hepatic and extrahepatic manifestations

Hepatic involvement is not uncommon in typhoid fever. We report a case of typhoid fever complicated by acute hepatitis, acute choliangitis, acute acalculous cholecystitis, anaemia and severe thrombocytopenia [platelets 1x10[3]/ul]. He received antibiotics, steroids, immunoglobulin, multiple platelet and packed RBC transfusion. Fever responded and blood parameters started improving after 16th day of the treatment and patient was discharged healthy on 21st day of the admission. In conclusion, hepatic dysfunction with jaundice is a serious development in typhoid fever and patient may take longer time to respond to treatment