Tetanus in adults: a review of 85 cases at Chon Buri Hospital.

From 1988 to 1999, 85 cases of adult tetanus were admitted to the medical service of Chon Buri Hospital. The male to female ratio was 2.2:1. In 50 patients disease was severe enough to require paralysis and artificial ventilation. Fourteen patients needed diazepam and artificial ventilation but not paralysis; and in twenty-one the condition was mild, requiring diazepam only. Eleven patients died, all of them had severe grade of tetanus. The mortality rate was 12.9 per cent. In 70 patients a wound was the source of infection, most of which were minor, often receiving no medical attention. No wounds or obvious source of infection could be found in 15 patients. Tetanus is a preventable disease. The treatment of tetanus is time-consuming and costly and there is still a considerable mortality rate. In moderate to severe cases, the patients usually have to spend three to four weeks in an intensive care unit.

Puffer fish poisoning: clinical features and management experience in 25 cases.

Between 1989 and 1999, 25 cases of puffer fish poisoning (PFP) were admitted to the medical service of Chon Buri Hospital. The severity of the poisoning was classified into four stages based on clinical signs and symptoms of PFP. Of the 25 patients, 23 were males and 2 were females. Three patients were in stage 1, four were in stage 2 and eighteen were in stage 4. Paresthesia was the early presenting complaint of all patients. Paresthesia consisting of either numbness or tingling of lips, tongue, around the mouth, hands, and feet. Muscle weakness, dizziness, vertigo, nausea and vomiting were common complaints. Eighteen patients developed acute flaccid paralysis and respiratory failure requiring ventilatory support. All patients received symptomatic and supportive treatment and general supportive care, including gastric lavage and intravenous fluid. Intubation and mechanical ventilation was considered especially when paralysis was progressing rapidly. Most were taken off the respirator 12-48 hours later. All patients completely recovered without any sequelae. Clinical features of PFP, toxicity of puffer fish and management were discussed.

An outbreak of horseshoe crab poisoning in Chon Buri, Thailand: clinical, toxicologic and therapeutic considerations.

In 1994-1996, an outbreak of horseshoe crab poisoning by eating toxic eggs of the horseshoe crab Carcinoscorpius rotundicauda affected over 100 persons in Chon Buri which located on the eastern coast of Thailand. We discuss clinical description and management of this first major outbreak. The responsible toxin has been partially purified by means of ultrafiltration and high performance liquid chromatography. The horseshoe crab toxin is identified as tetrodotoxin (TTX) and anhydro TTX.

An epidemic of tetrodotoxin poisoning following ingestion of the horseshoe crab Carcinoscorpius rotundicauda.

At certain seasons of the year in Thailand, the horseshoe crab Carcinoscorpius rotundicauda may be toxic to human and fatal poisoning occasionally occur. Tetrodotoxin (TTX) and its derivatives were major toxins in the toxic eggs of the horseshoe crab. An epidemic of poisoning by eating toxic eggs of the horseshoe crab affected 71 persons in Chon Buri which located in the eastern coast of Thailand. Patients generally presented with neurologic symptoms such as paresthesia, vertigo, weakness, respiratory paralysis, altered consciousness with unreactive dilated pupils in addition to gastrointestinal symptoms such as nausea and vomiting. Nineteen patients required artificial ventilation and there were two deaths. This is the first large outbreak of tetrodotoxin poisoning recognized in Thailand.

Pelagic paralysis from puffer fish poisoning.

A case of severe puffer fish poisoning was reported. After ingestion of puffer fish, symptoms develop rapidly with paralysis of the whole body, respiratory distress and nonreactive dilated pupils. After ventilatory support, the patient gradually recovered to normal activity within 48 hrs.

Neuroleptic malignant syndrome: a report of a case and review of the literature.

A case of NMS was reported. NMS is an uncommon but potentially lethal complication of treatment with neuroleptics. The diagnosis of NMS should seriously be considered in any individual receiving neuroleptic medications who develops unexplained fever associated with muscle rigidity. The discontinuation of neuroleptics and the use of general supportive measures are crucial. On the basis of more rapid clinical response, either bromocriptine or dantrolene could be added to traditional supportive care.

Vogt-Koyanagi-Harada syndrome.

Clinical analysis was done in 7 cases of Vogt-Koyanagi-Harada syndrome. Nearly all of the patients were Thai women. The most common manifestation was headache and blurred vision. CSF pleocytosis without meningeal irritation signs were encountered in every cases. Ophthalmological, neurological and otological findings responded, in 2-4 weeks, to the systemic administration of high dose corticosteroids.