The clinical course and outcome of generalized tetanus: A 5 - year - experience from the medical intensive care unit, Siriraj Hospital.

ABSTRACT

A retrospective analysis of patients with tetanus who were admitted to the Medical ICU during January 1995 - December 1999 is reported. The aims were to examine potentially different clinical course as well as outcome. Of 21 patients, 16 were male and 5 were female. The mean age was 44.3 +16 years. The site of infection was noted in 17 patients; and of these, 8 patients sought medical care where tetanus toxoid was given but not passive immunization. The mean incubation period was 6.1 + 8.7 days (range 4-30 days) while the mean period of onset was 3 + 2.7 days (range 1-13 days). Seven patients (33%) died. Six of them had pneumonia as a cause while the other one died from hyperkalemia. The cause of pneumonia in 5 patients was ventilator associated and the other had severe pneumonia following bronchopulmonary aspiration. Early cardiac arrest occurred in 3 patients, two resulted from bronchopulmonary aspiration and one from hyperkalemia. The mean ICU stay was 17 + 24.6 days and the mean duration of ventilation was 12.3 + 24.9 days. The mean cost of treatment was 112,207 + 100,194 baht (range 7,259 - 200,165 baht). In conclusion, tetanus can occur despite post-exposure medical care and the outcome as judged by mortality rates, ICU stays, complications and costs were not satisfactory. Proper post-exposure wound care and immunization needs to be emphasized. Strict adherence to management guidelines regarding the care of these patients and prevention of nosocomial infection are necessary. New treatment modalities which could shorten the disease course or reduce the need to paralyze and provide respiratory support would be useful in improving the patients' outcomes.