Tetanus in adult population: uncommon modes of transmission

ABSTRACT

To document and evaluate various injuries leading to tetanus in adults. Retrospective study involving indoor patients with tetanus. Tetanus section of medical Ward of Mayo Hospital, /K.E.Medical College, Lahore. Ninety one patients admitted in the ward in the year 1997. Main outcome measures: Some unreported wounds possibly leading to tetanus in adults. There was male preponderance [MF = 1.51] Majority [93.4%] were be low the age of 60 years and 75 patients [82.4%] were below the age of 50 years. Fifty six [61.5%] patients were from urban slums and 35 [38.5%] were from rural areas and none from posh localities. Eighty six [94.5%] were not vaccinated and 5 [5.5%] were not sure of having vaccination against tetanus. Commonest site of the wound was on foot and leg [46.1%] followed by uterus and vagina [26.4%], other sites being arm [12.1%] hand, [11%] nose, head, thigh and back 1.1% each. Commonest type of wound was roadside accident [37.3%], illegally induced abortions, delivery and post delivery handling [26.4%]. Other unusual wounds were nail injuries [7.7%] elective surgery [5.5%] firearms and crackers [4.4%]. I/M. injections [4.4%] thorn [3.3%] electiricshock [2.2%] scratch of hen paw [2.2%], dog bite [1.1%]. No cause found in 5 [5.5%] patients. Mean stay in the ward was 33.6 +/- 19.2 days. Fifty [55%] patients recovered completely and were discharged home. The mortality was 42.8% and 2.2% left the ward against medical advice. Besides common injuries, that can lead to tetanus, uncommon wounds of firearms and crackers, illegally induced abortions [dai] mis-handling, tubal ligation, IUCD etc. have not been reported in the past to cause tetanus, and should not be overlooked. Most of the survivors had longer incubation period. Severe and fatal tetanus was noted in patients with shorter incubation period