Abstract
The aims and objectives of this study were to study clinical profile and factors affecting
mortality in tetanus. This was a retrospective study of 25 tetanus patients (aged
6 months–12 years) admitted to pediatric intensive care unit of a tertiary center
(over 3 years). In this study, 25 tetanus cases (mean age 6.6 years) were analyzed;
16 were males and 9 were females. Incubation period ranged from 2 to 30 days (mean
8.2 days), period of onset from 11 to 120 hours (mean 42.8 hours), and duration of
spasms from 4 to 26 days (mean 14 days). The commonest portal of entry was posttrauma
(52%), followed by otogenic (40%). Eighteen patients had moderate and 7 had severe
tetanus. Fifteen were unimmunized and 10 were partially immunized. The commonest complaints
were trismus and spasms (100%), hypertonia (72%), fever (60%), dysphagia (48%), and
neck stiffness (44%). Eight patients required primary tracheostomy and 11 required
primary endotracheal intubation. Complications encountered were pneumonia (58%), conjunctivitis
(41%), gastrointestinal bleed (37.5%), urinary infection (33%), acute kidney injury
(AKI) following rhabdomyolysis (33%), sepsis (29%), disseminated intravascular coagulation
(DIC) (25%), bedsores (25%), and acute respiratory distress syndrome (ARDS) (20%).
Oral diazepam was most commonly used, followed by midazolam, vecuronium, and magnesium
sulfate. Mortality rate was 32% (five moderate and three severe cases died). Short
period of onset (less than 48 hours), AKI following rhabdomyolysis, sepsis, DIC, ARDS,
and inotrope need were significantly associated with higher mortality. It is concluded
that the commonest portal of entry was posttrauma. None of the patients was completely
immunized. Short period of onset, AKI, sepsis, DIC, ARDS, and inotrope need predicted
a higher mortality.
Keywords
autonomic disturbances - period of onset - trismus
