Complete elimination of tetanus is still elusive in developing countries: a review of adult tetanus cases from referral hospital in Eastern Nepal.

AIM To analyse demography, clinical presentation, treatment, complications and outcome of patients with tetanus over a 2-year period. MATERIALS AND METHODS A retrospective analysis of medical records of all patients with tetanus admitted to the intensive care unit of B.P Koirala Institute of Health Sciences, Dharan, Nepal between July 2004 and June 2006. RESULTS Tetanus accounted for 1.1 % of our ICU admission. Eight tetanus patients (mean age 52 years; M: F ratio 7:1) were admitted. The tetanus prone wounds of seven patients were managed at home. The most common presenting complaints were trismus and stiffness of neck and back (87.5%). Elective intubation was followed by tracheostomy in all the patients. Overall mean duration of ventilatory support was 12.5 days. Treatments given in ICU were diazepam, magnesium sulphate, tetanus immunoglobulin, metronidazole, wound management and supportive measures. Five patients (62.5%) developed autonomic instability and three patients had ventilatory associated pneumonia (37.5%). Average ICU stay was 15.1 days while hospital stay was 20.1 days. Five patients (62.5%) survived the course of disease. Two patients (25%) left the hospital against medical advice while the other (12.5%) died in ICU. CONCLUSION Tetanus is a vaccine preventable disease. Tetanus prone wounds should be managed appropriately. Respiratory compromise and autonomic instability are the main causes of morbidity and mortality. Early recognition, intense support and prompt treatment improves morbidity and mortality of patients diagnosed with tetanus.