Tetanus natural history: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
Tetanus results in death in almost 10-20% of cases. The rate of death is higher among older people. The fatality rate of tetanus might be associated with prolonged [[contractions]] and [[convulsions]].<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223 }} </ref> In the recent years:<ref>{{Cite journal | Tetanus results in death in almost 10-20% of cases. The rate of death is higher among older people. The fatality rate of tetanus might be associated with prolonged [[contractions]] and [[convulsions]]. Tetanus without [[spasm]]s has an excellent prognosis.<ref name="pmid25149223">{{cite journal| author=Thwaites CL, Beeching NJ, Newton CR| title=Maternal and neonatal tetanus. | journal=Lancet | year= 2015 | volume= 385 | issue= 9965 | pages= 362-70 | pmid=25149223 | doi=10.1016/S0140-6736(14)60236-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25149223 }} </ref> In the recent years:<ref>{{Cite journal | ||
| author = [[C. Louise Thwaites]], [[Nicholas J. Beeching]] & [[Charles R. Newton]] | | author = [[C. Louise Thwaites]], [[Nicholas J. Beeching]] & [[Charles R. Newton]] | ||
| title = Maternal and neonatal tetanus | | title = Maternal and neonatal tetanus | ||
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}}</ref> | }}</ref> | ||
*The case fatality rate of non-neaonatal tetanus is 8-50%. | *The case fatality rate of non-neaonatal tetanus is 8-50% in the developing countries. | ||
*According to one study the case fatality rate is 11%. | |||
*The mortality rate of neonatal tetanus is 3-88%. | |||
*Most commonly fatal cases are found in: | *Most commonly fatal cases are found in: | ||
**Individuals of age 60 years or older (approximately 18%) | **Individuals of age 60 years or older (approximately 18%) | ||
Revision as of 20:57, 1 June 2017
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Risk calculators and risk factors for Tetanus natural history |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Tetanus can have an incubation period of 2 to 38 days with the man being 7 to days post exposure. The presentation and progression may vary depending on the type tetanus. Generalized tetanus can involve the respiratory muscles making it difficult to breathe. The complications of tetanus include fractures, laryngospasm, aspiration pneumonia and pulmonary embolism.Tetanus has a fatality rate of almost 11%. The fatality rate of tetanus might be associated with prolonged convulsions and contractions.[1]
Natural History
Tetanus can have an incubation period of 2 to 38 days with the man being 7 to days post exposure. Patients with generalized type can have spasmodic contractions of the muscles associated with inability to breathe an thus apnea develops. This can lead to the death of the individual if not addressed immediately.[1][2]
Complications
There are many complications associated with tetanus infection. Some of the complications are as follows:[3][4]
- Laryngospasm
- This can be associated with spasms of the muscles of respiration which leads to breathing difficulties.
- Fractures of the spine or long bones
- This may result from prolonged contractions and convulsions
- Hyperactivity of autonomic nervous system
- This may lead to an abnormal heart rhythm and/or hypertension
- Nosocomial infections
- Common because of prolonged hospitalization
- There are commonly some secondary infections including:
- Sepsis from indwelling catheters
- Hospital-acquired pneumonia
- Decubitus ulcers
- Pulmonary embolism
- Apparent in drug users and the elderly
- Aspiration pneumonia
- Common late complication
- Found in 50%-70% of autopsied cases
Prognosis
Tetanus results in death in almost 10-20% of cases. The rate of death is higher among older people. The fatality rate of tetanus might be associated with prolonged contractions and convulsions. Tetanus without spasms has an excellent prognosis.[1] In the recent years:[5][6][7]
- The case fatality rate of non-neaonatal tetanus is 8-50% in the developing countries.
- According to one study the case fatality rate is 11%.
- The mortality rate of neonatal tetanus is 3-88%.
- Most commonly fatal cases are found in:
- Individuals of age 60 years or older (approximately 18%)
- Unvaccinated people (approximately 22%)
- In about 20% of deaths, no obvious pathology is detected
- Death is attributed directly to the direct effects of tetanus toxin
References
- ↑ 1.0 1.1 1.2 Thwaites CL, Beeching NJ, Newton CR (2015). "Maternal and neonatal tetanus". Lancet. 385 (9965): 362–70. doi:10.1016/S0140-6736(14)60236-1. PMID 25149223.
- ↑ "Tetanus | Symptoms and Complications | Lockjaw | CDC".
- ↑ J. J. Farrar, L. M. Yen, T. Cook, N. Fairweather, N. Binh, J. Parry & C. M. Parry (2000). "Tetanus". Journal of neurology, neurosurgery, and psychiatry. 69 (3): 292–301. PMID 10945801. Unknown parameter
|month=ignored (help) - ↑ Andreas Rummel, Steffen Bade, Jurgen Alves, Hans Bigalke & Thomas Binz (2003). "Two carbohydrate binding sites in the H(CC)-domain of tetanus neurotoxin are required for toxicity". Journal of molecular biology. 326 (3): 835–847. PMID 12581644. Unknown parameter
|month=ignored (help) - ↑ C. Louise Thwaites, Nicholas J. Beeching & Charles R. Newton (2015). "Maternal and neonatal tetanus". Lancet (London, England). 385 (9965): 362–370. doi:10.1016/S0140-6736(14)60236-1. PMID 25149223. Unknown parameter
|month=ignored (help) - ↑ Martha H. Roper, Jos H. Vandelaer & Francois L. Gasse (2007). "Maternal and neonatal tetanus". Lancet (London, England). 370 (9603): 1947–1959. doi:10.1016/S0140-6736(07)61261-6. PMID 17854885. Unknown parameter
|month=ignored (help) - ↑ M. H. Trujillo, A. Castillo, J. Espana, A. Manzo & R. Zerpa (1987). "Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases". Chest. 92 (1): 63–65. PMID 3595250. Unknown parameter
|month=ignored (help)