Tetanus natural history: Difference between revisions
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==Overview== | ==Overview== | ||
Tetanus can have an incubation period of 2 to 38 days | Tetanus can have an incubation period of 2 to 38 days. The presentation and progression may vary depending on the type of tetanus. Generalized tetanus can involve the respiratory muscles making it difficult to breathe. The complications of tetanus include [[fracture]]s, [[laryngospasm]], aspiration [[pneumonia]] and [[pulmonary embolism]]. Tetanus has a case fatality rate of approximately 11%. The fatality rate of tetanus is associated with prolonged [[convulsions]] and [[contractions]]. Tetanus without [[spasm]]s has an excellent prognosis. Early diagnosis is associated with a good 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><ref>{{Cite journal | ||
| author = [[J. C. Patel]] & [[B. C. Mehta]] | | author = [[J. C. Patel]] & [[B. C. Mehta]] | ||
| title = Tetanus: study of 8,697 cases | | title = Tetanus: study of 8,697 cases | ||
| Line 17: | Line 17: | ||
==Natural History== | ==Natural History== | ||
Tetanus can have an incubation period of 2 to 38 days | Tetanus can have an incubation period of 2 to 38 days. Initial presentation involves neck and jaw stiffness. Spasms are common in the first week and may persist for up to 3 weeks, followed by rigidity that can persist for 4-8 weeks. Patients with the generalized type can have spasmodic contractions of the muscles associated with inability to breathe an thus [[apnea]] develops. If left untreated this can lead to the death.<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><ref name="urlTetanus | Symptoms and Complications | Lockjaw | CDC">{{cite web |url=https://www.cdc.gov/tetanus/about/symptoms-complications.html |title=Tetanus | Symptoms and Complications | Lockjaw | CDC |format= |work= |accessdate=}}</ref> | ||
==Complications== | ==Complications== | ||
Complications of a tetanus infection may include: | |||
*[[Laryngospasm]] | *[[Laryngospasm]] | ||
**This can be associated with [[spasms]] of the [[muscles]] of [[respiration]] which leads to breathing difficulties. | **This can be associated with [[spasms]] of the [[muscles]] of [[respiration]] which leads to breathing difficulties. | ||
| Line 50: | Line 29: | ||
*[[Nosocomial]] infections | *[[Nosocomial]] infections | ||
**Common because of prolonged hospitalization | **Common because of prolonged hospitalization | ||
*[[Pulmonary embolism]] | *[[Pulmonary embolism]] | ||
**Apparent in drug users and the elderly | **Apparent in drug users and the elderly | ||
| Line 59: | Line 35: | ||
**Common late complication | **Common late complication | ||
**Found in 50%-70% of autopsied cases | **Found in 50%-70% of autopsied cases | ||
Common secondary complications of prolonged hospitalization for tetanus include: | |||
*[[Sepsis]] from indwelling catheters | |||
*[[Hospital-acquired pneumonia]] | |||
*[[Decubitus ulcers]] | |||
==Prognosis== | ==Prognosis== | ||
Tetanus results in death in | Tetanus results in death in approximately 10-20% of cases. The mortality rate is higher among older people. The fatality rate of tetanus is associated with prolonged [[contractions]] and [[convulsions]]. Tetanus without [[spasm]]s has an excellent prognosis. Early diagnosis is associated with a good 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><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 | ||
| Line 105: | Line 84: | ||
}}</ref> | }}</ref> | ||
*The case fatality rate of non- | *The case fatality rate of non-neonatal tetanus is 8-50% in the developing countries. | ||
*According to one study the case fatality rate is 11%. | *According to one study the case fatality rate is 11%. | ||
*The mortality rate of neonatal tetanus is 3-88%. | *The mortality rate of neonatal tetanus is 3-88%. | ||
* | *Poor prognostic factors include: | ||
**Individuals of age 60 years or older (approximately 18%) | **Individuals of age 60 years or older (approximately 18%) | ||
**Unvaccinated people (approximately 22%) | **Unvaccinated people (approximately 22%) | ||
**Delayed diagnosis | |||
** | |||
*In about 20% of deaths, no obvious pathology is detected | *In about 20% of deaths, no obvious pathology is detected | ||
**Death is attributed directly to the direct effects of tetanus toxin | **Death is attributed directly to the direct effects of tetanus toxin | ||
Revision as of 14:55, 27 June 2017
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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. The presentation and progression may vary depending on the type of 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 case fatality rate of approximately 11%. The fatality rate of tetanus is associated with prolonged convulsions and contractions. Tetanus without spasms has an excellent prognosis. Early diagnosis is associated with a good prognosis.[1][2]
Natural History
Tetanus can have an incubation period of 2 to 38 days. Initial presentation involves neck and jaw stiffness. Spasms are common in the first week and may persist for up to 3 weeks, followed by rigidity that can persist for 4-8 weeks. Patients with the generalized type can have spasmodic contractions of the muscles associated with inability to breathe an thus apnea develops. If left untreated this can lead to the death.[1][3]
Complications
Complications of a tetanus infection may include:
- 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
- Pulmonary embolism
- Apparent in drug users and the elderly
- Aspiration pneumonia
- Common late complication
- Found in 50%-70% of autopsied cases
Common secondary complications of prolonged hospitalization for tetanus include:
- Sepsis from indwelling catheters
- Hospital-acquired pneumonia
- Decubitus ulcers
Prognosis
Tetanus results in death in approximately 10-20% of cases. The mortality rate is higher among older people. The fatality rate of tetanus is associated with prolonged contractions and convulsions. Tetanus without spasms has an excellent prognosis. Early diagnosis is associated with a good prognosis.[1][4][5][6][7]
- The case fatality rate of non-neonatal 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%.
- Poor prognostic factors include:
- Individuals of age 60 years or older (approximately 18%)
- Unvaccinated people (approximately 22%)
- Delayed diagnosis
- In about 20% of deaths, no obvious pathology is detected
- Death is attributed directly to the direct effects of tetanus toxin
- Neonatal tetanus is associated with 14% of overall neonatal deaths and is responsible for 14% (215,000) of overall neonatal deaths.
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.
- ↑ J. C. Patel & B. C. Mehta (1999). "Tetanus: study of 8,697 cases". Indian journal of medical sciences. 53 (9): 393–401. PMID 10710833. Unknown parameter
|month=ignored (help) - ↑ "Tetanus | Symptoms and Complications | Lockjaw | CDC".
- ↑ 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) - ↑ J. C. Patel & B. C. Mehta (1999). "Tetanus: study of 8,697 cases". Indian journal of medical sciences. 53 (9): 393–401. PMID 10710833. Unknown parameter
|month=ignored (help)