Skip to main content
NCBI home page
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1987 Dec;99(3):675–684. doi: 10.1017/s095026880006653x

Tetanus and its complications: intensive care and management experience in 150 Indian patients.

F E Udwadia 1, A Lall 1, Z F Udwadia 1, M Sekhar 1, A Vora 1
PMCID: PMC2249251  PMID: 3428373

Abstract

A total of 150 patients were treated for tetanus in the tetanus ward of the J. J. Hospital, Bombay, between October 1983 and January 1986. The complications of tetanus and the mode of management in the presence of restricted resources are outlined. Intensive care, proper nutrition, early tracheostomy and ventilator support in severe tetanus were chiefly responsible for an overall reduction in mortality from 30 to 12%. The mortality in severe tetanus was reduced from 70 to 23%. Sudden death due to unexpected cardiac arrest was an important complication in severe tetanus. We observed that an abrupt marked rise in rectal temperature (greater than 107 degrees F, 41.7 degrees C), if undetected, could lead to sudden circulatory collapse and death. Well-marked hypoxaemia was observed in all patients with severe tetanus, and was related to ventilation perfusion inequalities and to an increase in the true venous admixture (increased Qs/Qt) in the lungs. Bronchopulmonary infections and the adult respiratory distress syndrome added significantly to morbidity and mortality. Autonomic cardiovascular disturbances included bradycardia alternating with tachycardia, and hypertension which was either labile, paroxysmal or sustained. Persistent hypotension was of ominous significance. Amongst numerous complications involving other systems, sepsis and septic shock were associated with a high mortality.

Full text

PDF
675

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benedict C. R., Kerr J. H. Assessment of sympathetic overactivity in tetanus. Br Med J. 1977 Sep 24;2(6090):806–806. doi: 10.1136/bmj.2.6090.806. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. CLIFTON B. HYPOTENSION ASSOCIATED WITH TETANUS. Lancet. 1964 Apr 11;1(7337):785–788. doi: 10.1016/s0140-6736(64)92979-4. [DOI] [PubMed] [Google Scholar]
  3. Corbett J. L., Kerr J. H., Prys-Roberts C., Smith A. C., Spalding J. M. Cardiovascular disturbances in severe tetanus due to overactivity of the sympathetic nervous system. Anaesthesia. 1969 Apr;24(2):198–212. doi: 10.1111/j.1365-2044.1969.tb02838.x. [DOI] [PubMed] [Google Scholar]
  4. Edmondson R. S., Flowers M. W. Intensive care in tetanus: management, complications, and mortality in 100 cases. Br Med J. 1979 May 26;1(6175):1401–1404. doi: 10.1136/bmj.1.6175.1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hollow V. M., Clarke G. M. Autonomic manifestations of tetanus. Anaesth Intensive Care. 1975 May;3(2):142–147. doi: 10.1177/0310057X7500300211. [DOI] [PubMed] [Google Scholar]
  6. Kanarek D. J., Kaufman B., Zwi S. Severe sympathetic hyperactivity associated with tetanus. Arch Intern Med. 1973 Oct;132(4):602–604. [PubMed] [Google Scholar]
  7. Kerr J. H., Corbett J. L., Prys-Roberts C., Smith A. C., Spalding J. M. Involvement of the sympathetic nervous system in tetanus. Studies on 82 cases. Lancet. 1968 Aug 3;2(7562):236–241. doi: 10.1016/s0140-6736(68)92350-7. [DOI] [PubMed] [Google Scholar]
  8. Kerr J. H., Corbett J. L., Spalding J. M. Sympathetic overactivity in severe tetanus. Proc R Soc Med. 1969 Jul 7;62(7):659–662. doi: 10.1177/003591576906200710. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kokal K. C., Dastur F. D., Mahashur A. A., Kolhatkar V. P. Disordered pulmonary function in tetanus. J Assoc Physicians India. 1984 Aug;32(8):691–695. [PubMed] [Google Scholar]
  10. Levesque P. R., Rosenberg H. Rapid bedside estimation of wasted ventilation (Vd/Vt). Anesthesiology. 1975 Jan;42(1):98–100. doi: 10.1097/00000542-197501000-00015. [DOI] [PubMed] [Google Scholar]
  11. Nicholson D. Editorial: Tetanus--still a therapeutic challenge. Heart Lung. 1976 Mar-Apr;5(2):226–227. [PubMed] [Google Scholar]
  12. Trujillo M. J., Castillo A., España J. V., Guevara P., Egañez H. Tetanus in the adult: intensive care and management experience with 233 cases. Crit Care Med. 1980 Jul;8(7):419–423. [PubMed] [Google Scholar]
  13. Tsueda K., Oliver P. B., Richter R. W. Cardiovascular manifestations of tetanus. Anesthesiology. 1974 Jun;40(6):588–592. doi: 10.1097/00000542-197406000-00015. [DOI] [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES