Managing Severe Tetanus without Ventilation Support in a Resource-limited Setting in Bangladesh

Md Golam Hasnain Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia;
Nutrition and Clinical Service Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Shomik Maruf Nutrition and Clinical Service Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Proggananda Nath Infection and Tropical Medicine, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh;

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Azim Anuwarul Infection and Tropical Medicine, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh;

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Md Nasir Uddin Ahmed Infection and Tropical Medicine, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh;

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Iqbal Hossain Chowdhury Department of Intensive Care Unit, Bangabondhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh;

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Ariful Basher Critical Care Medicine (CCM), Bangabondhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh

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DOI:
https://doi.org/10.4269/ajtmh.18-0180
Volume/Issue:
Volume 99: Issue 5
Page(s):
1234–1238
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Tetanus, a vaccine-preventable and potentially fatal disease, continues to remain prevalent in low- and middle-income countries. Furthermore, physicians are often unfamiliar with management of severe tetanus without ventilator support. Therefore, we proposed a modified treatment protocol that provides a low-cost and effective solution for the management of severe tetanus in resource-constrained settings. This is an observational study of 42 patients with severe tetanus treated during 2015–2016 at Surya Kanta Hospital, Bangladesh. This facility does not have an intensive care unit (ICU), and patients admitted here were provided treatment with the modified protocol. A total number of 42 patients with severe tetanus were treated with the modified protocol. Among them, 24 (57.1%) recovered completely, six (14.3%) recovered with the sequela, and 12 (28.6%) died. Among those who recovered with the sequela, four needed mechanical support during walking and two had a visual impairment. No significant adverse event was recorded during the treatment period. The results gathered during this case series provide a sustainable, low-cost, and effective solution to management of severe tetanus in resource-constrained settings where ICUs are unavailable.

Author Notes

Address correspondence to Md Golam Hasnain, Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health (SMPH), Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales 2308, Australia. E-mail: mdgolam.hasnain@uon.edu.au

Ethical considerations: De-identified patient data were collected after obtaining the respective institution’s approval.

Authors’ addresses: Md Golam Hasnain, Centre for Clinical Epidemiology and Biostatistics (CCEB), School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle (UoN), Newcastle, Australia, E-mail: mdgolam.hasnain@uon.edu.au. Shomik Maruf, Nutrition and Clinical Service Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: shomik_stj@yahoo.com. Proggananda Nath and Md Nasir Uddin Ahmed, Infection and Tropical Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh, E-mails: progganath@yahoo.com and brignasir584@gmail.com. Azim Anuwarul, Diarrhoeal Diseases, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh, E-mail: azimanwarul@gmail.com. Iqbal Hossain Chowdhury, Department of Intensive Care Unit, Bangabondhu Sheikh Mujib Medical University (BSMMU), Mymensingh, Bangladesh, E-mail: Iqbal.hossain.56@gmail.com. Ariful Basher, Critical Care Medicine (CCM), Bangabondhu Sheikh Mujib Medical University (BSMMU), Mymensingh, Bangladesh, E-mail: ariful.dr@gmail.com.

These authors contributed equally to this work.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2018
Received:
28 Feb 2018
|
Accepted:
12 Jul 2018
|
Published Online:
10 Sep 2018
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    Chalya PL, Mabula JB, Dass RM, Mbelenge N, Mshana SE, Gilyoma JM, 2011. Ten-year experiences with tetanus at a tertiary hospital in northwestern Tanzania: a retrospective review of 102 cases. World J Emerg Surg 6: 20.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Brauner JS, Vieira SR, Bleck TP, 2002. Changes in severe accidental tetanus mortality in the ICU during two decades in Brazil. Intensive Care Med 28: 930–935.

  • 3.

    Joshi S, Agarwal B, Malla G, Karmacharya B, 2007. Complete elimination of tetanus is still elusive in developing countries: a review of adult tetanus cases from referral hospital in eastern Nepal. Kathmandu Univ Med J 5: 378–381.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Chukwubike OA, God’spower AE, 2009. A 10-year review of outcome of management of tetanus in adults at a Nigerian tertiary hospital. Ann Afr Med 8: 168–172.

  • 5.

    Kyu HH, Mumford JE, Stanaway JD, Barber RM, Hancock JR, Vos T, Murray C, Naghavi M, 2017. Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study. BMC Public Health 17: 179.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Okoromah CN, Lesi FE, 2004. Diazepam for treating tetanus. Cochrane Database Syst Rev 1: CD003954.

  • 7.

    Yen LM et al. 1997. Management of Tetanus: A Comparison of Penicillin and Metronidazole. Symposium of Antimicrobial Resistance in Southern Viet Nam, Ho Chi Minh City, Vietnam.

    • PubMed
    • Export Citation
  • 8.

    Altura BM, Altura BT, 1981. Magnesium ions and contraction of vascular smooth muscles: relationship to some vascular diseases. Fed Proc 40: 2672–2679.

  • 9.

    James MF, Manson ED, 1985. The use of magnesium sulphate infusions in the management of very severe tetanus. Intensive Care Med 11: 5–12.

  • 10.

    Attygalle D, Rodrigo N, 1997. Magnesium sulphate for control of spasms in severe tetanus. Can we avoid sedation and artificial ventilation? Anaesthesia 52: 956–962.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Attygalle D, Rodrigo N, 2002. Magnesium as first line therapy in the management of tetanus: a prospective study of 40 patients. Anaesthesia 57: 811–817.

  • 12.

    Thwaites CL, Yen LM, Loan HT, Thuy TTD, Thwaites GE, Stepniewska K, Soni N, White NJ, Farra JJ, 2006. Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet 368: 1436–1443.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Osalusi BS, Ogun SA, Ogunniyi A, Kolapo KO, 2008. Comparison of the efficacy of magnesium sulphate and diazepam in the control of tetanus spasms. Sci Res Essays 3: 571–576.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Ali G, Kamal M, Khan AN, 2011. Comparison of the efficacy of magnesium sulphate and diazepam in the control of tetanus spasm. J Postgrad Med Inst 25: 106–110.

  • 15.

    Kole AK, Roy R, Kar SS, Kole DC, 2013. Experience of use of magnesium sulfate in the treatment of tetanus in a tertiary referral Infectious Disease Hospital, Kolkata, India. Ann Trop Med Public Health 6: 456–459.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    WHO Vaccine-Preventable Disease Monitoring System, 2016. Global Summary. Available at: http://www.who.int/immunization/monitoring_surveillance/data/en/. Accessed December 12, 2017.

    • PubMed
    • Export Citation
  • 17.

    Chaudhry R, Dhawan B, Mohanty S, Dey AB, 2001. Tetanus in the elderly: a forgotten illness. Lancet 1805: 357.

  • 18.

    Norredam K, Hainau B, 1970. Treatment of tetanus in tropical Africa: a comparison between a barbiturate and diazepam in the treatment of non-neonatal tetanus. Ann Soc Belges Med Trop Parasitol Mycol 50: 239–246.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Joseph A, Pulimood BM, 1978. Use of diazepam in tetanus—a comparative study. Indian J Med Res 68: 489–491.

  • 20.

    Karanikolas M, Velissaris D, Marangos M, Karamouzos V, Fligou F, Filos KS, 2010. Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series. J Med Case Rep 4: 100.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Mathew PJ, Samra T, Wig J, 2010. Magnesium sulphate for treatment of tetanus in adults. Anaesth Intensive Care 38: 185–189.

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