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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.
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: email@example.com. Shomik Maruf, Nutrition and Clinical Service Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: firstname.lastname@example.org. Proggananda Nath and Md Nasir Uddin Ahmed, Infection and Tropical Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh, E-mails: email@example.com and firstname.lastname@example.org. Azim Anuwarul, Diarrhoeal Diseases, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh, E-mail: email@example.com. Iqbal Hossain Chowdhury, Department of Intensive Care Unit, Bangabondhu Sheikh Mujib Medical University (BSMMU), Mymensingh, Bangladesh, E-mail: Iqbal.firstname.lastname@example.org. Ariful Basher, Critical Care Medicine (CCM), Bangabondhu Sheikh Mujib Medical University (BSMMU), Mymensingh, Bangladesh, E-mail: email@example.com.
These authors contributed equally to this work.