Evaluation of Tetanus Cases Presenting to the Emergency Department at a Tertiary hospital in Somalia
Abstract
Aim: Tetanus is an infection characterized by muscle spasms and trismus caused by toxins produced by Clostridium tetani. Although tetanus is a vaccine-preventable disease, it continues to be a public health problem in developing countries with high mortality rates.
This study was conducted to evaluate the clinical profile and outcome of tetanus patients and determine the factors affecting the hospitalization unit, the length of hospital stay, and mortality.
Materials and Methods: This is a retrospective cross-sectional study conducted with patients diagnosed with tetanus in a Tertiary care emergency department (ED) in Somalia. The relationship of demographic data, symptoms, laboratory findings, applied treatment methods with the hospitalization unit (regular inpatient floor/intensive care unit), length of hospital stay, and mortality were analyzed.
Results: Sixty-seven patients diagnosed with tetanus during a 4-year study period were included. The mean patient age was 12,8±14,89 years, and 73,1% were males. Generalized muscle spasm (85,7%) was the most common symptom, benzodiazepines (95,5%.) were the most commonly used medications, and the mean length of hospital stay was 10.73±8.15 days. The rate of patients hospitalized in the ICU was 20,9%. The overall mortality rate was calculated as 19,5%. The presence of opisthotonos, neck stiffness, risus sardonicus, generalized muscle spasm, and dyspnea significantly correlated with mortality (p<0.05).
Conclusion: Tetanus remains a significant public health problem with high mortality in Somalia. Late-stage clinical findings at ED presentation are strongly associated with admission to the intensive care unit and mortality.
References
- 1. Derbie A, Amdu A, Alamneh A, Tadege A, Solomon A, Elfu B, et al. Clinical profile of tetanus patients attended at Felege Hiwot Referral Hospital, Northwest Ethiopia: a retrospective cross sectional study. Springerplus. 2016;5(1):892.
- 2. Almas T, Niaz MA, Zaidi SMJ, Haroon M, Khedro T, Alsufyani R, et al. The Spectrum of Clinical Characteristics and Complications of Tetanus: A Retrospective Cross-Sectional Study From a Developing Nation. Cureus. 2021;13(6):e15484.
- 3. Qaderi S, Qaderi F, Tarki FE, Shah J, Afaghi S, Delsoz M, Shah A. Generalized, non-neonatal tetanus is a highly fatal disease in Afghanistan: A case series study. Int J Infect Dis. 2021;103:568-72.
- 4. Bae C, Bourget D. Tetanus. 2023 May 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.
- 5. Dhir SK, Dewan P, Gupta P. Maternal and Neonatal Tetanus Elimination: Where are We Now? Res Rep Trop Med. 2021;12:247-61.
- 6. Mondkar SA, Tullu MS, Deshmukh CT, Srinivasa Rangan R, Agrawal M. Clinical Profile and Outcome of Pediatric Tetanus at a Tertiary Care Center. J Pediatr Intensive Care. 2020;10(4):256-63.
- 7. Tadele H. Clinical Profile and Outcome of Pediatrics Tetanus: The Experience of a Tertiary Hospital in Ethiopia. Ethiop J Health Sci. 2017;27(5):559-64.
- 8. Hao NV, Yen LM, Davies-Foote R, Trung TN, Duoc NVT, Trang VTN, et al. The management of tetanus in adults in an intensive care unit in Southern Vietnam. Wellcome Open Res. 2021;6:107.
- 9. WHO. Immunization dashboard for Somalia. Geneva: World Health Organization; 2023. [updated 2018; cited 13 March 2024]. Available from: https://immunizationdata.who.int/index.html
- 10. Doğan A, Mohamed Alİ A, Abdullahi Alİ M, Orul H. Assessment of tetanus Immunization among healthcare workers in Mogadishu, Somalia. Hum Vaccin Immunother. 2023;19(1):2202128.
- 11. Wang X, Yu R, Shang X, Li J, Gu L, Rao R, et al. Multicenter Study of Tetanus Patients in Fujian Province of China: A Retrospective Review of 95 Cases. Biomed Res Int. 2020;2020:8508547.
- 12. Masthi NR, Bharat G, Aswini, Chitra, Arul PP. A clinico epidemiological study of tetanus cases admitted to epidemic disease hospital, Bangalore. Indian J Public Health.2008;52(4):210-1.
- 13. Dafallah MA, Ragab EA, Mohamed Ahmed Elawad OA. Experience with Tetanus in a Tertiary Care Hospital in Sudan: A Retrospective Review. Emerg Med Int. 2021;2021:4818312.
- 14. Chalya PL, Mabula JB, Dass RM, Mbelenge N, Mshana SE, Gilyoma JM. Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases. World J Emerg Surg. 2011;6:20.
- 15. Bae S, Go M, Kim Y, Hwang S, Kim SW, Kwon KT, et al. Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011-2019. BMC Infect Dis. 2021;21(1):247.
- 16. Duggal MN, Bari A, Zeeshan F, Jabeen U. Frequency of risk factors, vaccination status and outcome of tetanus in children at the Children's Hospital Lahore. J Pak Med Assoc. 2019;69(2):174-7.
- 17. Hasnain MG, Maruf S, Nath P, Anuwarul A, Ahmed MNU, Chowdhury IH, Basher A. Managing Severe Tetanus without Ventilation Support in a Resource-limited Setting in Bangladesh. Am J Trop Med Hyg. 2018;99(5):1234-8.
Somali'de Üçüncü Basamak Bir Hastanenin Acil Servisine Başvuran Tetanoz Olgularının Değerlendirilmesi
Abstract
Amaç: Tetanoz, Clostridium tetaninin ürettiği toksinlerin neden olduğu kas spazmları ve trismusla karakterize bir enfeksiyondur. Tetanoz aşıyla önlenebilir bir hastalık olmasına rağmen gelişmekte olan ülkelerde ölüm oranlarının yüksek olduğu bir halk sağlığı sorunu olmaya devam etmektedir.
Bu çalışma, tetanoz hastalarının klinik profillerini ve sonuçlarını değerlendirmek, hospitalizasyon ünitesini, hastanede kalış süresini ve mortaliteyi etkileyen faktörleri belirlemek amacıyla yapıldı.
Gereç ve Yöntem: Bu çalışma; Somali'deki Üçüncü basamak bir acil serviste tetanoz tanısı alan hastalarla yürütülen retrospektif, kesitsel bir çalışmadır. Demografik veriler, semptomlar, laboratuvar bulguları ve uygulanan tedavi yöntemleri ile hospitalizasyon ünitesi (servis/yoğun bakım ünitesi), hastanede kalış süresi ve mortalite ilişkisi analiz edildi.
Bulgular: Dört yıllık çalışma süresinde tetanoz tanısı alan 67 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 12,8±14,89 yıl olup %73,1'i erkekti. En sık görülen semptom jeneralize kas spazmı (%85,7), en sık kullanılan ilaç ise benzodiazepinler (%95,5) idi ve ortalama hastanede kalış süresi 10,73±8,15 gündü. Yoğun bakımda yatan hasta oranı ise %20,9 olarak saptandı. Toplam mortalite oranı ise %19,5 olarak hesaplandı. Opisthotonos, boyun sertliği, risus sardonicus, jeneralize kas spazmı ve dispne varlığı mortalite ile anlamlı korelasyon göstermiştir (p<0.05).
Sonuç: Tetanoz Somali'de mortalitesi yüksek, önemli bir halk sağlığı sorunu olmaya devam etmektedir. Acil servise başvuru sırasında geç dönem klinik bulgular olması, hastanın yoğun bakım ünitesine kabulü ve mortalite ile güçlü bir şekilde ilişkilidir.
References
- 1. Derbie A, Amdu A, Alamneh A, Tadege A, Solomon A, Elfu B, et al. Clinical profile of tetanus patients attended at Felege Hiwot Referral Hospital, Northwest Ethiopia: a retrospective cross sectional study. Springerplus. 2016;5(1):892.
- 2. Almas T, Niaz MA, Zaidi SMJ, Haroon M, Khedro T, Alsufyani R, et al. The Spectrum of Clinical Characteristics and Complications of Tetanus: A Retrospective Cross-Sectional Study From a Developing Nation. Cureus. 2021;13(6):e15484.
- 3. Qaderi S, Qaderi F, Tarki FE, Shah J, Afaghi S, Delsoz M, Shah A. Generalized, non-neonatal tetanus is a highly fatal disease in Afghanistan: A case series study. Int J Infect Dis. 2021;103:568-72.
- 4. Bae C, Bourget D. Tetanus. 2023 May 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.
- 5. Dhir SK, Dewan P, Gupta P. Maternal and Neonatal Tetanus Elimination: Where are We Now? Res Rep Trop Med. 2021;12:247-61.
- 6. Mondkar SA, Tullu MS, Deshmukh CT, Srinivasa Rangan R, Agrawal M. Clinical Profile and Outcome of Pediatric Tetanus at a Tertiary Care Center. J Pediatr Intensive Care. 2020;10(4):256-63.
- 7. Tadele H. Clinical Profile and Outcome of Pediatrics Tetanus: The Experience of a Tertiary Hospital in Ethiopia. Ethiop J Health Sci. 2017;27(5):559-64.
- 8. Hao NV, Yen LM, Davies-Foote R, Trung TN, Duoc NVT, Trang VTN, et al. The management of tetanus in adults in an intensive care unit in Southern Vietnam. Wellcome Open Res. 2021;6:107.
- 9. WHO. Immunization dashboard for Somalia. Geneva: World Health Organization; 2023. [updated 2018; cited 13 March 2024]. Available from: https://immunizationdata.who.int/index.html
- 10. Doğan A, Mohamed Alİ A, Abdullahi Alİ M, Orul H. Assessment of tetanus Immunization among healthcare workers in Mogadishu, Somalia. Hum Vaccin Immunother. 2023;19(1):2202128.
- 11. Wang X, Yu R, Shang X, Li J, Gu L, Rao R, et al. Multicenter Study of Tetanus Patients in Fujian Province of China: A Retrospective Review of 95 Cases. Biomed Res Int. 2020;2020:8508547.
- 12. Masthi NR, Bharat G, Aswini, Chitra, Arul PP. A clinico epidemiological study of tetanus cases admitted to epidemic disease hospital, Bangalore. Indian J Public Health.2008;52(4):210-1.
- 13. Dafallah MA, Ragab EA, Mohamed Ahmed Elawad OA. Experience with Tetanus in a Tertiary Care Hospital in Sudan: A Retrospective Review. Emerg Med Int. 2021;2021:4818312.
- 14. Chalya PL, Mabula JB, Dass RM, Mbelenge N, Mshana SE, Gilyoma JM. Ten-year experiences with Tetanus at a Tertiary hospital in Northwestern Tanzania: A retrospective review of 102 cases. World J Emerg Surg. 2011;6:20.
- 15. Bae S, Go M, Kim Y, Hwang S, Kim SW, Kwon KT, et al. Clinical outcomes and healthcare costs of inpatients with tetanus in Korea, 2011-2019. BMC Infect Dis. 2021;21(1):247.
- 16. Duggal MN, Bari A, Zeeshan F, Jabeen U. Frequency of risk factors, vaccination status and outcome of tetanus in children at the Children's Hospital Lahore. J Pak Med Assoc. 2019;69(2):174-7.
- 17. Hasnain MG, Maruf S, Nath P, Anuwarul A, Ahmed MNU, Chowdhury IH, Basher A. Managing Severe Tetanus without Ventilation Support in a Resource-limited Setting in Bangladesh. Am J Trop Med Hyg. 2018;99(5):1234-8.
Details
| Primary Language | English |
|---|---|
| Subjects | Pediatric Emergency, Pediatric Infectious Diseases, Emergency Medicine, Infectious Diseases, Clinical Microbiology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 9, 2024 |
| Submission Date | December 6, 2023 |
| Acceptance Date | May 24, 2024 |
| Published in Issue | Year 2024Volume: 63 Issue: 3 |
