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Tetanus patient profiles and factors affecting clinical outcomes at Dr. Soedono general hospital, Madiun in 2019-2020



Abstract

Link of Video Abstract: https://youtu.be/VC3Gcd7oS5Y

 

Introduction: Tetanus is a disease that can be diagnosed clinically. However, there is a lack of research data on tetanus patients and their clinical outcomes, especially in adult tetanus patients in Indonesia. This study aims to determine the factors that influence the outcome of tetanus patients.

Method: A cross-sectional study was performed from May to June 2021 at Dr. Soedono Madiun General Hospital. Subjects were recruited by total sampling. The data that will be taken in this study are gender, age, immunization history, incubation period, onset, port of entry, Philips score, and clinical outcomes of patients.

Result: Were 112 patients diagnosed with tetanus at Dr. Soedono General Hospital from January 2019 to December 2020. The male subjects outnumbered female subjects by 81.3%. The youngest subject was 19 years old, and the oldest was 81 years old. The tetanus immunization status showed that 2 patients were known to be fully immunized, 21 were not fully immunized, and 89 (79.5%) had unknown immunization status. This study showed that the port of entry of the wound is most often the entry point for tetanus in the inferior extremity of 72 patients (64.3%). Most onset occurred in 1-7 days, with a mean onset for generalized tetanus was 2.3 ± 1.8 days. The mean incubation period for the appearance of tetanus symptoms in this study was 9.4 ± 5.6 days. The most common comorbid disease in this study was diabetes mellitus (11.6%). This study's clinical outcome of tetanus showed that 74 patients (66.1%) had improved, while 38 patients (33.9%) died during treatment.

Discussion: This study's most common port of entry was on the inferior extremities. This lower limb predominance as the port of entry could be explained by the fact that C. tetani exists in soil; hence, any lower limb injury would be open to contamination and infection by this organism. Based on the Dakar and Phillips score system, tetanus has a worse prognosis when there is a faster incubation period, faster onset, more proximal port of entry location, immunization status, comorbidities and signs of muscle spasm, fever, and tachycardia are obtained.

Conclusion: In this study, tetanus still has a high mortality rate. Male gender, age over 45, a moderate to severe disease degree (considering a relatively short incubation time, short onset period, and unknown immunization status) are a few factors that may affect this high mortality rate.

Keywords: tetanus clinical outcome patient profile

References

  1. Mahieu R, Reydel T, Maamar A, Tadié JM, Jamet A, Thille AW, et al. Admission of tetanus patients to the ICU: a retrospective multicentre study. Ann Intensive Care. 2017;7(1). doi: 10.1186/s13613-017-0333-y
  2. Theng L, Christin T, Bahar E. Faktor-Faktor Yang Berpengaruh Dalam Luaran Klinis Pasien Tetanus Di Rsup Dr. Mohammad Hoesin Palembang. Maj Kedokt Neurosains Perhimpun Dr Spes Saraf Indones. 2018;35(3). doi: 10.52386/neurona.v35i3.16
  3. Sudoyo W, Setiati S, Alwi I, Simadibrata M, Setiyohadi B, Fahrial A. Buku ajar ilmu penyakit dalam Jilid I Edisi VI. JakartA: Pusat Penerbitan Departemen Ilmu Penyakit Dalam FKUI; 2016.
  4. Ropper A, Samuels M, Klein J. Adams and Victor’s principles of neurology: disorders caused by bacterial toxins. Mcgraw Hill Eduacation. 2014. 1215–7 p.
  5. Hassel B. Tetanus: Pathophysiology, treatment, and the possibility of using botulinum toxin against tetanus-induced rigidity and spasms. Vol. 5, Toxins. 2013. doi: 10.3390/toxins5010073
  6. Bae C, Bourget D. Tetanus. StatPearls Publ Treasure Isl. 2023; doi: http://www.ncbi.nlm.nih.gov/books/NBK459217
  7. Meena M, Kumar S, Gopalakrishnan M, Bohra G, Garg M. Diagnosis and management of cryptogenic occupational tetanus: A case report from Rajasthan, India. Indian J Occup Environ Med. 2020;24(1). doi: 10.4103/ijoem.IJOEM_74_19
  8. Fan Z, Zhao Y, Wang S, Zhang F, Zhuang C. Clinical features and outcomes of tetanus: A retrospective study. Infect Drug Resist. 2019;12. doi: 10.2147/IDR.S204650
  9. Li J, Liu Z, Yu C, Tan K, Gui S, Zhang S, et al. Global epidemiology and burden of tetanus from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Int J Infect Dis. 2023;132. doi: 10.1016/j.ijid.2023.04.402
  10. 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). doi: 10.1186/s40064-016-2592-8
  11. Zieliński A, Rudowska J. Tetanus in Poland in 2013. Przegl Epidemiol. 2015;69(2):263–5, 379–80.
  12. CDC. Tetanus Epidemiology and prevention of vaccine - preventable disease. Centers Dis Control Prev. 2015;13:341–51.
  13. Riccò M, Vezzosi L, Cella C, Pecoraro M, Novembre G, Moreo A, et al. Tetanus vaccination status in construction workers: Results from an institutional surveillance campaign. Acta Biomed. 2019;90(2). doi: 10.23750/abm.v90i2.6759
  14. Tiwari T, Moro P, Acosta A. Chapter 21-Tetanus. CDC Epidemiol Prev Vaccine-Preventable Dis. 2021;315–328.
  15. Hakim DDL, Faried A, Nurhadiya A, Laymena EH, Arifin MZ, Imron A, et al. Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review. Int J Emerg Med. 2021;14(1). doi: 10.1186/s12245-021-00346-9
  16. Khan MAS, Hasan MJ, Rashid MU, Sagar SK, Khan S, Zaman S, et al. Factors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh. PLoS Negl Trop Dis. 2022;16(3). doi: 10.1371/journal.pntd.0010235
  17. Ingole K, Mundhada S, Powar R. Tetanus in developing countries: A review and case series. Int J Appl Res. 2016;2(6):556–60.
  18. Ganesh M, Sheikh NK, Shah P, Mehetre G, Dharne MS, Nagoba BS. Detection of Clostridium tetani in human clinical samples using tetX specific primers targeting the neurotoxin. J Infect Public Health. 2016;9(1). doi: 10.1016/j.jiph.2015.06.014
  19. Khakheli MS, Khuhro BA, Jamali AH. Tetanus: Still a killer in adults. Anaesthesia, Pain Intensive Care. 2013;17(2).
  20. Khrisnan L, Anam, Panigoro R. Factors Affecting Mortality in Adult Tetanus Patients. Althea Med J. 2015;2(2). doi: 10.15850/amj.v2n2.550
  21. Farrar JJ. Neurological Aspects Of Tropical Disease: Tetanus. J Neurol Neurosurg Psychiatry. 2000;69(3). doi: 10.1136/jnnp.69.3.292
  22. Thwaites CL, Beeching NJ, Newton CR. Maternal and neonatal tetanus. Lancet. 2015 Jan;385(9965):362–70. doi: 10.1016/S0140-6736(14)60236-1
  23. Rampengan N, Pangestu Y, Tatura S, Rampengan T. Profil Kasus Tetanus Anak Di RS Prof. Dr. RD Kandou Manado. Sari Pediatri. Sari Pediatr. 2016;14(3):172–8.
  24. Laksmi NKS. Penatalaksanaan Tetanus. Cdk. 2014;41(11).
  25. Tejaya N, Ramli MMDR. Generalized Tetanus in A Patient with Infected Sutured Wound: A Case Report. AKSONA. 2023;3(1). doi: 10.20473/aksona.v3i1.37362

How to Cite

Setiyandari, B. H. ., Winantyo, T. ., & Ali, I. . (2023). Tetanus patient profiles and factors affecting clinical outcomes at Dr. Soedono general hospital, Madiun in 2019-2020. Bali Medical Journal, 12(3), 3101–3104. https://doi.org/10.15562/bmj.v12i3.4849
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Bernadeta Hernik Setiyandari
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Tjahjo Winantyo
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Iskandar Ali
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