Transcript Clinical Study Of Pediatric Tetanus A Hospital Based Study

Clinical study of Pediatric Tetanus
A hospital based study
Dr. Sanjeev Chetry
Dr. Kamal Lochan Bora
Prof. D.K. Patgiri
Introduction





Areteus “ inhuman calamity, and
unseemly sight, a spectacle painful
event to be hold, not to be recognised
by dearest friends.”
Occurs sporadically.
Not a notifiable disease.
Not an uncommon condition in this
part
No comprehensive data available
Materials and methods
All cases in age group of 0 – 12yrs
with features suggestive of tetanus.
 Period : April 2002 to August 2005
 Grading done as per Modified Patel
and Joag criteria.
 Medical and Surgical management.

Age wise distribution of cases
Age
0 – 1 month
Number
of cases
10
Percentage
(%)
20.8
1month - <2yrs
3
6.3
2yrs - <6yrs
14
27.1
6 – 12yrs
21
45.8
Total
48
100
Age and sex wise distribution of the cases
Percentage of cases —
35
33.4
30
25
18.8
20
15
10
12.5
12.4
4.2
5
0
8.3
8.3
2.1
0<1mo
1mo<2yr
Age --
2yr6<6yrs 12yrs
Male
Female
Incidence of Tetanus
according to locality
12.5 %
Tea garden
Rural
Urban
39.6 %
47.9 %
SHOWING POSSIBLE MODE OF ENTRY
Neonatal Tetanus
Practices
Application of
goat’s excreta
Use of bamboo
knife to cut
Umbilical cord
Application of
ash & mustard
oil
Total
No. of
cases
4
Post Neonatal Tetanus
Etiology
No. of
cases
Definite h/o injury
21
H/o chronic ear
discharge
14
2
4
unknown
10
3
Age and mode of infection in
Post Neonatal Tetanus
16
14
No. of cases -
12
10
otogenic
post traumatic
unknown
8
6
4
2
0
1mo-<2yrs
2-<6yrs
Age -
6-12yrs
Clinical features of Neonatal Tetanus
Clinical features
Fever
Fever
opisthotonus
opisthotonus
excessive cry
excessive cry
Stiffness and rigidity
Stiffness and rigidity
Refusal of feeding
Refusal of feeding
0
20
40
60
80
Percentages of cases
100
120
Clinical features in Post Neonatal Tetanus
Clinical features
Number of cases Percentage %
Trismus
38
100
Stiffness and
rigidity
34
89.5
Intermittent spasm
26
55.3
Difficulty in
swallowing
15
39.5
Fever
14
36.4
Incidence of Tetanus according to grade
(as per Modified Patel & Joag criteria)
21.1 %
10.5 %
Mild
Moderate
Severe
68.4 %
Showing incubation period
Days
0–7
No. of cases
Percentage %
18
37.5
8 – 14
8
16.7
15 – 21
0
0
> 22
5
10.4
Not known
17
36.4
Showing Immunisation status
Immunisation status of mother
Neonatal
Tetanus 10 Unimmunised
7
Immunised
1
Partially
immunised
2
Unimmunised Immunisation Unknown
not completed
Post
child
Neonatal 38
30
5
3
Tetanus
Showing Mortality
Neonatal Tetanus Post neonatal Tetanus
20 %
34.5 %
80 %
mortality
mortality
survival
survival
65.5 %
Key message






No change in occurence of cases.
Its only the tip of an iceberg.
Otogenic tetanus is most common below 6yrs
while post traumatic tetanus is common above
6yrs.
Check for tetanus immunisation in all cases
with Otitis Media.
Awareness about birth and cord care practices.
Awareness about immunisation and its practical
implementation in tea garden of upper Assam
is the need of hour to reduce the incidence of
cases.