Tetanus in developing countries: a case series and review.| Autores: | Kara Gibson, J Bonaventure Uwineza, Willy Kiviri, Joel Parlow | | Idioma: | Eng. | | Fecha: | 2009-03-19 | | Revista: | Canadian journal of anaesthesia = Journal canadien dNULLanesthesie
(0832-610X)
| | Entrega: | Can J Anaesth. 2009 Apr;56(4):307-15 | |
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Abstract:
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PURPOSE:
Few anesthesiologists have expertise in the diagnosis and treatment of tetanus, a disease that remains prevalent in developing countries. We report on a series of four cases of tetanus cases recently encountered in Rwanda. We review the clinical epidemiology, pathophysiology, diagnosis and the treatment of tetanus, and provide implications for anesthesiologists and critical care physicians. CLINICAL FEATURES: We report four cases, two involving adults who were inadequately vaccinated and experienced injuries, and two involving neonates, both of whom underwent umbilical cord transection using unsterilized equipment. All patients required tracheal intubation, and were mechanically ventilated when equipment was available. One adult and one neonate succumbed to the disease. These cases highlight the difficulties of diagnosis and management of complicated diseases in the resource-challenged health care setting of developing countries.
CONCLUSIONS:
The differential diagnosis of tetanus may be confusing, and survival depends on the rapidity of treatment with antitoxin, as well as adequate supportive care. High doses of sedatives and muscle relaxants, as well as prolonged mechanical ventilation, are usually necessary. Mortality remains high, usually resulting from late respiratory failure and cardiovascular collapse, associated with autonomic instability. Anesthesiologists and critical care physicians have an important role to play in the management of these patients. Increased involvement in humanitarian health organizations, immigration from developing countries, and emergence of high risk groups in developed countries will likely result in more exposure of anesthesiologists to the complexities of this disease.
| | Copyright: | Canadian journal of anaesthesia = Journal canadien dNULLanesthesie
Department of Anesthesiology, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. | | Full text: |  DOI - Canadian journal of anaesthesia = Journal canadien dNULLanesthesie (DOI) | | Temas: | Adulto, Cuidados Criticos, Paises En Desarrollo, Diagnostico Diferencial, Resultado Fatal, Humanos, Lactante, Recien Nacido, Intubacion Intratraqueal, Varón, Respiracion Artificial, Tetano, Antitoxina Tetanica, Toxoide Tetanico | | | |
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Artículos de otras especialidades: Neurofisiología Clínica, Anestesiología y Reanimación, Medicina Intensiva, Medicina Familiar y Comunitaria, Endocrinología, Medicina Interna, Psicología, Medicina Preventiva, Psiquiatría, Alergología, Neumología, Reumatología |
