Clinical study of Pediatric Clinical study of Pediatric TetanusTetanus

A hospital based study A hospital based study

Dr. Sanjeev ChetryDr. Sanjeev ChetryDr. Kamal Lochan BoraDr. Kamal Lochan Bora Prof. D.K. PatgiriProf. D.K. Patgiri

IntroductioIntroductionn

Areteus “ inhuman calamity, and Areteus “ inhuman calamity, and unseemly sight, a spectacle unseemly sight, a spectacle painful event to be hold, not to painful event to be hold, not to be recognised by dearest be recognised by dearest friends.”friends.”

Occurs sporadically.Occurs sporadically. Not a notifiable disease.Not a notifiable disease. Not an uncommon condition in Not an uncommon condition in

this partthis part No comprehensive data availableNo comprehensive data available

Materials and methodsMaterials and methods

All cases in age group of 0 – 12yrs All cases in age group of 0 – 12yrs with features suggestive of tetanus.with features suggestive of tetanus.

Period : April 2002 to August 2005Period : April 2002 to August 2005 Grading done as per Modified Patel Grading done as per Modified Patel

and Joag criteria.and Joag criteria. Medical and Surgical management.Medical and Surgical management.

Age wise distribution of Age wise distribution of casescases AgeAge Number Number

of casesof casesPercentage Percentage (%)(%)

0 – 1 month0 – 1 month 1010 20.820.81month - 1month - <2yrs<2yrs

33 6.36.3

2yrs - <6yrs2yrs - <6yrs 1414 27.127.16 – 12yrs6 – 12yrs 2121 45.845.8TotalTotal 4848 100100

05

101520253035

0 -<1mo

1mo-<2yr

2yr-<6yrs

6-12yrs

MaleFemale

12.58.3

4.22.1

18.8

8.3

33.4

12.4

Age and sex wise distribution of the cases

Perc

enta

ge o

f cas

es —

Age --

Incidence of Tetanus according to locality

Tea gardenRuralUrban

12.5 %

39.6 % 47.9 %

PracticesPractices No. of No. of casescases

Application of Application of goat’s excretagoat’s excreta

44

Use of Use of bamboo knife bamboo knife to cut to cut Umbilical cordUmbilical cord

22

Application of Application of ash & ash & mustard oilmustard oil

44

Total Total 1010

Etiology Etiology No. of No. of casescases

Definite h/o Definite h/o injuryinjury

2121

H/o chronic ear H/o chronic ear dischargedischarge

1414

unknownunknown 33

Neonatal Tetanus Post Neonatal Tetanus

SHOWING POSSIBLE MODE OF ENTRY

02468

10121416

1mo-<2yrs 2-<6yrs 6-12yrs

otogenicpost traumaticunknown

Age -

No.

of c

ases

- Age and mode of infection in

Post Neonatal Tetanus

Clinical features of Neonatal Tetanus

0 20 40 60 80 100 120

Refusal of feeding

Stiffness and rigidity

excessive cry

opisthotonus

Fever

Clinical fe

atur

es

Percentages of cases

Fever

opisthotonus

excessive cry

Stiffness and rigidity

Refusal of feeding

Clinical features Clinical features Number of Number of casescases

Percentage Percentage %%

TrismusTrismus 3838 100100

Stiffness and Stiffness and rigidityrigidity

3434 89.589.5

Intermittent Intermittent spasmspasm

2626 55.355.3

Difficulty in Difficulty in swallowingswallowing

1515 39.539.5

Fever Fever 1414 36.436.4

Clinical features in Post Neonatal Tetanus

Mild

Moderate

Severe

10.5 %

68.4 %

21.1 %

Incidence of Tetanus according to grade (as per Modified Patel & Joag criteria)

Showing incubation periodShowing incubation period DaysDays No. of casesNo. of cases Percentage %Percentage %

0 – 7 0 – 7 1818 37.537.5

8 – 14 8 – 14 88 16.716.7

15 – 2115 – 21 00 00

> 22> 22 55 10.410.4

Not knownNot known 1717 36.436.4

NeonatNeonatalalTetanuTetanuss

1010

Immunisation status of motherImmunisation status of motherUnimmunisUnimmuniseded

ImmunisedImmunised

PartiallyPartiallyimmuniseimmunisedd

77 11 22

PostPostNeonatNeonatalalTetanuTetanuss

3838

UnimmunisUnimmuniseded childchild

ImmunisatioImmunisation not n not completedcompleted

UnknownUnknown

3030 55 33

Showing Immunisation status

Neonatal Neonatal TetanusTetanus

mortality

survival

mortality

survival

80 %

20 % 34.5 %

65.5 %

Post neonatal Tetanus

Showing Mortality

Key messageKey message No change in occurence of cases.No change in occurence of cases. Its only the tip of an iceberg.Its only the tip of an iceberg. Otogenic tetanus is most common below 6yrs while Otogenic tetanus is most common below 6yrs while

post traumatic tetanus is common above 6yrs.post traumatic tetanus is common above 6yrs. Check for tetanus immunisation in all cases with Check for tetanus immunisation in all cases with

Otitis Media.Otitis Media. Awareness about birth and cord care practices.Awareness about birth and cord care practices. Awareness about immunisation and its practical Awareness about immunisation and its practical

implementation in tea garden of upper Assam is the implementation in tea garden of upper Assam is the need of hour to reduce the incidence of cases.need of hour to reduce the incidence of cases.