A ten-year retrospective study of tetanus at a general hospital in Malaysia

Abstract

Aims: To study the demographic and clinical features as well as outcomes of tetanus patients at the Sarawak General Hospital, Kuching from 1990 to 1999.

Methods: All cases of tetanus from January 1990 to September 1999 were identified from the computer record at the hospital and these were then restrospectively reviewed.

Results: A total of 22 cases of tetanus was seen at the Sarawak General Hospital in the ten-year period with a mean of 2.2 cases per year. There were 15 male (68.2%) and 7 female (31.8%) patients. Most cases occurred in the age group 60-69. Eighteen patients (81.8%) had a reasonably identifiable injury prior to the onset; all had their wounds debrided. Body stiffness, trismus and dysphagia were the three commonest presenting complaints. Twenty-one patients (95.5%) were admitted to the intensive care unit (ICU), with an average length of ICU stay of 21.4 days. Nineteen patients (86.4%) required mechanical ventilation for a varying period of time in the ICU. All patients (100%) had tracheostomy performed and intravenous diazepam infusion as part of their management. Twenty patients (90.9%) received intravenous crystalline penicillin as the treatment antibiotics. Twenty-one patients (95.5%) received intramuscular human antitetanus immunoglobulin. There were four deaths, accounting for a mortality of 18.2%.

Conclusion: In general, tetanus remains in Sarawak an important disease with substantial mortality and morbidity that primarily affects unvaccinated or inadequately vaccinated individuals. It is, however, highly preventable through both routine vaccination and appropriate wound management. Our case series show comparable pattern and outcome with other case series reported in the literatures.