Factors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh

Abstract

Background Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh. Methods This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26). Results A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07–15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05–10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications. Conclusion Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.

Tetanus in Uganda: Clinical Outcomes of Adult Patients Hospitalized at a Tertiary Health Facility Between 2011 and 2020

“…Our study revealed a high proportion of tetanus deaths occurring among those aged 31–40 years. This is in contrast to what Khan et al [ 35 ] reported from Bangladesh, where deaths mostly occurred among older individuals above 60 years of age. We recommend further studies to assess risk factors for mortality in our setting.…”

Tetanus secondary to oral and odontogenic infections: a case report and systematic literature review

“…Although such affections might be the primary cause of trismus, they could disguise superposed tetanus in some cases, especially in underlying compound mandibular fractures or facial lacerations [6,30,38]. In our study, the interval between trismus and death was relatively short (4.25±1.89 days), which is concordant with other studies [22,39]. Trismus is tetanus's most common premonitory symptom, followed by dysphagia and cervical stiffness [6,9,40].…”

“…Given the high lethality, the relevance of early diagnosis is obvious. A delay in treatment can be fatal [20,22,[31][32][33][34][35]. According to our results, the lethality of odontogenic tetanus was 30.77%.…”

“…The occupations varied, although the studies did not mention it in most cases. Although the incidence of non-odontogenic tetanus is frequently related to certain risky occupations and increases after natural disasters such as earthquakes and tsunamis, particularly in emerging countries, in this review, we did not find a pattern concerning the occupation [17,[19][20][21][22].…”

“…By contrast, tetanus severity depends upon of depth of the penetrating wounds, the amount of tetanus toxin that reaches the CNS, the IP, and the onset time -interval between the first symptoms and the first spasm -. The shorter the IP and the onset time, the more severe the clinical features of tetanus [6,22,27]. The diagnosis of tetanus can be challenging when there are no apparent external injuries.…”