Tetanus neonatorum—experience with intrathecal serotherapy at Muhimbili Medical Centre, Dar es Salaam, Tanzania

Mongi, P.; Mbise, Roger; Msengi, A.E.; Amsi, D. M. Do

doi:10.1080/02724936.1987.11748469

Cited by 13 publications

(4 citation statements)

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“…7 Opposite views came out in the studies of Bhandari which showed that intrathecal therapy lead to higher mortality than intramuscular therapy while Mongi showed that intrathecal therapy was superior to intramuscular in the treatment of neonatal tetanus. 8,9 Menon also observed the superiority of intrathecal treatment. 10 In 2004, Miranda-Filho and colleagues compared the efficacy of intramuscular HTIg (3,000 IU) plus intrathecal HTIg (1,000 IU) with intramuscular HTIg alone and found no significant difference in mortality.…”

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confidence: 91%

Evaluation of beneficial effects of addition of intramuscular human tetanus immunoglobulin to intrathecal therapy in the treatment of tetanus

Mahajan

2016

Int J Adv Med

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The earliest record of tetanus is in Edwin Smith Surgical Papyurs, supposed to be dated 19 th Century B.C. Hippocrates in 460 B.C. described the poor prognosis of this disease. Sushruta named the disease as 'dhanushtambha'. In the clinical picture, he described the lockjaw as paralysis of jaw bone and opisthotonus as 'bahirayamma'. Charak observed that it was due to provoked wind drying up the external nerves of the back and the nape of' the neck. He further recorded that either the disease killed the patient or caused deformity. Greek physician Aretaeus in first century A.D. mentioned it as "An inhuman calamity, an unseemly sight, a spectacle painful even to behold".Sir Charles reported a case of tetanus in London. Pollack from Dalin reported a similar case. Bose gave first comprehensive description of the disease. Nicoliers produced tetanus by injecting animals with garden soil. His subsequent description of the bacillus obtained from ABSTRACT Background: The treatment of tetanus has evolved from supportive management only to specific treatment to neutralize the tetanus toxinstetanospasmin & tetanolysin. Human Tetanus Immunoglobulin (HTIg) is a large molecule and cannot cross the blood brain barrier. Introduction of intrathecal therapy considerably decreased mortality in the disease. Combined administration of intramuscular and intrathecal HTIg should neutralize the tetanus toxins in the circulation and central nervous system simultaneously. The study was done to detect beneficial effects of adding intramuscular HTIg to the intrathecal therapy. Methods: 125 patients of tetanus were randomized to two groups. Study group was given intrathecal plus intramuscular HTIg while control group was given intrathecal HTIg alone. Each group was subdivided into three grades according to severity. Mortality rate and three sequential recovery parameters i.e. duration of spasms, shift to oral therapy and duration of hospital stay were measured. Results: No significant difference in mortality was found. However, in patients who survived, the addition of intramuscular HTIg lead to a benefit of 2.07, 2.67 & 2.31 days in mild, moderate & severe grades respectively in the duration of spasms. Further, it became possible to start oral therapy 2.13, 1.6 & 1.8 days earlier in mild, moderate & severe tetanus. Duration of hospital stay was reduced by 3.87 days, 2.36 days and 3 days in mild, moderate and severe tetanus respectively. Conclusions: Though the addition of intramuscular HTIg to intrathecal therapy in tetanus does not confer any survival benefit, it causes faster recovery in patients who survive.

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confidence: 91%

Evaluation of beneficial effects of addition of intramuscular human tetanus immunoglobulin to intrathecal therapy in the treatment of tetanus

Mahajan

2016

Int J Adv Med

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“…Administration of tetanus antitoxin using the intrathecal route offers a potential benefit in treating severe tetanus as tetanus toxin acts within the central nervous system (CNS). Case series and small randomized trials have reported large ( some >50%) improvements in mortality and hospital stay in both adults and neonates treated with intrathecal antitoxin 8– 19 . However, most reports are of poor quality with large methodological differences and possible biases.…”

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confidence: 99%

Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial

et al. 2018

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Despite long-standing availability of an effective vaccine, tetanus remains a significant problem in many countries. Outcome depends on access to mechanical ventilation and intensive care facilities and in settings where these are limited, mortality remains high. Administration of tetanus antitoxin by the intramuscular route is recommended treatment for tetanus, but as the tetanus toxin acts within the central nervous system, it has been suggested that intrathecal administration of antitoxin may be beneficial. Previous studies have indicated benefit, but with the exception of one small trial no blinded studies have been performed. The objective of this study is to establish whether the addition of intrathecal tetanus antitoxin reduces the need for mechanical ventilation in patients with tetanus. Secondary objectives: to determine whether the addition of intrathecal tetanus antitoxin reduces autonomic nervous system dysfunction and length of hospital/ intensive care unit stay; whether the addition of intrathecal tetanus antitoxin in the treatment of tetanus is safe and cost-effective; to provide data to inform recommendation of human rather than equine antitoxin. This study will enroll adult patients (≥16 years old) with tetanus admitted to the Hospital for Tropical Diseases, Ho Chi Minh City. The study is a 2x2 factorial blinded randomized controlled trial. Eligible patients will be randomized in a 1:1:1:1 manner to the four treatment arms (intrathecal treatment and human intramuscular treatment, intrathecal treatment and equine intramuscular treatment, sham procedure and human intramuscular treatment, sham procedure and equine intramuscular treatment). Primary outcome measure will be requirement for mechanical ventilation. Secondary outcome measures: duration of hospital/ intensive care unit stay, duration of mechanical ventilation, in-hospital and 240-day mortality and disability, new antibiotic prescription, incidence of ventilator associated pneumonia and autonomic nervous system dysfunction, total dose of benzodiazepines and pipecuronium, and incidence of adverse events. Trial registration: ClinicalTrials.gov NCT02999815 Registration date: 21 December 2016

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“…1980). Seven years later, Mongi concluded that ITS was superior to IMS in the treatment of neonatal tetanus (Mongi et al. 1987).…”

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confidence: 99%

Intrathecal vs. intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: a meta‐analysis

Kabura

Ilibagiza

Menten

et al. 2006

Tropical Med Int Health

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Summarybackground Mortality caused by tetanus is still a serious health problem in developing countries. Apart from immunization, early treatment with equine antitetanus serum (ATS) or human tetanus immunoglobulin (TIG) is the real treatment that can avoid death. On pathophysiological grounds intrathecal administration would be preferred because of high concentrations of the antiserum in cerebrospinal fluid and thus around the nerve roots. Many studies concluded on its effectiveness whereas others did not find any superiority of this method. However, most of those studies were not random and/ or had no sufficient weight. results A total of 942 patients were included in 12 trials, 484 in the intrathecal group and 458 in the intramuscular one. The combined RR of mortality for intrathecal vs. IMS was 0.71 (95% CI, 0.62-0.81). The superiority of intrathecal therapy also emerged when the analysis was performed in subcategories of both adults and neonates and for high and low dose of intrathecal serotherapy.conclusion Intrathecal administration of ATS or TIG is more beneficial than intramuscular administration in the treatment of tetanus.keywords tetanus, intrathecal, equine tetanus antitoxin, human antitetanus immunoglobulin

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Tetanus neonatorum—experience with intrathecal serotherapy at Muhimbili Medical Centre, Dar es Salaam, Tanzania

Cited by 13 publications

References 14 publications

Evaluation of beneficial effects of addition of intramuscular human tetanus immunoglobulin to intrathecal therapy in the treatment of tetanus

Evaluation of beneficial effects of addition of intramuscular human tetanus immunoglobulin to intrathecal therapy in the treatment of tetanus

Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial

Intrathecal vs. intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: a meta‐analysis

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