Fatal Tetanus in a Patient with Carcinoma of the Breast – A Case Report

Tetanus in patients with malignant wounds can be fatal. We report a case of a patient with carcinoma of the breast, with a malignant wound. She had applied native medication and approached us for pain management. She developed typical features of tetanus which despite prompt detection and management by the palliative care team, turned fatal. We further discuss the need to keep the possibility of the diagnosis in mind, educate the caregivers to be aware of the possibility of a toxic infection like tetanus that can occur in patients with open wounds, ascertain the immunisation status if possible and conclude by reiterating the conclusions of other authors that prophylactic tetanus immunisation for those with malignant wounds could be effective in reducing the resultant morbidity-mortality.

Current incidence of certain clostridial infections: gas gangrene and tetanus

Clostridial myonecrosis or gas gangrene (myonecrosis) and tetanus are relatively rare nowadays, but they are still considered serious conditions associated with poor prognosis and high mortality. Life-threatening infections caused by Clostridium species have been known and studied for centuries, as they differed from other infections in terms of typical clinical manifestations, challenges of therapy and prevention. The aim of the study was to analyse the global incidence of gas gangrene and tetanus and challenges of prevention and treatment of these diseases. The review of up-to-date scientific literature demonstrated that gas gangrene continues to be a problem due to its rapid progression and challenging treatment. There are two main forms of the disease—traumatic and spontaneous. Traumatic gas gangrene is usually caused by C. perfringens, C. septicum, C. novyi (oedematiens), or C. histolyticum. Its incidence increases dramatically during wars, natural disasters, and other calamities. The literature review demonstrated that over the past 40 years there has been a rise in the frequency of spontaneous gas gangrene caused by C. septicum in people with compromised immune systems, in injecting drug users, and in women during various gynecological procedures and during normal delivery. Despite the effectiveness of the tetanus immunisation programme, the infection remains widespread in countries with insufficient vaccination coverage. The risk of tetanus in developed countries is high among elderly unvaccinated or partially vaccinated people, among injecting drug users, and vaccine refusers. The paper describes some clinical cases of gas gangrene and tetanus which demonstrate problems associated with challenging diagnosis and treatment, low awareness among primary healthcare personnel about mechanisms of anaerobic infection development, and anti-vaccination movement.

Wound Closure and Care in Oral and Maxillofacial Surgery

Management of soft tissue wounds needs a careful assessment of the wound, a good understanding of wound types and healing as well as adequate knowledge and skill for wound care. The various steps in wound care include cleansing and debridement, haemostasis, tetanus immunisation and antibiotic medication and wound closure.Wound closure can be accomplished in diverse ways, but suturing remains the mainstay. A wide variety of materials are available for wound suturing. One has to choose the right material and technique depending on the wound type and closure needs. Alternate techniques such as staples, tapes and adhesives are fast gaining popularity.

Knowledge, attitude and practices about tetanus toxoid immunisation amongst general population of an urban semi-slum area: a cross-sectional interview-based study from Western India

Background: Members of the public are frequently unaware of tetanus immunisation schedules and its importance in preventing tetanus. This community-based, cross-sectional, complete enumeration, interview-based study was conducted to assess the knowledge, attitude and practices about tetanus toxoid immunisation amongst the general population in an urban semi-slum area located about 30 kms from Mumbai city in Western India.Methods: Respondents comprised adult residents of either sex, who gave written informed consent to participate in the study. After obtaining approvals, the study was explained during routine home visits and the respondents were interviewed at a time convenient to them. A direct face-to-face interview was conducted using a semi-structured proforma and their responses were recorded and statistically analysed.Results: Of the 161 participants (90 males; 71 females), 16.15% were illiterates. 95.65% thought that a single tetanus toxoid injection was adequate to prevent tetanus while none knew that pregnant women are immunised to protect newborns against tetanus. 67.08% were unaware about the need for maintaining cold chain for storage of tetanus toxoid. 96.89% had received only one injection of tetanus toxoid, irrespective of the type of injury or previous immunisation status. The belief that an adult requires tetanus toxoid after every injury exhibited education-wise significant difference (p=0.02).Conclusion: Sustained and focussed health education efforts are necessary to combat misconceptions regarding tetanus toxoid immunisation.

Management of unscheduled tetanus prophylaxis in Emergency Departments: Point-of-Care implementation as a rapid tool for the evaluation of anti-tetanus antibodies

Background and aim: Each analytical activity, including those carried out in Point of Care (POCT) must be, at law, under the control of Laboratory Medicine. Before the implementation of the rapid tetanus quick stick (TQS) test for the evaluation of the specific tetanus immunisation, a multi-disciplinary and multi-professional group was created. The aim of this study was to evaluate the ability of Emergency Department (ED) staff to manage and correctly understand the result of TQS test in POCT. <br />Materials and Methods: This analysis took into consideration 152 patients admitted to ED with traumatic wounds; information on the state of tetanus immunisation at their arrival wasn’t recorded. Blood sample analysis was performed twice. The Laboratory confirmed a 100% concordance between their results and ELISA test (standard criterion). Study design consisted of 2 phases: the first one (50 test) to preliminarily evaluate if any corrective action or improvement of procedures is required, and the second one (102 tests) to confirm the quality of corrective actions. <br />Results: The concordance of results between TQS test in Laboratory and POCT test in ED was 80% in the first phase and 95% in the second one.<br />Conclusions: The use of the rapid TQS test is a valuable tool; however, to avoid serious mistakes of interpretation, periodic checks on the quality of the results must be arranged.