Autonomic nervous system dysfunction predicts poor prognosis in patients with mild to moderate tetanusReport as inadecuate

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BMC Neurology

, 5:2

First Online: 31 January 2005Received: 08 August 2004Accepted: 31 January 2005


BackgroundAutonomic nervous system ANS dysfunction is present in up to one third of patients with tetanus. The prognostic value of ANS dysfunction is known in severe tetanus but its value is not well established in mild to moderate tetanus.

MethodsMedical records of all patients admitted with tetanus at two academic tertiary care centers in Karachi, Pakistan were reviewed. The demographic, clinical and laboratory data was recorded and analyzed. ANS dysfunction was defined as presence of labile or persistent hypertension or hypotension and sinus tachycardia, tachyarrythmia or bradycardia on EKG. Patients were divided into two groups based on presence of ANS dysfunction ANS group and non ANS group. Tetanus severity was classified on the basis of Ablett criteria.

ResultsNinety six 64 males; 32 females patients were admitted with the diagnosis over a period of 10 years. ANS group had 31 32% patients while non ANS group comprised of 65 68% patients. Both groups matched for age, gender, symptom severity, use of tetanus immunoglobulin and antibiotics. Twelve patients in ANS group had mild to moderate tetanus Ablett I and II and 19 patients had severe-very severe tetanus Ablett III and IV. Fifteen 50% patients in ANS group required ventilation as compared to 28 45% in non-ANS group p = 0.09. Fourteen 47% patients died in ANS group as compared to 10 15% in non ANS group p= 0.002. Out of those 14 patients died in ANS group, six patients had mild to moderate tetanus and eight patients had severe- very severe tetanus. Major cause of death was cardiac arrhythmias 13-14; 93% in ANS group and respiratory arrest 7-10; 70% in non ANS group. Ten 33% patients had complete recovery in ANS group while in non ANS group 3548% patients had complete recovery p= 0.05.

ConclusionsANS dysfunction was present in one third of our tetanus population. 40% patients with ANS dysfunction had only mild to moderate tetanus. ANS dysfunction, irrespective of the need of mechanical ventilation or severity of tetanus, predicted poor outcome.

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Author: Mohammad Wasay - Bhojo A Khealani - Naasha Talati - Rohmah Shamsi - Nadir A Syed - Naseem Salahuddin



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