title: Tetanus in developing countries: a case series and review.
abstract: OBJECTIVE
  Few anesthesiologists have expertise in the diagnosis and treatment of tetanus, a disease that remains prevalent in developing countries. We report on a series of four cases of tetanus cases recently encountered in Rwanda. We review the clinical epidemiology, pathophysiology, diagnosis and the treatment of tetanus, and provide implications for anesthesiologists and critical care physicians.
  
  
  METHODS
  We report four cases, two involving adults who were inadequately vaccinated and experienced injuries, and two involving neonates, both of whom underwent umbilical cord transection using unsterilized equipment. All patients required tracheal intubation, and were mechanically ventilated when equipment was available. One adult and one neonate succumbed to the disease. These cases highlight the difficulties of diagnosis and management of complicated diseases in the resource-challenged health care setting of developing countries.
  
  
  CONCLUSIONS
  The differential diagnosis of tetanus may be confusing, and survival depends on the rapidity of treatment with antitoxin, as well as adequate supportive care. High doses of sedatives and muscle relaxants, as well as prolonged mechanical ventilation, are usually necessary. Mortality remains high, usually resulting from late respiratory failure and cardiovascular collapse, associated with autonomic instability. Anesthesiologists and critical care physicians have an important role to play in the management of these patients. Increased involvement in humanitarian health organizations, immigration from developing countries, and emergence of high risk groups in developed countries will likely result in more exposure of anesthesiologists to the complexities of this disease.
authors.affiliation: Department of Anesthesiology, Queen's University, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
authors.forename: Kara
authors.initials: K
authors.lastname: Gibson
authors.forename: J
authors.initials: J
authors.lastname: Bonaventure Uwineza
authors.forename: Willy
authors.initials: W
authors.lastname: Kiviri
authors.forename: Joel
authors.initials: J
authors.lastname: Parlow
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods; D003906:Developing Countries; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D012121:Respiration, Artificial; D013742:Tetanus / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013743:Tetanus Antitoxin / Q000008:administration & dosage*; D013745:Tetanus Toxoid / Q000008:administration & dosage*
chemical_list: D013743:Tetanus Antitoxin; D013745:Tetanus Toxoid