Intrathecal therapy in tetanus. A meta-analysis

OBJECTIVE.--To assess the efficacy of intrathecal therapy with tetanus antibody (antitetanus equine serum or human tetanus immune globulin) in neonatal and adult tetanus using meta-analytical techniques. DATA SOURCES.--Clinical trials identified by searching MEDLINE and by reviewing bibliographies of published articles. STUDY SELECTION.--Studies in English with concurrent controls treated without intrathecal therapy. DATA EXTRACTION.--Data were extracted by one author and verified by the second; conflicts were resolved by discussion. DATA SYNTHESIS.--No major treatment effect was found in neonatal tetanus when all studies were considered. A benefit was suggested for antitetanus equine serum in adult disease, but this finding should be accepted with caution. Subgroup analyses were limited in power. Methodological difficulties in neonatal and adult trials were common and safety has not been established. CONCLUSIONS.--Intrathecal therapy for tetanus with either antitetanus equine serum or human tetanus immune globulin is not of proven benefit and should only be given in the context of well-designed, controlled trials.     

Puerperal tetanus.

Fifty cases of puerperal tetanus were studied. It constituted 6.66% of total cases of tetanus with overall mortality of 52% which was higher in cases with incubation period of 14 days or less, period of onset 48 hours or less, higher grades, cases with temperature more than 37.7 degrees C and patients with respiratory complications. Significantly higher mortality rate after 48 hours signifies the need of effective local control of infection to improve prognosis. Prevention, early detection and prompt treatment of respiratory complications which is the main cause of death may further reduce mortality rate in these patients.     

Horner's syndrome in severe tetanus.

A 66 year old man was admitted with a left Horner''s syndrome, and trismus due to tetanus. Three days later he had respiratory arrests, classical tetanic spasms and was ventilated. He had associated severe autonomic dysfunction, tachyarrhythmias, hypotension, sweating and constipation. There was complete resolution of the left Horner''s syndrome with recovery from tetanus.     

Acute transverse myelopathy complicating tetanus.

A 12-year-old boy presented with typical features of short incubation tetanus. Spastic paraparesis with a mid-thoracic sensory level was present from the time of the initial examination. X-rays of the spine and lumbar myelogram were normal. The paraparesis improved rapidly and within a month the patient was free of neurological deficit. The case is possibly a rare example of tetanus involving the central nervous system other than the anterior horn cells.