Tetanus: suggestions for an unusual management

Background:Tetanus is an acute, often fatal, disease caused by anexotoxin produced by Clostridium tetani. Not jet extinct: in Italy actuallywe observe about 70 cases a year(the highest in Europe). In UnitedStates current mortality is 13.2%.The main causes of death are: no-socomial or aspiration pneumonia, devices infections and sepsis.Analysis:We have revisited our cases of tetanus from 2002 to 2012to assess the performance of intermediate care in this disease ma-nagement. We had 14 patients admitted to Emergency Medicine(EM) in Ancona hospital: 3 male(21.4%) and 11 woman (78.6%),with mean age 72,5 (Range 39-90).Twelve of them (85.7%) had anasogastric tube for enteral nutrition; all had usual therapy with mu-scle relaxers, sedatives, antibiotic, wound treatment as needed, pas-sive immunization, specific vaccination, and bedrest with anonstimulating environment. Four of them required admission in ICU(28.5%). Mean Albet score for MU and ICU pz was 2,1 and 2,7 re-spectively and mean SAPS2 score was 25,8 and 35,8 respectively.Severe inactions was observed in 30% MU pz vs 75% ICU pz. Ex-pected mortality for Albet wash 49,4% and 71,3% whereas forSAPS2 was 8,2% and 18,5% respectively; real mortality was 0% inMU and 50% in ICU. The mean hospital stay was 20.6 d for patientsin EM and 70.7 d if needed ICU.Conclusions:Our data show that it is possible treatment of patientswith tetanus in subintensive medical ward, with reduction of infections,hospital stay and probably a better prognosis. Clearly that manage-ment require careful monitoring and selection of patients.