Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Of 99 patients with adult tetanus, 7 developed the clinical and biochemical features of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The diagnosis for these 7 patients was severe tetanus (dysphagia with frequent severe spasms); 5/7 patients had evidence of autonomic overactivity (tachycardia, sweating, cardiovascular lability, and hypersalivation). They all responded favorably to fluid restriction, SIADH was self-limited and resolved as the disease regressed.
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PMID:Inappropriate ADH secretion in tetanus. 685 96

A 47-year-old man presented with backache and signs of acute abdomen. An exploratory laparotomy was performed. Post-operatively he developed hypoxaemia in the operating theatre and was brought to the Surgical Intensive Care Unit for ventilatory support and further investigations. History was then retaken and revealed a minor foot injury one month ago with subsequent development of muscle spasm and dysphagia. The diagnosis of tetanus was made. The patient was then treated with human antitetanus immune globulin and crystalline penicillin. Ventilatory support was continued, aided by infusion of morphine, diazepam and alcuronium. The recovery course was complicated by chest infection, urinary tract infection and sympathetic overactivity. He improved later and ventilatory support was discontinued three weeks after admission. He then made uneventful recovery and was discharged from the hospital forty days after admission.
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PMID:A case of tetanus mimicking acute abdomen. 776 95

Eighteen patients with generalized tetanus seen during an 8-year period in three regional hospitals in Hong Kong are reviewed. Eighty-nine per cent of the patients were intravenous heroin addicts who developed a severe type of generalized tetanus with autonomic dysfunction. Pain or stiffness of the neck or back was the commonest presenting symptom, followed by trismus and dysphagia. Most of the patients developed muscle spasms within 24 h of the onset of presenting symptoms. Early ventilatory support and tracheostomy, together with intensive nursing care, were the mainstay of the treatment. Pulmonary and gastrointestinal complications were common during the course of illness and treatment of autonomic dysfunction was often unsatisfactory. The case fatality rate was 25% among the heroin addicts, but full recovery was the usual outcome for those who survived. The simultaneous administration of intrathecal tetanus immunoglobulin tends to reduce mortality.
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PMID:Management of tetanus: a review of 18 cases. 807 28

Tetanus is an infection caused by Clostridium tetani. In the United States, tetanus remains a significant problem primarily among nonimmunized or inadequately immunized individuals. This article reports a fatal case of tetanus that occurred in a 45-year-old parenteral drug abuser who presented to Harlem Hospital Center with nuchal rigidity, trismus, dysphagia, and spasms of the pectoralis musculature. Multiple cutaneous ulcerations also were observed. Despite aggressive measures that included: endotracheal intubation, administration of human tetanus, hyperimmune globulin, tetanus toxoid, and intravenous penicillin, the patient rapidly deteriorated and manifestations of heightened sympathetic nervous system activity, seizures, and cardiac arrest ensued. The diagnosis of tetanus must be based upon clinical grounds. Clinicians must remain aware of the possibility of tetanus, especially among drug abusers who also are more likely to be evaluated for complications of human immunodeficiency viral infection, which in some cases may mimic tetanus or make the diagnosis more difficult to establish.
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PMID:Tetanus in a parenteral drug abuser: report of a case. 818 56

This article highlights the prevalence of diphtheria in urban slums in north India. In 1997, diphtheria cases reached 1326, and in a study conducted in September 1999, 4 diphtheria cases were reported in a tertiary care hospital. These cases occurred despite the vaccination programs against diphtheria. Clinical manifestation included fever, sore throat, dysphagia, and swelling in the neck of 2-10 days duration. Immunization records of these children revealed that 2 were nonimmunized and the other 2 received only 2 doses of diphtheria-pertussis-tetanus vaccine in their first year of life. Using electrocardiography, 3 of the cases were suggestive of myocarditis. Laboratory examinations, such as Albert's staining and Loeffler's serum slope, were used to confirm the diagnosis. This epidemic was found to be caused by a large population of susceptible children and adults, decline in childhood immunization, poor socioeconomic conditions, and large-scale population movements. In conclusion, the 44% dropout rate between the third dose of primary immunization and the first booster could be one factor in the emergence of diphtheria.
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PMID:Diphtheria in urban slums in north India. 1067 27

The medical records of 20 tetanus patients who were treated at a university teaching hospital in Taiwan during the period from October 1991 to July 1999 were retrospectively analyzed. There were 18 adults (six males and 12 females) with unknown previous immunization status and ages ranging from 34 to 87 years old (mean 63 years). Two patients were children, aged 3 and 5 years old, respectively; both of them had incomplete tetanus immunization. Of the 17 patients reporting previous acute injury, 10 had tetanus-prone wounds. Four of six patients who sought medical help for wound management received tetanus toxoid, but none received tetanus immunoglobulins. The most common symptoms were trismus, dysphagia, and muscular rigidity. Specific treatment consisted of active and passive immunization, wound management, parenteral antibiotics, and benzodiazepines, muscle relaxants or neuromuscular blockades for control of spasms and sedation. All adults were admitted to the intensive care unit and an artificial airway was established. Fourteen of them required ventilator support during the illness. Prophylactic tracheostomy was performed within 24 h after arrival in 12 (92%) of 13 patients. Two patients died with an overall mortality rate of 10%. Sequelae were rare in the patients who survived. Because of inclusion of the diphtheria-pertussis-tetanus (DPT) vaccine in the national Children's Vaccine Program and improvement in obstetrical practices and neonatal care in Taiwan, tetanus mainly occurs in people older than 65 years instead of neonates or children. Waning immunity to tetanus in the elderly and poor wound management practices by primary care physicians were contributory factors.
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PMID:Tetanus of the elderly. 1104 84

Report about a 80 year-old female patient admitted to hospital with dysarthria and dysphagia suspected to have had a stroke. The symptoms however were caused by a tetanus infection consequent upon a grossly contaminated ten-day-old wound. Since particularly geriatric patients are at risk of tetanus infections in industrialised countries, such patients ought to get regular booster-vaccinations.
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PMID:[Tetanus--differential diagnosis of cerebrovascular stroke]. 1137 64

Tetanus is a forgotten disease in the United States since many practicing primary care physicians have not seen a case of the disease in their career. A 73-year-old woman presented with dysphagia two weeks after she obtained a superficial laceration while gardening. Within days, the jaw spasms and subsequent respiratory compromise that necessitated five weeks of ventilator support revealed the devastation that this disease can cause. Tetanus spores are found in high concentration in the soils of rural areas, especially where farm animals have grazed. Populations most at risk in the U.S. include under- or non-immunized elderly and immigrant populations. Barriers to immunization include patient and physician non-compliance, missed opportunity for immunization and concern over vaccine side effects. Targeting high-risk groups will enable primary care physicians to be more proactive in providing immunization, and thus in preventing prevention this disease.
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PMID:Tetanus: a case report, epidemiology review and recommendations for immunization compliance. 1176 52

Tetanus is considered a major health problem in the developing and under-developed countries, with approximately 1 million new cases occurring each year. We have evaluated the tetanus patients and their presenting complaints, the clinical findings and their relations to the head and neck region along with the frequency of otolaryngological findings and their correlation to the prognosis of this highly mortal disease. There were a total of 37 patients with generalized tetanus diagnosed and treated between 1991 and 2001. There were 25 women and 12 men with a mean age of 55+/-15.6 years. The most common presenting symptom was trismus, followed by neck pain, dysphagia, generalized pain and facial muscular contractions. Wound evaluation revealed that 72.9% of the patients had tetanus-prone wounds, and 27% had either no obvious wounds or a wound considered to be trivial by the patient. Only 62% percent of the patients had sought medical attention immediately after being injured. Three patients in our series were admitted to the otolaryngology clinic with upper aerodigestive tract symptoms. A comparison of complaints with clinical findings revealed a significant lack of correlation, emphasizing that complete physical examination must be performed when evaluating patients with trismus, dysphagia and neck pain. Tracheotomy was performed in 21 cases. There was a direct correlation between the clinical stage and the requirement of tracheotomy. Wound debridment was performed, and antibiotherapy, tetanus toxoid vaccine and immunoglobulin were administered. The mortality rate was 59.4% (22/37). Shorter incubation periods and periods of onset and a higher grade of disease were significantly related to high mortality rates ( P=0.001). It is important to realize the fact that instead of looking for tetanus-prone wounds, one should be on the lookout for tetanus-prone patients. Consequently, on the part of the otolaryngologist, there should always be a high index of suspicion, and concerning patients with trismus or subacute progressive dysphagia, the possibility of tetanus must be borne in mind.
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PMID:Otolaryngologic aspects of tetanus. 1252 Mar 58

The aim of this study was to present the epidemiological and clinical characteristics of tetanus as related to case fatality in 43 adult patients hospitalized between 1990 and 2000 in Turkey's largest state tertiary hospital. All patients were > or =15 years of age, with the mean age being 45 years. Sixty-five percent of the patients were male. Most patients (77%) were from rural Anatolia. The most common clinical manifestations were trismus (100%), abdominal rigidity (93%), dysphagia (81%), and risus sardonicus (72%). The overall case fatality rate was 58%. In a multivariable logistic regression model an incubation period of < or =8 days versus >8 days was a significant predictor of case fatality (odds ratio, 4.8; P=0.044; 95%CI, 1.04-22.26), as was each day of delay between onset of symptoms and admission to the hospital (odds ratio, 7.4; P=0.035; 95%CI, 1.15-48.28). Although the case fatality rate of tetanus in our clinic has declined in the last 5 years, the overall rate was high. This suggests a need for adult vaccination programs and/or a plan to educate the public to recognize symptoms early and then rapidly seek medical care.
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PMID:Analysis of the case fatality rate of tetanus among adults in a tertiary hospital in Turkey. 1264 18


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