Complications
Muscle spasms can cause fractures of the vertebrae and other bones, as well as rhabdomyolysis (acute renal failure) and myositis ossificans circumscripta.[1]
Muscle spasms can cause rhabdomyolysis, which in turn can result in acute renal failure.[1]
Muscle spasms can cause intramuscular heterotopic calcification (myositis ossificans circumscripta).[1]
There is a high risk of aspiration resulting from poor cough due to muscle rigidity and sedation, pharyngeal spasms, dysphagia, gastric stasis, and increased intra-abdominal pressure during spasms. In severe tetanus, spasms may increase rapidly in frequency and duration; establishing a secure airway early is paramount before laryngeal obstruction and/or aspiration occurs.
Critical illness and assisted ventilation can lead to nosocomial infection.
Hospital-acquired pneumonia (HAP) is a known complication of severe tetanus. A randomized controlled trial of 229 adults and children with severe tetanus in Vietnam found no difference in the incidence of HAP between those nursed in the semi-recumbent and supine positions, although this finding may not be generalizable to patients managed in an intensive care unit of a developed country.[90]
Prolonged immobilization can lead to decubitus ulcers.
Assisted ventilation can lead to tracheal stenosis.
Critical illness can lead to gastrointestinal hemorrhage.
Critical illness and prolonged immobilization can lead to venous thromboembolism.
Most adult survivors experience no neurologic sequelae, although convalescence may be prolonged with residual muscle rigidity for several months.[1] In one retrospective study of 102 patients with tetanus managed at a tertiary center in Tanzania, 8.6% of survivors were discharged with permanent disability (persistent vegetative state due to hypoxic brain damage, limb amputations, and abnormal gait).[91]
Some small studies have suggested that neurologic sequelae following neonatal tetanus may be more common. The frequency of such complications may vary according to the medical facilities available.[2] Some evidence has demonstrated appreciable handicaps (cerebral palsy, mental deficit, behavioral disturbances) in survivors of neonatal tetanus, which have been attributed to anoxic brain damage resulting from prolonged spasms and apnea.[92] The frequent finding of enuresis, intellectual disability, and impairment of growth among Turkish children who had survived neonatal tetanus was described in a study.[93] In survivors of neonatal tetanus in Kenya, an increased frequency of microcephaly, mild neurologic abnormalities, developmental impairment (particularly fine motor difficulties), and behavioral problems was found, compared with other children in the community matched for age, sex, and locality.[94]
Critical illness and prolonged immobilization can lead to venous thromboembolism.
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