Retrospective evaluation of 155 adult equids and 21 foals with tetanus from Western, Northern, and Central Europe (2000-2014). Part 2: Prognostic assessment.
Van Galen, Gaby; Rijckaert, Joke; Mair, Timet al.
2017 • In Journal of Veterinary Emergency and Critical Care
[en] OBJECTIVE: To identify prognostic variables for adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids and 21 foals with tetanus. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization. CONCLUSIONS: Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.
Amory, Hélène ; Université de Liège - ULiège > Dép. clinique des animaux de compagnie et des équidés (DCA) > Médecine interne des équidés
Armengou, Lara
Bezdekova, Barbora
Durie, Inge
Findshoj Delany, Rikke
Fouche, Nathalie
Haley, Laura
Hewetson, Michael
van den Hoven, Rene
Kendall, Anna
Malalana, Fernando
Muller Cavalleri, Jessika
Picavet, Tresemiek
Roscher, Katja
Verwilghen, Denis
Westermann, Cornelie
Saegerman, Claude ; Université de Liège - ULiège > Département des maladies infectieuses et parasitaires (DMI) > Epidémiologie et analyse des risques appl. aux sc. vétér.
Retrospective evaluation of 155 adult equids and 21 foals with tetanus from Western, Northern, and Central Europe (2000-2014). Part 2: Prognostic assessment.
Publication date :
2017
Journal title :
Journal of Veterinary Emergency and Critical Care
ISSN :
1479-3261
eISSN :
1476-4431
Publisher :
Blackwell, Oxford, United Kingdom
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
(c) Veterinary Emergency and Critical Care Society 2017.
Green SL, Little CB, Baird JD, et al. Tetanus in the horse - a review of 20 cases (1970 to 1990). J Vet Intern Med 1994; 8:128–132.
Muylle E, Oyaert W, Ooms L, et al. Treatment of tetanus in horse by injections of tetanus antitoxin into subarachnoid space. J Am Vet Med Assoc 1975; 167:47–48.
Muylle E, De Roose P, Oyaert W, et al. Symptomatologie, behandeling en resultaten bij 108 gevallen van tetanus bij paarden. Vlaams Diergeneeskd Tijdschr 1974; 43:416–423.
van Galen G, Delguste C, Sandersen C, et al. Tetanus in the equine species: a retrospective study of 31 cases. Tijdschr Diergeneeskd 2008; 133:512–517.
Kay G, Knottenbelt DC. Tetanus in equids: a report of 56 cases. Equine Vet Educ 2007; 19:107–112.
Steinman A, Haik R, Elad D, et al. Intrathecal administration of tetanus antitoxin to three cases of tetanus in horses. Equine Vet Educ 2000; 12:237–240.
Reichmann P, Lisboa JAN, Araujo RG. Tetanus in equids: a review of 76 cases. J Equine Vet Sci 2008; 28:518–523.
Lambo JA, Anokye EA. Prognostic factors for mortality in neonatal tetanus: a systematic review and meta-analysis. Int J Infect Dis 2013; 17:E1100–E1110.
Greatorex JC. Intravenous nutrition in treatment of tetanus in horses. Vet Rec 1975; 97:498–498.
Attygalle D, Rodrigo N. Magnesium sulphate for control of spasms in severe tetanus. Can we avoid sedation and artificial ventilation? Anaesthesia 1997; 52:956–962.
Trujillo MH, Castillo A, Espana J, et al. Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases. Chest 1987; 92:63–65.
Edmondson RS, Flowers MW. Intensive care in tetanus: management, complications, and mortality in 100 cases. Br Med J 1979; 1:1401–1404.
van Galen G, Marcillaud Pitel C, Saegerman C, et al. European outbreaks of atypical myopathy in grazing equids (2006–2009). Spatiotemporal distribution, history and clinical features. Equine Vet J 2012; 44:614–620.
van Galen G, Saegerman C, Rijckaert J, et al. Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000–2014). Part 1: description of history and clinical evolution. J Vet Emerg Crit Care 2017; 27(6):7–11. https://doi.org/1111/vec.12668
Lam PK, Trieu HT, Lubis IN, et al. Prognosis of neonatal tetanus in the modern management era: an observational study in 107 Vietnamese infants. Int J Infect Dis 2015; 33:7–11.
Cook TM, Protheroe RT, Handel JM. Tetanus: a review of the literature. Br J Anaesth 2001; 87:477–487.
Burkitt JM, Sturges BK, Jandrey KE, et al. Risk factors associated with outcome in dogs with tetanus: 38 cases (1987–2005). J Am Vet Med Assoc 2007; 230:76–83.
Wilkins PA, Palmer JE. Mechanical ventilation in foals with botulism: 9 cases (1989–2002). J Vet Intern Med 2003; 17:708–712.
Ansari MM, Matros LE. Tetanus. Compend Contin Educ 1982; 4:105–109.
Pilaca AS, Beqiri AI, Ndreu AH, et al. Factors affecting the prognosis of Albanian adult patients with generalized tetanus. G Chir 2012; 33:105–109.
Saltoglu N, Tasova Y, Midikli D, et al. Prognostic factors affecting deaths from adult tetanus. Clin Microbiol Infect 2004; 10:229–233.
Ahmadsyah I, Salim A. Treatment of tetanus: an open study to compare the efficacy of procaine penicillin and metronidazole. Br Med J (Clin Res Ed) 1985; 291:648–650.
Ganesh Kumar AV, Kothari VM, Krishnan A, et al. Benzathine penicillin, metronidazole and benzyl penicillin in the treatment of tetanus: a randomized, controlled trial. Ann Trop Med Parasitol 2004; 98:59–63.