The role of toxin-antitoxin systems in the survival of multidrug tolerant pathogens and designing of new approaches to treat them

Background: Tetanus is a nervous system disorder characterized by muscle spasms that is caused by the toxin-producing anaerobe, Clostridium Tetani. It is almost obsolete disease in developed country but one of the most neglected diseases in developing country. Methods & Materials: Case series, Here we describe the 320 cases of diagnosed tetanus cases admitted in Infectious unit of Mymensingh Medical college Hospital during the period of 3 year from July2011 to July 2014. Results: Median age of the patient was 40(R-3-70) years and 264(82.5%) were male; outnumbered were female. Most 95%(304) patients were from rural area and 65%(208) had family income around 100 US$/month. Clinical pictures revealed almost all (95.7%) had lock jaw, pain in the neck and back. About 47.8% patinets had resus sardonicus and 28% had opisthotonus. 87% had both upper and lower limb spasticity. One hundred twenty four (38.75%) had history of wound in lower limb, 21.6% (69)had upper limb and 20 had history of CSOM, 10 had incomplete abortion, 16 had due to surgical complication. Large number of patients(81) failed to reveal any causative factor. Incubation period between wound and tetanus developed from 6-90 days. Inj. TT and TIG(1500 to 3000IU) was given intramuscularly as a single dose in all patients. All patients were treated with Inj. Metronidazole and occasionally with other add in antibiotics. Spasm was mostly controlled by continuous infusion of Inj. Diazepam ranging from 30mg to 100mg/day . Inj Magnesium sulphate heptahydrate BP 4% w/v in 100ml i.v. solution was used 8 hourly as an additional therapy for control convulsion. Parenteral feeding followed by late oral feeding was given to maintain nutrition. Sixtysix (20%) patient died mostly due to lack of ICU support , 15 recovered with sequele . Most of the patients (75%) died within 3 days of treatment(R-115days). Most patients(87%) had lack a history of receipt of full series of tetanus toxoid immunization and inadequate prophylaxis following a wound. Conclusion: Low dose of magnesium is a good choice for treatment of tetanus; where modern logistic support is almost nills. Prevention of tetanus is a real priority subject in our community health.