Indian Pediatrics - Editorial

Letters to the Editor

Indian Pediatrics 2003; 40:177-178

Reply

Our work is based on the experience at Calicut Medical College with intrathecal(I/T) TIG. The reference study(l) was conducted soon after reports of the successful use of this treatment in India were published(2,3). As it was found to be safe, of great benefit and less expensive, the use of I/T TIG was continued there. The second author was working in that institution at the time. We have been using this modality of treatment in our institution since 1989. Unfortunately, due to inadequate records, we have not been able to publish the data prior to 1995.

As already mentioned in our report, the proportion of patients with poor prognostic features at presentation was very high, viz., incubation period of 1 week or less in 41.5%, period of onset 3 days or less in 80.5%, generalized tetanus in 85.4% and fever at onset in 65.9%.

As per Patel and Joag’s classification of severity of tetanus(4), the number of patients in each grade at presentation was as follows: 4 patients each (9.8%) in Grade I and II, 10 patients (20.4%) in Grade III, 18 (43.9%) in Grade IV and 6 (14.6%) in Grade V. The 3 patients who died were all of Grade IV severity. The site of inoculum was otitis media in 21 (51.2%), a recent injury in 12 (29.2%) and unknown in 8 (19.6%). We were unable to gather precise data regarding the duration of spasms or the presence of autonomic distur-bances in all our patients.

We did not attempt to correlate presenting features with outcome. We merely presented our observations that a large number of patients in our series had poor prognostic features at presentation.

We do believe that I/T administration of TIG has contributed to the less severe course of the disease in our patients. It would be unethical for us to withold I/T TIG from any patient, given the observed benefits; hence a randomized controlled trial would not be feasible in our hospital. May we suggest that a well-designed controlled trial of the same be conducted at the larger teaching institutes in our country?

Janaki Menon,
Lulu Mathews,
Department of Pediatrics,
Medical College, Trissur,
Kerala, India.

References

1. Ramachandran N. A comparative study of different regimens in the management of tetanus with special reference to intrathecal serotherapy. Thesis for MD Pediatrics, University of Calicut, 1982.

2. Gupta PS, Kapoor R, Goyal S, Batra UK, Jain BK. Intrathecal human tetanus immunoglobulin in early tetanus. Lancet 1980; 2: 439-440.

3. Gupta PS, Kapoor R. Intrathecal tetanus immunoglobulin (human). Indian J Pediatr 1982; 49: 15-17.

4. Patel JC, Joag GG. Grading of tetanus to evaluate prognosis. Indian J Med Sci 1959; 13: 834-840.