A Pilot Study to Assess Safety and Feasibility of Intrathecal Immunoglobulin for the Treatment of Adults with Tetanus

• Published in: The American journal of tropical medicine and hygiene Vol. 99; no. 2; pp. 323 - 326
• Main Authors: Loan, Huynh Thi, Yen, Lam Minh, Kestelyn, Evelyne, Hao, Nguyen Van, Mai, Nguyen Thi Hoang, Thuy, Duong Bich, Duong, Ha Thi Hai, Dung, Nguyen Thi Phuong, Phu, Nguyen Hoan, Lieu, Pham Thi, Thanh, Tran Tan, Geskus, Ronald, van Doorn, H Rogier, Tan, Le Van, Wyncoll, Duncan, Day, Nicholas P J, Hien, Tran Tinh, Thwaites, Guy E, Chau, Nguyen Van Vinh, Thwaites, C Louise
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01-01-2018; The American Society of Tropical Medicine and Hygiene
• Subjects: Immunoglobulins; Tetanus
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.18-0153

Tetanus remains a significant burden in many low- and middle-income countries. The tetanus toxin acts within the central nervous system and intrathecal antitoxin administration may be beneficial, but there are safety concerns, especially in resource-limited settings. We performed a pilot study to assess the safety and feasibility of intrathecal human tetanus immunoglobulin in five adults with tetanus before the conduct of a large randomized controlled trial. Intrathecal injection via lumbar puncture was given to all patients within a median 140 (range 100-165) minutes of intensive care unit (ICU) admission. There were no serious adverse effects associated with the procedure although three patients had probably related minor adverse events which resolved spontaneously. Median ICU length of stay was 14 (range 5-17) days. Two patients required mechanical ventilation and one developed a deep vein thrombosis. Within 240 days of hospital discharge, no patients died and all patients returned to work.