Tetanus from Intramuscular Quinine Injection InWarri Niger Delta. Case series: A ten year retrospective study

Aim: To evaluate the development of tetanus from intramuscular injection in children inWarri, Niger Delta of Nigeria Materials and Methods; Retrieval and analysis of case notes of all children with tetanus seen between 1999 and 2008 at Central Hospital Warri with referrals from surrounding General Hospitals and GN Children's Clinic one of the four private hospitals for children in Warri and its environs, and noting those resulting from intramuscular injections. Results: A total of one hundred and seventy five children were diagnosed with tetanus with twelve due to intramuscular injections. Out of the twelve, ten were from intramuscular quinine injection giving a per centage of 83.3%. Six out of the ten from intramuscular quinine were males. The case fatality rate in males is 100% but 50% in females. The patients were given the injections mainly in private clinics and the remaining from a chemist store. The incubation period in all of them was less than seven days. Only one of the patients with tetanus from intramuscular quinine injection survived, giving a mortality rate of 80%. Conclusion: Tetanus from intramuscular quinine in children is relatively uncommon probably because less usage of that route for quinine administration. However, when it occurs, it is highly fatal. Other routes of parentheral quinine administration such as intrarectal are recommend. There is however a recent WHO giudelines on the treatment of severe falciparum malaria which showed the superiority of intravenous artesunate over quinine