Tétano canino ­ Relato de caso / Tetanus in dogs ­ Case report / Tétano canino ­ Relato de caso

O tétano refere-se a uma condição infecciosa ocasionada por toxinas do Clostridium tetani, bacilo Gram positivo e anaeróbico, o qual ao sofrer lise e morte nos tecidos do hospedeiro libera toxinas capazes de bloquear a liberação do neurotransmissor inibidor de glicina e a liberação do ácido gama-amino butírico, levando a um quadro de tetania. Os sinais clínicos da enfermidade são o trismo e opistótono, entre outros. O diagnóstico se dá por meio de histórico e sinais clínicos e o tratamento é sintomático. O presente artigo tem o objetivo de relatar um caso clínico de tétano em um macho canino da raça Pitbull, de um ano de idade. O cão foi, atendido no Hospital Veterinário da Universidade Paranaense, Umuarama, PR, com sinais clínicos neurológicos como rigidez muscular e opistótono, iniciados após ferimento no coxim plantar. Pelo histórico e sinais clínicos firmou-se o diagnóstico de tétano. Foi instituído tratamento, mas o animal teve óbito, sendo que a doença tem alta mortalidade na espécie.(AU)

Tetanus is an infectious condition caused by Clostridium tetani toxins, a Gram-positive, anaerobic bacillus, which, when undergoing lysis and death in the host tissues, releases toxins capable of blocking the release of the glycine inhibitory neurotransmitter and the release of gamma-amino butyric acid, leading to a tetanic state. The clinical signs of the disease are trismus and opisthotonus, among others. The diagnosis is made by means of history and clinical signs, with symptomatic treatment. This article aims to report a clinical case of tetanus in a one-year-old Pitbull male canine. The dog was attended at the Veterinary Hospital at Universidade Paranaense, in the city of Umuarama, Paraná, presenting neurological clinical signs such as muscular and opisthotonous rigidity, initiated after injury to the plantar cushion. The diagnosis of tetanus was confirmed by the history and clinical signs. Treatment was instituted but the animal died, since the disease present a high mortality rate in the species.(AU)

El tétano se refiere a una condición infecciosa ocasionada por toxinas de Clostridium tetani, bacilo Gram positivo y anaeróbico, el cual al sufrir lise y muerte en los tejidos del hospedero suelta toxinas capaces de bloquear la liberación del neurotransmisor inhibidor de glicina, y la liberación del ácido gama amino butírico, llevando a un cuadro de tetania. Los signos clínicos de la enfermedad son el trismo y opistódomo, entre otros. El diagnóstico se da por medio de histórico y signos clínicos y el tratamiento es sintomático. El presente artículo tiene el objetivo de relatar un caso clínico de tétano en un canino macho de la raza Pitbull, de un año de edad. El perro ha sido atendido en el Hospital Veterinario de la Universidad Paranaense, Umuarama PR, con señales clínicos neurológicos como rigidez muscular y opistódomo, iniciados tras herimiento en el coxin plantar. Por el histórico y señales clínicos se ha llegado al diagnóstico de tétano. Se empezó el tratamiento, pero el animal vino a óbito, siendo que la enfermedad tiene alta mortalidad en la especie.(AU)

Tetanus; still cannot be prevented, a three year retrospective study in DHQ hospital, Faisalabad

Tetanus still remains a major public health problem in Pakistan like in most other developing countries, with a high morbidity and mortality. To study the demographic profile the clinical profile, the outcome of the tetanus patients and effectiveness of tetanus immunization coverage in district Faisalabad. Retrospective record based study. Surgical unit-5 DHQ Hospital, Faisalabad from January 2010 to December 2012. All data of 198 patients of tetanus of any age and sex, diagnosed clinically was collected, compiled and analyzed from the Medical Records Department of the Hospital. Out of 198 patients of tetanus,138[69.7%] were males and 60[30.3%] were females. Their ages ranged from 1 to 85 years with a mean and a standard deviation respectively of 29.36 and 17.48 years.162 [81.8%] were from rural and36[18.2%] were from urban areas. 47[23.7%] patients were having prior immunization and151[76.3%] were not immunized. The most common presenting symptoms were trismus [47.5%], body stiffness [24.2%],fits[19.2%] and respiratory distress[9.1%]. 23[11.6%] patients were having mild disease,71[35.9%] patients were having moderate disease,71[35.9%] patients were having severe disease and 33[16.7%] were having very severe disease. Overall mortality rate was 41.4%. Respiratory failure was the most common cause of death and there was statistically significant association between mortality and increasing grades of disease. By making expanded programme of immunization [EPI] more effective and removing flaws from out-dated vaccination through incomplete vaccination. By improving awareness in public and complete vaccination through EPI program, we can reduce the incidence of tetanus

Clinical classification of tetanus patients

The authors propose a clinical classification to monitor the evolution of tetanus patients, ranging from grade I to IV according to severity. It was applied on admission and repeated on alternate days up to the 10th day to patients aged > or = 12 years admitted to the State University Hospital, Recife, Brazil. Patients were also classified upon admission according to three prognostic indicators to determine if the proposed classification is in agreement with the traditionally used indicators. Upon admission, the distribution of the 64 patients among the different levels of the proposed classification was similar for the groups of better and worse prognosis according to the three indicators (P > 0.05), most of the patients belonging to grades I and II of the proposed classification. In the later reclassifications, severe forms of tetanus (grades III and IV) were more frequent in the categories of worse prognosis and these differences were statistically significant. There was a reduction in the proportion of mild forms (grades I and II) of tetanus with time for the categories of worse prognostic indicators (chi-square for trend: P = 0.00006, 0.03, and 0.00000) whereas no such trend was observed for the categories of better prognosis (grades I and II). This serially used classification reflected the prognosis of the traditional indicators and permitted the comparison of the dynamics of the disease in different groups. Thus, it becomes a useful tool for monitoring patients by determining clinical category changes with time, and for assessing responses to different therapeutic measures.

Adult tetanus: unfinshed problem

As the immunization coverage of children and pregnant women widened, it is to be expected that neonatal and childhood tetanus will become rare. In Egypt, the recommendations for booster doses every 10 years in adults are poorly followed and no intervention takes place in persons above 9-10 years of age except for wound prophylaxis. The aim of this retrospective study was to describe epidemiological features of tetanus cases over the period from 1998 to 2004. Cases of non-neonatal tetanus were 238, mean annual frequency 34 +/- 3.3, most of the cases were adolescents and adults of both sexes except 4 children below 15 years, male to female ratio 4.4:1, 56.3% were farmers. Only 66% of the studied cases sustained an acute injury before onset of illness; 66.2% occurred after puncture wounds of whom 20.2% had stepped on a nail, 8.9% had an injury related to surgery or gluteal injection. Frequent sites for injury were the lower limb mainly the foot in 72.6% of cases, hand in 15.3%, head in 2.55% and teeth in 1 .3%. No data were available as regards the post-injury care of the wound, anti-tetanic prophylaxis, or the patients vaccination status. The incubation period ranged from 5-30 days and was related to severity of tetanus. Case-fatality rate was 18.9%; it increased at extremes of age and reached its maximum [62.1%] in patients =60 years. Case-fatality rate was significantly influenced by age, sex, site of injury, and duration of hospital stay but was not significantly influenced by type of tetanus or incubation period. All adult cases of tetanus were managed in the intensive care unit with assisted ventilation for 11 .8%. Thus considering expenses incurred in managing tetanus patients, it seems necessary to include booster doses in the Expanded Immunization Program, and to develop vaccination programs targeting adult males and elderly population of both sexes. Occupation may be an important consideration in the development of immunization policies

Criterios de pronóstico en el tétanos del adulto / Prognostic criteria of tetanus in adults

Se reviso las historias clínicas de 76 pacientes con tétanos del adulto. Los factores asociados significativamente a los casos severos o muy severos fueron: una edad mayor o igual a 70 años, un periodo de incubación menor o igual a 7 dias, un tiempo de enfermedad menor igual a 4 dias y una puerta de entrada quirúrgica. se evaluo tres clasificaciones de pronóstico diferentes. Debido al tamaño pequeño de la muestra, los resultados de letalidad encontrados tienen intervalos de confianza muy amplios, lo que no permite detectar diferencias significativas en la letalidad entre las tres clasificaciones. Consideramos que la clasificación que toma en cuenta el tiempo de enfermedad y la presencia de espasmos, es la mas simple y facil de reproducir en el medio urbano y urbano-marginal

Tétanos: un factor de alto riesgo / Tetanus: a high risk factor

Se analizaron restrospectivamente 53 casos de tétanos del adulto admitidos en la sala de terapia intensiva entre los años 1986 y 1987. Cerca de la mitad de los ingresos (47 por ciento) tuvieron el antecedente de la aplicación de inyectables por vía intramuscular. La mortalidad de ese grupo fue del 84 por ciento vs. el 33 por ciento del grupo asociado a heridas. El período de incubación en 22 de 25 pacientes fue menor de 5 días, con generalización de los síntomas en las 24 horas siguientes a la aparición del trismus. Esta evolución se observó en 5 de 21 pacientes con antecedentes de heridas. Se advierte sobre el aumento de la enfermedad asociada a inyecciones IM y la identificación de un grupo de alto riesgo en quienes se recomienda asegurar la correcta inmunización previo a la terapeútica por esa vía de administración