Tétanos generalizado en un adolescente / Spread tetanus in an adolescent

Se presenta el caso clínico de un adolescente de 13 años de edad, con antecedentes de buena salud, quien solo recibió inmunización durante la etapa neonatal, el cual sufrió una herida causada por un clavo enmohecido en el dorso del pie derecho y acudió al Hospital Wete de Zanzíbar, Tanzania, por presentar dolores musculares, espasmos generalizados, risa sardónica y trismo, por lo cual se le diagnosticó tétanos generalizado. Se prescribió tratamiento médico con hidratación parenteral, toxina antitetánica, toxoide tetánico, antibióticos, sedantes y curación local de dicha herida. Luego de 2 meses de hospitalización el paciente tuvo una evolución satisfactoria.

The case report of a 13 years adolescent, with history of good health who just received immunization during the neonatal period is presented. He suffered from a wound caused by a rusty nail in the back of the right foot and he went to the Wete Hospital in Zanzibar, Tanzania, presenting muscular pains, spread spasms, sardonic laugh and trismus, reason why he was diagnosed spread tetanus. Treatment was prescribed with parenteral hydration, anti-tetanus toxin, anti-tetanus toxoide, antibiotics, sedative and total cure of this wound. After 2 months of hospitalization the patient had a favorable clinical course.

Tétanos generalizado en adulto. Reporte de caso / Adult generalized tetanus. Case report

RESUMEN Fundamento: El tétanos es una enfermedad infecciosa causada por las esporas de la bacteria Clostridium tetani que afecta el sistema nervioso. La inmunización contra esta enfermedad ha permitido reducir la morbilidad y la mortalidad en Cuba por esa causa. Los pocos casos reportados son pacientes sin previa vacunación contra el tétanos, por lo que constituye de interés para la comunidad científica el reporte de aquellos que desarrollan esa enfermedad después de haber sido vacunados. Objetivo: Describir el caso de un paciente con diagnóstico de tétanos generalizado a pesar de que ya había sido vacunado contra esa enfermedad. Presentación del caso: Paciente de 33 años, con el antecedente de haber sido vacunado contra el tétanos, al cual le diagnosticaron tétanos generalizado, por lo se decidió su ingresó en la unidad de cuidados intensivos. Clínicamente se manifestó por contracciones musculares generalizadas y rigidez, los síntomas y signos neurológicos tuvieron una duración de 4 semanas. A pesar de las complicaciones el paciente egresó con adecuada calidad de vida. Conclusiones: La presentación de este caso busca concientizar en la comunidad científica la importancia de considerar el diagnóstico de tétanos en pacientes ya vacunados, lo cual es poco frecuente y obliga a actuar con prontitud.

ABSTRACT Background: Tetanus is an infectious disease caused by the bacterium Clostridium tetani spores which affects the nervous system. In Cuba, immunization against this disease has made it possible to reduce morbidity and mortality from this cause. The few cases reported are patients without prior vaccination against tetanus, so is the interest to the scientific community the reporting of those who develop this disease after having been vaccinated. Objective: To describe a patient´s case with a generalized tetanus diagnosis despite has already been vaccinated against this disease. Case report: A 33-year-old patient, with a history of has been vaccinated against tetanus, and diagnosed with generalized tetanus, so it was decided he to be admitted to the intensive care unit. Clinically manifested by generalized muscle contractions and stiffness, the neurological symptoms and signs lasted 4 weeks. Despite the complications, the patient discharged from hospital with an adequate life quality. Conclusions: This case presentation searches for raising awareness in the scientific community about the importance of considering the diagnosis of tetanus in previous vaccinated patients, which is rare and requires quickness of action.

La morbimortalité du tétanos à l'hôpital Sominé Dolo de Mopti

Introduction. Le tétanos est un problème de santé publique. La létalité qui lui est associée est très élevée. L'objectif de ce travail était de décrire les aspects cliniques, thérapeutiques et évolutifs du tétanos chez l'adulte. Méthodes. Il s'agissait d'une étude rétrospective des cas de tétanos à l'hôpital Sominé Dolo de Mopti. Les données ont été collectées à partir des dossiers des malades et portaient sur le nom, le sexe, l'âge, la profession, la provenance, le statut vaccinal, la porte d'entrée. Le score de Dakar a été utilisé pour évaluer le pronostic des patients. Résultats. Nous avons colligé 11 cas dont un tétanos obstétrical. La prévalence hospitalière était de 1,03% ; l'âge moyen de 41ans avec des extrêmes de 21 et 70 ans. La tranche d'âge de 20 - 30 ans était la plus affectée avec 36,36%. Aucun des patients n'avait été antérieurement vacciné contre le tétanos. La durée moyenne d'hospitalisation a été de 11,36 jours. Tous les patients ont présenté le trismus, dans plus de 50% des cas, la fièvre était associée aux paroxysmes. Nous rapportons un taux de létalité de 54,54% dont 83,33% sont survenus dans les quatre jours qui ont suivi l'hospitalisation. Le délai moyen de survenu du décès était de 4 jours. Conclusion. Le tétanos continue d'être une menace à l'atteinte de l'objectif de la couverture sanitaire universelle. Des efforts de sensibilisation et des programmes de vaccination plus inclusifs devraient permettre d'en réduire la morbimortalité

Aspects épidémiologiques, cliniques et évolutifs du tétanos au CHR de Maradi au Niger

Introduction : Le tétanos est caractérisé par un tableau clinique fait des spasmes musculaires sévères faisant suite à des blessures. La bactérie en cause, Clostridium tétani, a été découverte en 1884 et mise en culture pour la première fois en 1889. C'est une maladie totalement évitable et d'ailleurs quasiment éliminée des pays développés grâce à la vaccination généralisée et à une rigoureuse prophylaxie post-exposition, toutes deux parfaitement codifiées. Objectif : Cette étude rétrospective avait pour but de décrire les aspects épidémiologiques, cliniques et évolutifs du tétanos au CHR de Maradi au Niger. Matériel et méthodes : Les dossiers de malades hospitalisés au service des maladies contagieuses du CHR de janvier 2011 à aout 2018 ont été évalués. Résultats : Nous avions colligé 49 cas de tétanos sur un total de 2930 malades hospitalisés dans le service soit un taux de prévalence de 1,67 %; 32,65 % des patients étaient âgés de 0 à 15 ans. La porte d'entrée tégumentaire a été la plus fréquemment retrouvée (vingt huit cas). D'autres portes d'entrée ont été notées : fracture ouverte (5 cas), injection intramusculaire (1 cas), ombilicale (2 cas), brulure corporelle (2cas). 57,14% des malades étaient au stade II de la classification de Mollaret. On a enregistré 19 décès sous traitement, soit un taux de létalité de 38,78 %. Le stade clinique des patients à l'admission a été associé au décès avec une P = 0,0030.Conclusion: La sensibilisation des populations, le renforcement du programme élargi de vaccination et l'amélioration de la prise en charge des malades devraient permettre de réduire encore davantage la mortalité liée au tétanos

Tétanos secundario a mordedura y arañazo de gato en una paciente previamente vacunada / Tetanus after cat scratch and bites in a previously immunized patient

Tetanus is declining due to vaccination, professional labor management and appropriate wound care. Tetanus cases have been reported despite immunization. We report the case of a previously healthy 21 years old female patient that presented a mild generalized tetanus requiring admission after mild and recurrent cat scratch and bites. She had received six vaccine shots during childhood, and a booster dose five years earlier after a rabbit bite. Symptoms appeared seven weeks after the last contact, and included headache, muscle spasms and mild opisthotonus. Laboratory evaluation, including CSF analysis and microbiological investigation, as well as imaging studies were all normal. The patient received 6,000 IU of human antitoxin immunoglobulin. No autonomic manifestations or respiratory compromise were registered. Symptoms resolved rapidly and she was discharge after seven days with an order to complete a tetanus toxoid immunization schedule with three doses. Conclusions. Tetanus is possible in urban settings with a declining epidemiologic curve of disease in previously immunized patients. Severity of disease is modulated by previous vaccination.

El tétanos está en declinación gracias a la vacunación, manejo profesional del parto y el cuidado apropiado de las heridas. Se han reportado casos a pesar de la inmunización. Presentamos el caso clínico de una mujer previamente sana de 21 años que presentó un tétanos generalizado leve, luego de repetidas mordeduras y arañazos de su gato. Había recibido su esquema completo de seis dosis de vacuna antitetánica en la infancia y un refuerzo hacía cinco años luego de una mordedura por conejo. Los síntomas aparecieron siete semanas después del último contacto e incluyeron cefalea, espasmos musculares y opistótonos leve. La evaluación de laboratorio, incluyendo un estudio del LCR e imágenes fueron normales. La paciente recibió inmunoglobulina humana antitetánica. No hubo manifestaciones autonómicas ni compromiso respiratorio. Los síntomas regresaron rápidamente y se dio de alta a los siete días con indicación de completar tres dosis de vacuna antitetánica. Conclusiones: El tétanos es posible en ambientes urbanos con una curva epidemiológica en descenso en pacientes previamente inmunizados. La gravedad del cuadro es modulada por la vacunación previa.

Tétanos, una enfermedad vigente en población pediátrica: Reporte de un caso / Tetanus, a current disease in pediatric population: Case report

Introducción: El tétanos es una enfermedad aguda causada por una toxina producida por Clostridium tetanii. La enfermedad puede afectar a personas de cualquier edad, y la tasa de letalidad es alta. Gracias a la inmunización se ha logrado reducir el número de casos de la enfermedad, aunque se siguen presentando casos sobre todo en países con rezago social y económico. Objetivo: Describir caso clínico de un paciente pediátrico con tétanos generalizado, para reforzar la importancia de la profilaxis y diagnóstico precoz. Caso clínico: Escolar femenina de 6 años de edad con antecedente de esquema de inmunizaciones incompleto (una dosis de pentavalente), quien 10 días después de hacerse una herida cortopunzante por astilla de madera en brazo derecho, evolucionó con fiebre, dolor muscular y contracciones generalizadas, diagnosticándose tétanos generalizado en base a los antecedentes y el cuadro clínico. El tratamiento se estableció en base a las últimas recomendaciones de la Organización Mundial de la salud (OMS): esquema antibiótico Penicilina-Metronidazol, toxoide tetánico y gammaglobulina antitetánica a dosis altas. Se da de alta con secuelas motoras leves, las que se remitieron luego de 2 años de seguimiento y terapia de rehabilitación. Conclusión: El tétanos se sigue presentando en la población pediátrica principalmente asociado a falta de vacunación, es necesario conocer la enfermedad para hacer diagnóstico temprano y ofrecer manejo acorde a recomendaciones internacionales.

Introduction: Tetanus is an acute disease caused by a toxin produced by Clostridium tetanii. The disease can affect people of any age, and the fatality rate is high. Thanks to immunization the number of cases of the disease has decreased, although they are still present in isolation in countries with social and economic backwardness. Objective: To describe a case of a pediatric patient with generalized tetanus to reinforce the relevance of prophylaxis and early detection. Case Report: 6 years old female patient, with only one dose of pentavalent vaccine, 10 days after sharps injury by wood chips, starts with fever, muscle pain and generalized contractions, Tetanus was diagnosed by clinical symptoms and history. The management was based on the latest recommendations of the World Health Organization (WHO): Penicillin-Metronidazole antibiotic regimen, tetanus toxoid and tetanus high-dose gammaglobulin. After 2 years of follow-up under physiotherapy support, slight motor sequelae were observed. Conclusion: Tetanus is still presented in the pediatric population, associated with lack of vaccination. It is necessary to know the disease to provide proper diagnosis and management according to international lineaments.

Estudo de 119 casos de tétano ocorridos num hospital de referência na Bahia entre 2004 e 2010 / Study of 119 cases of teta nus ocurred in a reference hospita l of Bahia / Estudio de 119 casos de téta no ocurridos en un hospital de referencia em la bahia entre 2004 y 2010

O tétano é uma doença que ainda representa um grave problema de saúdepública no Brasil, apesar dos avanços na assistência hospitalar, sendo altos os níveis de morbidade e mortalidade. Os objetivos deste trabalho são identificar os fatores associados a óbito em pacientes com tétano acidental e neonatal e descrever as características clínicas da doença. Trata-se de estudo descritivo analítico de corte transversal, utilizando dados secundários. Os resultados evidenciaram que, nos 119 casos de tétano generalizado e neonatal internados no período de janeiro de 2004 a dezembro de 2010 num hospital de referência no estado da Bahia, 32 (26,5por cento) evoluíram para óbito, sendo 4 dos 5 casos de tétano neonatal. Em relação à situação vacinal, 22 (19,7por cento) pacientes tinham história de uso da vacina contra tétano antes do internamento hospitalar. Concluiu-se que a doença predominou no sexo masculino e nas faixas etárias entre 20 e 60 anos de idade. A quase totalidade dos pacientes não referiu vacinação ou usou esquema vacinal incompleto. A letalidade entreos casos de tétano neonatal foi extremamente elevada. A internação na UTI melhorou o prognóstico.

Tetanus is a disease that still represents a severe problem for Public Health in Brazil. Besides the improvement of therapies, the levels of morbidity and mortality are still high. The objectives of this study are to identify death associated factors and lethality causes in patients with generalized and neonatal tetanus and to describe clinical characteristics of the disease. This is a cross-section descriptive and analytic study with use of secondary data. The results showed that out of the 119 cases of hospitalized patients with generalized and neonatal tetanus in a reference hospital of Bahia from January 2004 to December 2010, 32 (26.5percent)died in which four out of the five were neonatal tetanus. According to the immunization situation 22 (19.7percent) patients were vaccinated against tetanus before the hospitalization. The results show that the majority of cases of tetanus was found in males aged from 20 to 60 yearsold. The vast majority of patients was not vaccinated or barely completed the immunization schedule. The lethality of neonatal tetanus was extremely high. The treatment in a ICU improves the prognosis.

El tétano es una enfermedad que, a pesar de las mejoras en la atenciónhospitalaria, todavía representa un grave problema de salud pública en Brasil, pero sus elevados niveles de morbilidad y mortalidad. Los objetivos de este estudio son identificar los factores asociados al óbito en pacientes con tétano accidental y neonatal y describir las características clínicas de la enfermedad. Estudio analítico descriptivo de enfoquetransversal, utilizando datos secundarios. Resultados: Se demostró que en 119 casos de tétano generalizado y neonatal ingresados, entre enero de 2004 a diciembre de 2010, en un hospital de referencia en el estado de Bahia, 32 (26,5por ciento) evolucionaron para óbito siendo, de los cinco casos, cuatro de tétano neonatal. En relación al estado de vacunación, 22 (19,7por ciento) de los pacientes tenían antecedentes del uso de la vacuna contra el tétano antes del ingreso hospitalario. Se concluye que la enfermedad predominó entre los hombres y en los grupos de edad entre 20 y 60 años. Casi todos los pacientes no hicieron referencia a la vacunación o inmunización incompleta. La tasa de letalidad entre los casos de tétano neonatal fue extremadamente alta. El ingreso en la UCI ha mejorado el pronóstico.

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

Trismus in cephalic tetanus from a foot injury

No abstract available.

Tétanos generalizado: caso clínico y revisión del tema / Generalized tetanus: clinical case report and review of the literature

Tetanus is a severe and potentially mortal disease, which affects the Nervous System, caused by the bacteria Clostridium tetani. It's endemic in developing countries, presenting in Chile with a rate of 0,02 cases per 100.000 habitants, but the antitetanic vaccine has reduced its incidence in developed countries. We present here a case report of a patient with generalized tetanus from our hospital. The clinical presentation was characterized by generalized increased muscle tone and trismus, and the patient was hospitalized in the Intensive Care Unit. The neurologic manifestations were important for a period of 3 weeks, but then they started decreasing until the patient was discharged, without complications and being able to sit and walk with assistance. In relation to this case, we will review the actualizations in the subject of Tetanus. The recommended treatment includes support therapy, prevention of complications, antibiotics, muscle relaxants and anti-tetanospasmin immunoglobulin; all therapies that our patient received partially. The disease has a mortality that reaches the 50 percent in some series, but the ones who survive have a good prognosis and full recovery. This is why the presentation of this case is important, being an infrequent disease that must be diagnosed timely and be treated adequately.

Introducción: El tétanos es una enfermedad grave y potencialmente mortal, que afecta al sistema nervioso y causada por la bacteria Clostridium tetani. Es endémica en países en desarrollo, teniendo en Chile el año 2007 una tasa de 0,02 casos por cien mil habitantes. La vacuna con el toxoide antitetánico ha disminuido ostensiblemente su incidencia en países desarrollados. Caso clínico: Se presenta el caso clínico de un paciente de 18 años con tétanos generalizado ingresado a nuestro hospital. Clínicamente se manifestó con un aumento del tono muscular generalizado y trismo. Se hospitalizó en la Unidad de Cuidados Intensivos. Los síntomas y signos neurológicos tuvieron una máxima intensidad de aproximadamente cuatro semanas; posteriormente fueron disminuyendo sin presentar complicaciones severas. Al alta el enfermo lograba sentarse y caminar con ayuda. Discusión: A propósito de este caso se hace una revisión de la literatura y actualización de esta grave enfermedad. El tratamiento recomendado incluye terapia de soporte, prevención de complicaciones, antibioterapia, relajantes musculares e inmunoglobulina antitetánica; terapias que este paciente recibió. Si bien esta enfermedad tiene una letalidad promedio de un 50 por ciento, los pacientes que sobreviven tienen buen pronóstico y recuperación completa. Por ello, la presentación de este caso clínico es importante, sobre todo siendo una condición poco frecuente, que debe diagnosticarse con prontitud y, así, recibir el tratamiento adecuado.

Perfil epidemiológico dos pacientes com tétano acidental em unidade de terapia intensiva / Perfil epidemiológico de pacientes con tétano accidental en la unidad de cuidados intensivos / Epidemiological profile of patients with accidental tetanus in the intensive care unit

A tendência dos casos de tétano acidental é para uma redução, entretanto a doença apresenta-se ainda com alto índice de letalidade. Diante dessa situação, objetivou-se descrever o perfil epidemiológico e clínico dos casos de tétano acidental internados em uma Unidade de Terapia Intensiva (UTI) em Fortaleza, Ceará, e levantar a incidência de óbitos pela doença. Estudo descritivo, retrospectivo, tipo série de casos, com 94 pacientes internados na UTI entre 2003 e 2009. Os dados foram coletados em formulário previamente elaborado. A análise foi univariada. Houve predomínio do sexo masculino (83), na faixa etária adulta jovem(20 a 49 anos), procedentes da capital, casados (55) e com ensino fundamental completo e incompleto. Em 47 casos a lesão ocorreu em membros inferiores e em 52 casos a injúria foi ocasionada por ferimento perfurante. As manifestações clínicas mais presentes foram: trismo,77 casos, e disfagia, 57 casos. Dos avaliados, 39 evoluíram a óbito. Concluiu-se que o tétano acidental, no Ceará, apresenta letalidade elevada.

The trend of cases of neonatal tetanus is assumed to reduce, however, the disease still presents a high mortality rate. Given this situation, the objective of this study was to describe the clinical and epidemiological profile of cases of tetanus admitted to an intensive care unit (ICU) in the northeastern state of Ceará, Brazil and to raise the incidence of deathsfrom the disease. This is a descriptive study, retrospective case series of 94 patients admitted between 2003 and 2009. The data was collected through a form previously elaborated. At unvaried analysis, there was male predominance (83), aged young adults (20 to 49 years), coming from the capital, married (55) and with complete primary education and incomplete. In 47 cases the injury occurred in the lower limbs and in 52 cases the injury was caused by puncture wound. The clinical present features were: trismus, and dysphagia in 77 cases, 57 cases. Of the studied 39 died. It was concluded that the tetanus, in Ceará, presents highmortality rate.

La tendencia de casos de tétano accidental indica una reducción, sin embargo, la enfermedad todavía presenta una alta tasa de mortalidad. Ante esta situación, se objetivó describir el perfil clínico y epidemiológico de los casos de tétano accidental ingresados en una unidad de cuidados intensivos (UCI), en Fortaleza, Ceará y registrar la incidencia de muertes por la enfermedad. Estudio descriptivo, retrospectivo de series de casos, con 94 pacientes ingresados en una UCI entre 2003 y 2009. Los datos fueron recolectados a través de un formulario previamente elaborado. El análisis fue univariado. Hubo predominio de varones (83), congrupo de edad adulta joven (20 a 49 años), procedente de la capital, casados(55) y con educación primaria completa e incompleta. En 47 casos se produjo la lesión en las extremidades inferiores y en 52 casos la lesión fue causada por herida penetrante. Las manifestaciones clínicas más presentes fueron: el trismo, en 77 casos, y la disfagia, en 57 casos. De los evaluados, 39 fueron a óbito. Se concluye que el tétano occidental, en Ceará, presenta alta tasa de mortalidad.

Le tetanos chez le grand enfant dans un hopital pediatrique a Yaounde; Cameroun

Le tetanos est evitable par la vaccination; mais peut survenir en cas d'une immunisation incomplete. Nous avons mene une etude sur les dossiers medicaux des enfants admis pour tetanos entre 2008-2009 au Centre Mere et Enfant de la Fondation Chantal BIYA a Yaounde. Le but etait d'analyser les circonstances de survenue et les manifestations cliniques du tetanos chez le grand enfant; afin de proposer des strategies de prevention adaptees au contexte camerounais. Le statut vaccinal etait inconnu chez un patient; les autres (80) n'avaient pas recu de rappel vaccinal. Les portes d'entree etaient les plaies aux membres; l'une etait secondaire a une injection medicamenteuse. Tous ont presente le tetanos generalise. Le deces etait survenu chez un patient. Le tetanos n'est pas rare chez le grand enfant au Cameroun. Il se degage ainsi la problematique des rappels vaccinaux

Perfil clínico-epidemiológico dos casos de tétano acidental ocorridos em Ribeirão Preto, Estado de São Paulo, no período de 1990 a 2009 / Clinical and epidemiological profile of accidental tetanus cases in Ribeirão Preto in the State of São Paulo from 1990 to 2009

INTRODUÇÃO: O tétano continua sendo um grave problema de saúde pública nos países em desenvolvimento. No Brasil, apesar dos avanços tecnológicos, não houve um decréscimo significativo da taxa de letalidade nos últimos anos. Nesta casuística, foram analisados dados clínicos e epidemiológicos dos pacientes diagnosticados em Ribeirão Preto, nas últimas duas décadas. MÉTODOS: Este é um estudo retrospectivo que analisou dados dos pacientes internados por tétano acidental no Hospital das Clínicas de Ribeirão Preto, entre 1990 e 2009. O diagnóstico do tétano foi realizado segundo critérios do Ministério da Saúde do Brasil. RESULTADOS: Onze (47,8%), casos positivos, dos 23 suspeitos de tétano, foram incluídos neste estudo. Não houve mortes, mas dois (18,2%) pacientes apresentaram déficit neurológico permanente. O indicador prognóstico Tetanus Severity Score variou entre 0 a 8 pontos. A mediana da permanência hospitalar foi de 17 dias, variando de 6 a 98 dias. A ausência de óbitos pode ser explicada pelo diagnóstico clinico precoce da doença com instituição imediata de terapia. CONCLUSÕES: Ribeirão Preto é uma área onde o tétano não é um relevante problema de saúde pública.

INTRODUCTION: Tetanus remains a major health problem in developing countries. In Brazil, despite technological advances, no significant decrease in the lethality rate of tetanus have been documented in recent years. Clinical and epidemiological data from patients who were treated in Ribeirão Preto in the state of São Paulo, Brazil in the last two decades were analyzed in this case series. METHODS: Retrospective data regarding the demographics, clinical presentations and prognoses of patients admitted with clinical suspicion of tetanus to a tertiary referral university hospital from 1990 to 2009 were identified. The tetanus diagnosis was defined according to the Brazilian Ministry of Health criteria. RESULTS: Eleven cases out of 23 patients with suspected tetanus were included in this study (47.8% of positive cases). The Tetanus Severity Score ranged from 0 to 8 points. There were no deaths, but two (18.2%) patients had permanent neurological deficits. The median length of hospital stay was 17 days (6-98 days). The absence of deaths can be explained by early clinical diagnosis and prompt treatment. CONCLUSIONS: Ribeirão Preto is an area in which tetanus is not a severe public health problem.

Tétano: quando a imunoprevenção falha / Tetanus: when vaccine prevention fails

O tétano é doença adquirida do sistema nervoso central pela contaminação de feridaspelo bacilo Gram positivo Clostridium tetani, presente em fezes de animais, solo, poeirae objetos enferrujados. O tétano, apesar de passível de imunoprevenção, ainda persistenos países em desenvolvimento, devido à cobertura vacinal incompleta e ao tratamentoinadequado de lesões traumáticas. Este trabalho descreve a evolução de pacienteatendido no Hospital Risoleta Tolentino Neves, com manifestações clínicas de tétano,caso em que a adequada abordagem terapêutica garantiu a cura. Alerta para a persistênciado tétano como doença grave e para a importância da observação do esquemavacinal e da correta abordagem de feridas.

Tetanus is a central nervous system disease, acquired by contamination of wounds by Clostridium tetani, a Gram positive bacillus present in animal feces, soil, dust and rusty objects. Although vaccine-preventable, the disease persists in developing countries, due to incomplete vaccine-coverage and inadequate treatment of traumatic injuries. This paper describes a case of a patient treated at Hospital Risoleta Tolentino Neves, with typi-cal clinical manifestations of tetanus, in whom the institution of an appropriate treatment contributed effectively to his healing. This case report highlights the persistence of tetanus in Brazilian context and aims to draw attention to the importance of observation of the immunization schedule and the correct approach to wound treatment.

Aspectos epidemiológicos do tétano acidental no Estado de Minas Gerais, Brasil, 2001–2006 / Epidemiological features of injury-related tetanus in the State of Minas Gerais, Brazil, 2001 - 2006

O artigo descreve o perfil epidemiológico dos casos de tétano acidental notificados à Secretaria de Estado de Saúde de Minas Gerais. Os dados analisados são do período de 2001 a 2006, totalizando 225 casos confirmados da doença, obtidos pelo Sistema de Informação de Agravos de Notificação do Sistema Único de Saúde (Sinan/SUS). A maior parte ocorreu entre homens (0,30 casos por 100.000 habitantes/ano), sendo o tipo de lesão mais observada a perfuro cortante (39,1 por cento) e os membros inferiores a região mais acometida (62,2 por cento). A faixa etária com maior incidência foi acima de 65 anos (0,89 casos por 100.000 habitantes) e o maior coeficiente de incidência ocorreu na área rural (0,31 casos por 100.000 habitantes/ano). Somente 6,3 por cento tinham esquema vacinal completo, enquanto 21,3 por cento informaram nunca terem sido vacinados. A letalidade no período estudado foi de 36,9 por cento. Conclui-se que, apesar de ser imunoprevenível, o tétano ainda constitui-se um importante problema de saúde pública em Minas Gerais.

This article describes the epidemiological features of injury-related tetanus cases notified by the Health Department of the State of Minas Gerais, Brazil at the Information System for Notifiable Diseases (Sinan). Data from 2001 to 2006 were analyzed, which includes 225 confirmed cases of the disease. Most cases occurred in men (0.30 cases per 100,000 population per year). The main source of infection were cut and puncture wounds (39.1 percent). Legs were the most frequently injured body part (62.2 percent). The highest incidence occurred in the age group of >65 years old (0.89 cases per 100,000 population per year) and in people living in rural areas (0.31 cases per 100,000 population per year). Only 6.3 percent of patients stated having completed their vaccination schedule and 21.3 percent informed that they had never been vaccinated against tetanus. The lethality rate found in this study was 36.9 percent. Results show that, despite being a vaccine-preventable disease, injury-related tetanus is an important public health problem in the State of Minas Gerais.

A 10-year review of outcome of management of tetanus in adults at a Nigerian Tertiary Hospital

Background : Tetanus remains one of the major public health hazards of the developing world. Previous studies in Nigeria indicate that mortality ranged from 26to 60. Mortality is much lower in the developed world because of the availability of facilities for intensive care of cases; unlike in most developing countries. Aim : To report our experience with the management of adult tetanus at the University of Port Harcourt Teaching Hospital over the past 10 years (1996-2005). Methods : Data of all patients aged 16 years and above managed for tetanus in the medical wards between January 1996 and December 2005 were retrieved from their case records and analyzed. Results : Eighty-six patients were managed for tetanus (50 males and 36 females); constituting about 1of all medical admissions over the 10-year period. Students; civil servants and commercial motorcyclists formed the major groups at risk. The commonest portal of entry was lower limb injuries (54). Case fatality rate (CFR) was 42.9; with a statistically significant higher CFR found among patients above 40 years of age (P= .000); patients with incubation period shorter than 7 days (P= .04); those with a shorter duration of hospitalization (P= .000) and those administered higher average daily diazepam doses (P= .044). Complications such as aspiration pneumonitis; laryngospasm and respiratory failure were major causes of mortality. Conclusion : Case fatality rate of tetanus has remained consistently high at our center. Factors that were significantly associated with high mortality included older age; age above 40 years ; incubation period of less than 7 days and higher degree of sedation with diazepam. It is recommended that preventive immunization against tetanus be given to all Nigerians with secondary vaccination at adulthood

Clinico-epidemiological study of tetanus at district headquarter hospital, Faisalabad

To study age, sex and regional frequency of tetanus. To define the status of immunization against tetanus. To find the outcome of the treatment provided. All the consecutive patients above 10 years of age with the clinical evidence of tetanus presenting at DHQ Hospital, Faisalabad were included in the study. Detailed history of the illness was obtained from the relatives. Physical examination carried out specifically looking for any evidence of injury. Associated co-morbid factors were noted and managed accordingly. Careful management of the tetanus was done in a separate unit with limited facilities. A total of 40 patients presented during one year of study with the clinical evidence of Tetanus. 28 patients were in between 10-30 years of age, 12 were of more than 40 years of age. There were 29 [72,5%] males and 11 [27.5%] females. Most of the patients [87.5%] belonged to rural areas and only 12.5% were from the urban areas. 25 patients had no knowledge about their tetanus immunization status. 15 patients gave history of tetanus immunization in the past but none of them had a booster dose within last 10 years. Male population belonging to rural areas is the commonest victims of tetanus. Most of them are affected during the 2[nd] and 3[rd] decades of life. There is a complete lack of knowledge about the tetanus immunization. Standard management of tetanus at dedicated centers with facilities for artificial ventilation can save many lives

Experience with Tetanus in a Tertiary Hospital in South East Nigeria

Background: Tetanus has for long been an avoidable source of morbidity and mortality particularly in developing countries. The aim of this study was to review the experience with managing tetanus in a regional tertiary hospital in Nigeria. Methods: A retrospective study of patients who were admitted with a clinical diagnosis of tetanus between January 1999 and December 2003 was done. Relevant data were extracted from the patients' case records. Results: A total of 12 patients were identified within the time frame with a diagnosis of tetanus. There were more male than female patients (ratio 1.4:1) with city dwellers constituting a small majority. The mean age of the patients was 29.8 years. Lower limb injuries accounted for the portal of entry in 75of cases while one case followed a practice of oral sex. All patients were managed in the general ward and no mortality was recorded despite the presence of dysautonomia in some patients. Conclusion: Despite the high rate of morbidity and mortality associated with tetanus in developing countries and despite some regional differences in presentation; careful clinical management even in resource poor countries can result in very good outcomes

Cephalic tetanus with left infranuclear facial palsy.

We report a case of 11 years old male who developed trismus associated with left infranuclear facial palsy following injury over forehead. Cephalic tetanus was diagnosed. Rarity of the case as well as mild course it ran, though the incubation period was less than seven days, is the reason for this case report.