RESUMEN
Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil) aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6), sickle cell anemia (n=2), Hansen s disease (n=1), malnutrition (n=1), diabetes mellitus (n=1), trauma (n=1) and unknown factors (n=7). In 6 other cases, in addition to the Hansen s disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68) were over 40 years old (17/25) and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25), or had partially completed such a regimen, or did not give precise information (6/25). Among the same series studied, over half (52) of the patients died (13/25). We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.
Asunto(s)
Humanos , Animales , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Clostridium tetani , Miasis/microbiología , Úlcera de la Pierna/microbiología , Úlcera por Presión/microbiología , Anciano de 80 o más Años , Anemia de Células Falciformes , Causalidad , Enfermedad Crónica , Insectos , Larva , Lepra , Miasis/parasitología , Tétanos/microbiologíaRESUMEN
Clostridium tetani es un habitante de suelos y el agente etiológico del tétanos. La distribución de este agente en suelos de diferentes países muestra un ámbito de 7 a 53 por ciento, tal amplitud podría deberse a la sensibilidad de los métodos empleados o reflejar una distribución real. Para evaluar su frecuencia en suelos de la Universidad de Costa Rica, 30 muestras de suelo fueron recogidas cerca de cada Facultad y cultivadas por C. tetani. Se encontraron 13 muestras positivas, 9 fueron toxigénicas y 4 no toxigénicas. Además, se identificaron 3 áreas del Campus en las cuales se encontraron conglomeraciones de cepas positivas