A 6-year review of post-neonatal tetanus at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Background: Tetanus is a vaccine-preventable disease but its incidence has remained unacceptably high in developing countries. Objective: To determine the prevalence, risk factors and outcome of post-neonatal tetanus at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Methods: A retrospective descriptive study from 1st January 2010 to 31st December 2015. Children aged 1 month to 15 years diagnosed with post-neonatal tetanus were studied. Information from the admission files was extracted. Data was analysed using SPSS version 20. Results: Total admissions during the study period were 14,458; 61 had post-neonatal tetanus, giving a prevalence of 0.4%. The M: F ratio was 1.5:1. The mean age was 7.4±3.2 years. Fifty-nine (96.7%) were not immunised against tetanus. Portal of entry for the organism was trauma injuries to the foot in 33(54.1%). Thirty-one (50.8%) were discharged, 5(8.2%) DAMA, while 25(41.0%) died, and case fatality was 41.0%. Conclusion: Post-neonatal tetanus is a major cause of morbidity and mortality in Sokoto. There is need for improved health education, sustainability of immunisation programmes and coverage to eradicate this scourge

Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality

Abstract Introduction Tetanus, an acute infectious disease, is highly prevalent worldwide, especially in developing countries. Due to respiratory failure and hemodynamic instability associated with dysautonomia, severe cases require intensive care, but little has been published regarding the management in the Intensive Care Unit. Objective To draw a 10-year clinical–epidemiological profile of Intensive Care Unit patients with severe tetanus, observe their evolution in the Intensive Care Unit and identify risk factors for mortality. Methods In this retrospective study, we used a standardized questionnaire to collect information from the records of patients with severe tetanus admitted to the intensive care unit of a referral hospital for infectious and contagious diseases in Northeastern Brazil. Results The initial sample included 144 patients, of whom 29 were excluded due to incomplete information, leaving a cohort of 115 subjects. The average age was 49.6 ± 15.3 years, most patients had no (or incomplete) vaccination against tetanus, and most were male. The main intensive care-related complications were pneumonia (84.8%) and dysautonomia (69.7%). Mortality (44.5%) was higher than expected from the mean APACHE II score (11.8), with shock/multiple organ failure as the main cause of death (72.9%). The independent factors most predictive of mortality were APACHE II score, dysautonomia, continuous neuromuscular blockade and age. Conclusion A high mortality rate was observed in our cohort of Intensive Care Unit patients with severe tetanus and a number of risk factors for mortality were identified. Our results provide important insights for the development of intervention protocols capable of reducing complications and mortality in this patient population.

Epidemiological trends of tetanus from East Delhi, India: a hospital-based study

To study the demographic profile, prognostic indicators, and mortality of tetanus patients and treatment outcomes following intramuscular anti-tetanus immunoglobulin [ATG] alone or combined intrathecal and intramuscular ATG. Retrospective study. Inpatients from a tertiary care hospital. One hundred children under 12 years of age diagnosed with tetanus and admitted from January 2003 to December 2007 were included in the study. Case records of patients with neonatal tetanus [n = 30] and post-neonatal tetanus [n = 70] were evaluated retrospectively. The diagnosis of tetanus was based on World Health Organization [WHO] criteria. The outcomes of patients treated with either intramuscular ATG or both intrathecal and intramuscular ATG were separately compared in the neonatal and post-neonatal groups. Our study revealed difficulty in feeding, trismus, spasms, rigidity, and opisthotonus posturing as the predominant clinical manifestations. The survival rate for children receiving tetanus immunoglobulin by the dual route was significantly higher than for children receiving the immunoglobulin via the intramuscular route. Seizures and tremors were poor prognostic factors associated with tetanus.

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.

Aspectos epidemiológicos do tetano acidental na regiâo metropolitana de Belo Horizonte, estado de Minas Gerais, Brasil – 2001-2006 / Aspectos epidemiologicos del tetanos accidental en la region metropolitana de Belo Horizonte, estado de Minas Gerais, Brasil – 2001-2006 / Epidemiological aspects of accidental tetanus infection in the metropolitan region of Belo Horizonte, state of Minas Gerais, Brazil – 2001-2006

O tétano é uma doença infecciosa não contagiosa, causada pelo Clostridium tetani. Mesmo sendo um agravo imunoprevinível de fácil controle, ainda constitui um importante problema de saúde pública. Realizou-se, aqui, um estudo descritivo, retrospectivo e transversal cujo objetivo foi conhecer o perfil epidemiológico dos casos confirmados de tétano acidental na região metropolitana de Belo Horizonte (RMBH) entre 2001 e 2006, identificando algumas variáveis que possam estar associadas à incidência, mortalidade e letalidade da doença. A coleta dos dados referentes aos 31 casos da doença, que correspondem à amostra, foi obtida na Secretaria de Estado da Saúde de Minas Gerais, por meio do Sistema de Informação de Agravos de Notificação. Os casos são oriundos de 23% das cidades que compõem a região, sendo a capital, Belo Horizonte, responsável por 38,7% dos casos. A maioria dos casos ocorreu em 2004 (0,21casos/100 mil habitantes), sendo a taxa média para o período do estudo de 0,11 casos/100 mil habitantes. A incidência entre o sexo masculino foi 2,88 vezes superior ao feminino. Quanto à distribuição etária, constatou-se que não houve acometimento do tétano acidental nos indivíduos menores de 20 anos e a faixa etária que registrou maior incidência foi a acima de 65 anos (0,41/100 mil habitantes). A área rural sobressaiu em termos de incidência (0,20 casos/100 mil habitantes). O domicílio e o ambiente de trabalho originaram 22,6% dos casos e a letalidade encontrada foi de 35,5%. Reforça-se, assim, a importância das ações de imunoprofilaxia do tétano pela atenção básica para desenvolver sua prevenção e controle.

Tetanus is a non-contagious infectious disease caused by the Clostridium tetany. Even though it is an easily controlled immunizable disease, it remains an important public health problem. This was a cross-sectional, retrospective and descriptive study whose intention was to determine the epidemiological profile of confirmed cases of accidental tetanus infection, and to identify the variables that might be associated with its incidence, mortality and lethalityin the metropolitan region of Belo Horizonte between 2001 and 2006. The sample was formed by data related to 31disease cases provided by the State Health Department of Minas Gerais via the Notifiable Diseases Information System.The cases came from 23.0% of the municipalities that comprise the region. The state capital of Belo Horizonte was responsible for 38.7% of the cases. The majority of them occurred in the year 2004 (0.21 cases/100,000 inhabitants),with an average rate during that period of 0.11 cases/100,000 inhabitants. The incidence among males was 2.88 times higher than females. Regarding age distribution, there were no cases of accidental tetanus among individuals under20 years of age and the age group with the highest incidence was the over-65s (0.41/100,000 inhabitants). Rural are ashad the most cases (0.20 cases/100,000 inhabitants). 22.6% of the cases were originated at home and at work with a 35.5% lethality rate. This research highlights the importance of prophylactic immunization actions against tetanus within primary health care system, in order to prevent and control its incidence.

El tétanos es una enfermedad infecciosa no contagiosa causada por el Clostridium tetani que, incluso siendo un agravioimunoprevenible de fácil control, aún constituye un importante problema de salud pública. Se realizó un estudiodescriptivo retrospectivo transversal cuyo objetivo fue conocer el perfil epidemiológico de los casos confirmados detétanos accidental en la Región Metropolitana de Belo Horizonte entre 2001 y 2006, identificándose algunas variablesque puedan estar asociadas a la incidencia, a la mortalidad y letalidad de la enfermedad. La recogida de datos referentesa los 31 casos de la enfermedad que corresponden a la muestra fue obtenida en la Secretaría de Estado de Salud deMinas Gerais por medio del Sistema de Información de Agravios de Notificación. Los casos son provenientes de 23,0% de las ciudades que componen la región cuya capital, Belo Horizonte, es responsable del 38,7% de los casos. La mayoría de los casos ocurrió en 2004 (0,21 casos/100.000 hab.) con un índice promedio de 0,11 casos/100.000 habitantes duranteel período del estudio. La incidencia entre los varones fue 2,88 veces superior a las mujeres. En lo que se refiere a la distribución por edades se constató que no se produjeron casos de tétanos accidental en los individuos menores de 20 años y el rango de edad que registró mayor incidencia fue superior a los 65 años (0,41/100.000 hab.). La zona rural se destacó en términos de incidencia (0,20 casos/100.000 hab.). La vivienda y el ambiente de trabajo originaron 22,6%de los casos y la letalidad encontrada fue del 35,5%. Se refuerza así la importancia de las acciones de imunoprofilaxis del tétanos por la atención básica para su control y prevención.

Tendência temporal do tétano acidental no período de 1981 a 2004 em Pernambuco com avaliação do impacto da assistência em unidade de terapia intensiva sobre a letalidade / Mortality trend due to accidental tetanus from 1981 to 2004 in Pernambuco and analysis of the impact on intensive care unit attendance

Apesar da redução na incidência de tétano acidental no Brasil, não houve queda significativa na letalidade. Nesta série de casos, comparamos a letalidade antes e após o estabelecimento padrão de manejo em unidade de terapia intensiva do paciente com tétano no Hospital Universitário Oswaldo Cruz, no período de 1981 a 2004. Em 24 anos, foram internados 1.971 pacientes e antes do manejo em Unidade de terapia intensiva a letalidade era de 35 por cento. Durante 1997 foi instituída a unidade de terapia intensiva para assistência dos pacientes com tétano, e de 1998 a 2004, a letalidade caiu para 12,6 por cento, OR= 0,27 (IC95 por cento= 0,18- 0,39); p<0,001. Esta tendência foi evidenciada em todas as faixas etárias e em ambos os sexos. A centralização da assistência a esses pacientes em um único serviço especializado com Unidade de terapia intensiva de forma precoce, portanto, tem sido decisiva na redução da letalidade, por contar com a vasta experiência da equipe de saúde no manejo do tétano e melhor tratamento sintomático, antecipando as graves complicações da doença.

Despite reductions in the incidence of accidental tetanus cases in Brazil, there has not been any significant decrease in its mortality. In this case series, the mortality rates before and after establishing standard management practices for tetanus patients in the intensive care unit at the Oswaldo Cruz University Hospital are compared over the period from 1981 to 2004. Over these 24 years, 1.971 patients were admitted. Before establishing the intensive care unit management, the mortality rate was 35 percent. The Intensive care unit for attending to tetanus patients was established in 1997. From 1998 to 2004, the mortality rate fell to 12.6 percent: OR = 0.27 (95 percent CI = 0.18-0.39); p < 0.001. This trend was seen in all age groups and both sexes. The centralization of attendance for these patients into a single specialized service with early treatment in an intensive care unit has therefore been decisive in reducing the mortality rate. This service can count on the medical team's vast experience of tetanus management, with better treatment of symptoms that forestalls the serious complications from this disease.

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

Tetanus in a rural setting of south-western Nigeria: a ten-year retrospective study

ABSTRACT: We review the records of 79 tetanus patients in two hospitals (one tertiary and one secondary level) in Owo, Ondo state, Nigeria from 1997 to 2006. The male: female ratio was 3:1. Ages were 14-70 years (mean 33.25 years, SD ±16.76). The overall case fatality rate (CFR), 32.91%, did was not significantly different in the two hospitals. CFR for men was 32.10% and for women 35.29%. The main factor indicative of bad prognosis was a short hospitalization period. It was observed that 30.38% of our patients were discharged against medical advice (DAMA), that financial constraint was the underlying problem in 50% of cases, and that the trend of DAMA occurred at the two study sites. This DAMA phenomenon could pose a great danger to the eradication of this vaccine preventable disease in rural areas

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

Tetanus in children- An exclusive study

To document the causes, mode of presentation and establish the morbidity and mortality of tetanus in childhood age group. Descriptive study. Department of Paediatric Surgery, Nishtar Medical College and Hospital, Multan. It was carried out for three years from January 2002 to December 2004. All paediatric patients presenting with tetanus during these three years were inducted in the study. However neonatal cases were excluded from study. All but two cases were admitted through emergency. The remaining two arise in the ward, one being treated for burns and other for long bone fracture in orthopaedic ward. Complete history and clinical findings were noted in a predesigned proforma and a treatment protocol was started. There is four bedded tetanus bay with basic treatment facilities in our ward. However our tetanus bay lacks ventilators and cardiopulmonary monitors. Complications arising 4 during the treatment were noted. A total of 96 patients were included in the study. There were 66 male and 30 female children. The youngest child was of 15 months of age and elder one of 12 years of age. Almost 2/3[rd] [65.62%] of 5 patients belonged to rural background. Wounds supposedly responsible for tetanus were present in 60 patients. Chronic SOM in 10 patients and idiopathic in 26 patients. Abdominal rigidity was present in 90.62% and lock jaw in 85% cases. Lock fit time was <2 days in 25[26.4%] cases. Seven patients required tarcheostomy. Respiratory and anemic complications were amongst the common. Overall mortality was 21.95%. Children make almost1/3[rd] of the total cases of tetanus. The disease pattern remains the same. However survival is better than adults and neonatal tetanus

Situación epidemiológica de la enfermedad diarreica agudad(EDA) en Nicaragua / Epidemiological situation of the disease diarreica acute (EDA) in Nicaragua

Presenta boletín epidemiológico de la semana 09, del 27 de febrero al 5 de marzo del 2005. Aborda la situación epidemiológica de la enfermedad diarreica agudad(EDA) en Nicaragua. Se ha registrado durante el año 2005 de la semana 1 al 9 para un total de 42, 986 lo que comparado con el año anterior (34,607) significa un incremento del 24 porciento (8,379) casos más que igual período del año anterior. Durante las semanas 1 a la 5, el comportamiento fue bastante estable, registrándose un promedio de 3,576 casos semanales. Entre los factores que han contribuido a la deshidratación severa y la muerte de los niños encontramos la demora en la búsqueda de la atención médica, demora en el inicio de la rehidratación oral, automedicación y en especial la práctica de pugar al niño por sus familiares. Hasta la semana No. 9 se han registrado un total de 39 muertes por diarrea lo que representa un incremento del 95 porciento (19 muertes más. En los SILAIS que se registraron mayores tasas de mortalidad son: Madriz, Granada, RAAS, Nuea Segovia, León , Jinotega y Estelí en relación al media nacional (0.7 x 100,000 hab) 5 (29 porciento) SILAIS se encentran por debajo, siendo éstos Chinandega, Managua, Matagalpa, RAAN y Masaya. Tambien se incluyen medidas que deben tomar la población para evitar las diarreas en los niños menores de cinco años, asimismo medidas a tomar por el personal de salud que atiende a estos niños

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

Survey to validate neonatal tetanus elimination in Andhra Pradesh, India.

Neonatal Tetanus (NNT) elimination has been defined as an annual incidence of <1 case of NNT per 1,000 live births in each district of a province, state, or country. Reported incidence of NNT does not always reflect the true dimension of the problem. Thus, NNT mortality survey was planned during November 2003 to validate NNT elimination in the state of Andhra Pradesh. Firstly, based on review of records and recommended standard algorithm, two highest risk districts, namely Kurnool and Mahbubnagar were identified. In the second stage, NNT mortality survey was conducted in these two districts using lot quality assurance-cluster sampling (LQA-CS) methodology. In each of the two districts, 62 neonatal deaths were detected with no deaths due to NN, indicating incidence of NNT below 1/1000 LB. Thus, validation of NNT elimination may be concluded.

Situación de la mortalidad perinatal en Nicaragua / Situation of the mortality perinatal in Nicaragua

Presenta Boletín Epidemiológico del Ministerio de Salud de Nicaragua bajo la responsabilidad de Sistema de Vigilancia Epidemiológica Nacional. Contiene el registro de la situación de la mortalidad perinatal, mortalidad neonatal de los obitos fetales. Enumera las enfermedades sujetas a vigilancia epidemiológica, las muertes por SILAIS. Debido a la problemática de la mortalidad perinatal, el Ministerio de Salud realizó un diagnóstico situacional de la atención obstétrica y perinatal en 21 hospitales y su red de servicios, encontrando como causas principales asociadas a la altas tasas de mortalidad perinatal los problemas de organización del servicio, falta de control y gerencia, debilidades en el sistema de información y registro, insuficientes insumos médicos y falta de manteniento de equipos. En este sentido se plantea cuatro grandes líneas estratégicas de intervención en dicha problemática

Mortalidad materna por causa obstétrica en Nicaragua / Motherly mortality by causes obstetrics in Nicaragua

En el Boletín se incluye información sobre las estadísticas de la mortalidad materna por causas obstétricas, distribución de las muertes maternas por SILAIS, la situación de los SILAIS Río San Juan y Jinotega, así como la clasificación de las muertes, las distribución de las defunciones según grupos de edades, lugar de ocurrencia y procedencia. Se hace un comentario donde se refleja que el mayor número de muertes han ocurrido en el área rural y en el domicilio, lo cual nos indica la necesidad del trabajo intersectorial y comunitario, siendo necesario una mayor participación de las instituciones gubernamentales y las ONGs en las comisiones locales de lucha contra la mortalidad materna, para el establecimiento de mecanismos conjuntos de coordinación y de gestión. También aborda las enfermedades y las muertes que estan sujetas a vigilancia epidemiológica distribuidas por SILAIS

Clostridium tetani, tétanos y su frecuencia en Costa Rica / Clostridium tetani, tetanus and frequency in Costa Rica

Clostridium tetani es un habitante cosmopolita de suelos y sedimientos marinos, y a veces también se aísla del intestino de animales. Este agente es un bacilo Gram positivo, esporulado, anaerobio, y produce la tetanospasmina, una neurotoxina muy potente, responsable del cuadro clínico conocido como tétanos. La bacteria es aislada del suelo de, virtualmente, cualquier lugar, con una frecuencia usualmente mayor del 30 por ciento, tal como también se ha descrito en Costa Rica. C. tetani, como otras especies del género Clostridium, exhibe el fenómeno de "swarming", el cual consiste en modificaciones morfológicas y fisiológicas, que conducen a células hiper-flageladas, gigantes, que se mueven activamente sobre medios de cultivo sólidos, formando una película de crecimiento. En Costa Rica, para el periodo de 1916 a 1970, hubo entre 365 y 200 casos mortales anualmente. Luego, las muertes por téntanos decrecieron a menos de 20 anuales, para el periodo de 1970 a 1980. Desde 1980 ha habido únicamente entre 3 y 0 casos por año. Hubo dos campañas intensas de vacunación, contra el tétanos; la primera en 1951, usando el DPT y la segundo en 1971, con el toxoide tetánico, que correspondió a la reducción abrupta del número de casos. Sin embargo, si el número de muertes se ajusta por tasa/100 000 habitantes, resulta una curva con una tendencia negativa, que fue más evidente a partir de 1926. Por esta razón, se deduce que otros factores, además de la vacunación, son responsables de tal reducción, como son la educación, el desarrollo en saneamiento, principalmente durante el parto y el aumento en el número de servicios de salud, entre otros. (Rev Cost Cienc Med 2000; 21(3-4): 191-202). Palabras clave: Clostridium tetani, tétanos, aislamiento en el suelo, mortalidad.

Identification of risk factors for death from tetanus in Pernambuco, Brazil: a case-control study

A case-control study was conducted to identify risk factors for death from tetanus in the State of Pernambuco, Brazil. Information was obtained from medical records of 152 cases and 152 controls, admitted to the tetanus unit in the State University Hospital, in Recife, from 1990 to 1995. Variables were grouped in three different sets. Crude and adjusted odds ratios, p-values and 95 percent confidence intervals were estimated. Variables selected in the multivariate analysis in each set were controlled for the effect of those selected in the others. All factors related to the disease progression - incubation period, time elapsed between the occurrence of the first tetanus symptom and admission, and period of onset - showed a statistically significant association with death from tetanus. Similarly, signs and/or symptoms occurring on admission or in the following 24 hours (second set): reflex spasms, neck stiffness, respiratory signs/symptoms and respiratory failure requiring artificial ventilation (third set) were associated with death from tetanus even when adjusted for the effect of the others