An Eight-Year Review of Morbidity and Mortality among Adult Patients with Tetanus at a Tertiary Hospital in Zaria, Northern Nigeria.

Background: Tetanus infection is a major cause of morbidity and mortality in many developing countries. The infection results from contamination of wound by Clostridium tetani in unimmunized individuals. The morbidity is mainly due to sustained skeletal muscle spasms from unopposed action of tetanospamin on excitatory neurons in the central nervous system. The clinical presentation and outcome depend on both patient and disease factors. Health education and immunization would contribute to prevention and eradication of the infection. This review studied morbidity and mortality patterns among adults treated for tetanus at a tertiary hospital in Zaria from January 2006 to December 2013. Materials and Methods: Medical records of adults admitted with the diagnosis of tetanus were retrieved and reviewed. Information on socio-demography, clinical presentation, complications, co morbidities and outcomes were obtained and analysed using the Statistical Package for Social Sciences version 17.0. Results: Forty-seven patients were admitted during the period, with an average of 6 patients per year. Male (70.2%): female (29.8%) ratio was 2.4: 1. Their ages ranged from 15 years to 65 years, the age group 20-39 years constituting 76.6% of the population. 51.2% were students. The lower limbs were portal of entry in 70.6% of cases, and 52.9% of the wounds were dirty. 82.4% of the patients were unimmunized and overall mortality was 40.4%. Predictors of mortality were short incubation period, short onset time, severe muscle spasms, non-immunization and presence of complications. Conclusion: Tetanus remains a major preventable disease among unimmunized and low income people. Therefore, immunization of people at risk would prevent tetanus infection and its associated complications.

Spinal Neurobrucellosis is an Unusual Cause of Nontraumatic Paraplegia in Zaria, Northern Nigeria: A report of 3 Cases and Review of Current Literature.

Introduction: Brucellosis is a zoonotic febrile infection common among farmers or herdsmen who come into contact with animals or animal products. Neurological complications are uncommon, but when they occur can be confused with other neurological diseases, particularly those due to tuberculosis (TB). Aim: This report is intended to remind health workers and people living in Brucella endemic communities that spinal neurobrucellosis can mimic Potts’ disease as the cause of nontraumatic paraparesis or paraplegia. Study Design: longitudinal case series. Methodology: We report the cases of three patients who presented with paraplegia following months of constitutional symptoms of fever, headache, malaise and weight loss. All were exposed to cows, goats and sheep. One patient had received antituberculous therapy for 18 months with minimal recovery. Serology and neuroimaging were used to confirm the diagnosis. Results: All patients recovered within 6 to 12 weeks of rifampicin, doxycycline, trimethoprim-sulfamethoxazole or streptomycin, but with residual paraparesis. Conclusion: spinal neurobrucellosis can be confused with Pott’s disease (TB of the spine) with consequent poor treatment outcome.