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.

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.

Tétano acidental no Estado do Ceará, entre 2002 e 2005 / Accidental tetanus in the State of Ceará, between 2002 and 2005

Descrevem-se as características demográficas e clínicas de indivíduos com tétano acidental no Ceará. Analisou-se, retrospectivamente, 131 casos de tétano acidental notificados em hospital de referência estadual entre 2002 e 2005. Destes, a maioria (84,8 por cento) ocorreu entre homens e em moradores da zona urbana (93,2 por cento). A faixa etária com maior incidência foi a de 35 a 49 anos (35,2 por cento). História vacinal completa esteve relatada em quatro (3 por cento) casos, sendo ferimento perfurocortante o mais observado, e os membros inferiores os mais acometidos. O trismo esteve relacionado a 86,2 por cento dos casos, seguido por contraturas (54,1 por cento). Entre os notificados houve 95,5 por cento confirmados, cujo óbito incidiu em 33 (26,4 por cento) pacientes. Conclui-se que o tétano acidental no Ceará atinge a população de maneira expressiva, apesar de ser uma doença imunoprevinível. Urge autoridades e órgãos gestores da saúde programarem estratégias que visem mudanças de políticas públicas relacionadas à cobertura vacinal dos susceptíveis, principalmente adultos.

The demographic and clinical characteristics of individuals with accidental tetanus in Ceará are described. This was retrospective analysis of 131 cases of accidental tetanus notified in a state referral hospital between 2002 and 2005. Most of these cases (84. 8 percent) occurred among men and among people living in the urban zone (93. 2 percent). The age group with highest incidence was between 35 and 49 years old (35. 2 percent). A complete vaccination history was reported in four (3 percent) cases. Puncturing/cutting wounds were the cause most commonly observed and the legs were the area most affected. Trismus (lockjaw) was reported in 86. 2 percent of the cases, followed by muscle contractions (54. 1 percent). Among the notified cases, 95. 5 percent were confirmed and 33 patients (26. 4 percent) died. We conclude that accidental tetanus in Ceará significantly affects the population, in spite of being a disease that is preventable by immunization. The health authorities and health administration entities are urged to program strategies that aim towards changes in public policies concerning the vaccination coverage for susceptible individuals, particularly adults.

Detección inmunoenzimática de la toxina de la bacteria Clostridium tetani: una alternativa a las pruebas biológicas con ratones / Immunoenzimatic detection of the Clostridium tetani bacterial toxin: an alternative to mice bioassays

Cell-free extracts from 20 strains of Clostridium tetani isolated from soil samples, were tested for tetanus toxin production using an enzyme immunoassay. All the extracts were classified as positive for the toxin presence, and eight of them showed absorbance values corresponding to tetanus toxin concentrations between 3.2 and 88 ng/ml; thus, they fell within the linear absorbance range (0.135-0.317). All dilutions of toxin used to obtain the calibration curve (0.0071 to 1.1 ng) were lethal for mice.

Neonatal tetanus in southern Iran: predisposing and prognostic factors

The predisposing and prognostic factors for neonatal tetanus [NNT] have not been adequately studied in southern Iran. The present study was undertaken in Fars Province to further clarify the status of neonatal tetanus in this region. The mortality rate was correlated with demographic and clinical findings in 112 cases of neonatal tetanus. In addition, the height and weight of NNT patients were compared to those of 112 age- and sex-matched normal neonates. Patients were predominantly males [82%] with a male to female ratio of 4.8:1. Although the clinical presentation and outcome of male and female patients were very similar, both groups had a significantly [p<0.05] lower birth weight compared to their control counterparts. None of the mothers had been immunized against tetanus and 92% had delivered at home under unsterile conditions. The mortality rate was 44% and strongly related to the age of the patients on admission. Conclusions: Male sex, low birth weight, and a lack of immunization of mother, all predispose the newborn to tetanus. The mortality rate was inversely proportional to the age of the newborn

Mordeduras humana e animal / Animal and human bites

As lesöes ocasionadas por mordeduras humana e animal podem ter consequências graves, como: infecçöes bacterianas, amputação, hidrofobia e tétano. Siscute-se neste trabalho, à luz da literatura atual, a conduta terapêutica e profilática para uma adequada assistência a ser adotada pela equipe de saúde.

Un caso de tétanos infantil posiblemente asociado a una aguja contaminanda / Infantile case of tetanus possibly associated to contaminated needle

Clostridium tetani es el agente etiológico del tétanos. Esta bacteria es un bacilo esporulado anaerobio, habitante normal del suelo. Antes de 1970 se presentaban de 300 a 200 muertes anuales por esta causa. Luego fue prácticamente controlada y actualmente se presentan menos de 3 casos anuales y no hay tétanos neonatorum. El último caso de tétanos infantil presentado en Costa Rica, ocurrió en 1989, y debido las características relevantes que rodearon la historia de ese caso, cuyo desenlace fue fatal es que lo informamos, como un ejemplo de hechos que no debieron ocurrir. Se trató de un niño de 50 días de edad, hospitalizado por una diarrea con vómitos y manifestaciones espasmóticas, que murió 24 horas más tarde con el diagnóstico de tétanos. Su historia clínica reveló que cuando se inició la diarrea un médico particular le recetó antibióticos intramusculares. Los antibióticos fueron inyectados en su casa por el abuelo del niño. Presuminos que la puerta de entrada para las esporas de C. tetani fue la lesión de la aguja intramuscular. Este caso representa una lección sobre el manejo de agujas. También, es necesario que siempre pensemos en tétanos porque su agente etiológico es un habitante normal de nuestros suelos y la vacunación no elimina de nuestro ambiente.

Clostridium tetani is the etiological agent of tetanus. This bacterium is a spore forming anaerobic rod, that inhabit the soil. Before 1970 it causes 200 to 300 deaths per year in Costa Rica. Afterwards the disease was practically controlled and nowadays there are less than 3 cases by year and no cases in infants were observed. The last case in an infant tetanus that occurred in Costa Rica was in 1989; some relevance characteristics of its clinical story, which end was fatal, aimed this report, this is an example of facts that never would occur. He was a 50 day old child that had diarrhea and vomiting 3 days before admission, his grandfather gave him antibiotic injection at home. The child was admitted to hospital with muscular spasms and dead 24 hours later. We presume an infected needle was the entrance door for the Clostridium tetani spores. This case represents a lesson for the antiseptic management of needles. We should always keep tetanus in mind because its agent is a normal inhabitant in our soils and vaccination does not eliminate it from the environment.

Tétanos neonatal en Cartagena ¿existe control y profilaxis?: experiencia con 196 casos

Objetivos: Identificar las características clínicas del tétano neonatal y verificar la eficacia de los programas de vacunación como profilaxis para esta entidad. Materiales y métodos: Se ralizó un estudio descriptivo retrospectivo analítico de corte longitudinal con 196 pacientes con diagnóstico de tétano neonatal. Resultados: Se revisaron 196 neonatos con tétano, de procedencia en un 75 por ciento del área rural. Las madres en el 94 por ciento no tuvieron control prenatal y en el 100 por ciento de los pacientes pertenecieron al estrato socioeconómico bajo. La letalidad fue del 60 por ciento con un máximo de muertes al quinto día de la enfermedad. Conclusiones: El tétano neonatal afecta al estrato social bajo y a la población rural, quizás producto de la falta de educación y/o déficit en los programas de vacunación, en el área ruaral especialmente.

Tetanus in adult population: uncommon modes of transmission

To document and evaluate various injuries leading to tetanus in adults. Retrospective study involving indoor patients with tetanus. Tetanus section of medical Ward of Mayo Hospital, /K.E.Medical College, Lahore. Ninety one patients admitted in the ward in the year 1997. Main outcome measures: Some unreported wounds possibly leading to tetanus in adults. There was male preponderance [M:F = 1.5:1] Majority [93.4%] were be low the age of 60 years and 75 patients [82.4%] were below the age of 50 years. Fifty six [61.5%] patients were from urban slums and 35 [38.5%] were from rural areas and none from posh localities. Eighty six [94.5%] were not vaccinated and 5 [5.5%] were not sure of having vaccination against tetanus. Commonest site of the wound was on foot and leg [46.1%] followed by uterus and vagina [26.4%], other sites being arm [12.1%] hand, [11%] nose, head, thigh and back 1.1% each. Commonest type of wound was roadside accident [37.3%], illegally induced abortions, delivery and post delivery handling [26.4%]. Other unusual wounds were nail injuries [7.7%] elective surgery [5.5%] firearms and crackers [4.4%]. I/M. injections [4.4%] thorn [3.3%] electiricshock [2.2%] scratch of hen paw [2.2%], dog bite [1.1%]. No cause found in 5 [5.5%] patients. Mean stay in the ward was 33.6 +/- 19.2 days. Fifty [55%] patients recovered completely and were discharged home. The mortality was 42.8% and 2.2% left the ward against medical advice. Besides common injuries, that can lead to tetanus, uncommon wounds of firearms and crackers, illegally induced abortions [dai] mis-handling, tubal ligation, IUCD etc. have not been reported in the past to cause tetanus, and should not be overlooked. Most of the survivors had longer incubation period. Severe and fatal tetanus was noted in patients with shorter incubation period