ABSTRACT
OBJECTIVES: To describe the relation between HIV infection and tetanus. METHODS: This prospective study includes all patients admitted to our infectious diseases department with tetanus between July 15 and December 31, 2007, who underwent screening for HIV-1 and 2. RESULTS: The study included 21 patients (sex-ratio = 9.5). Their mean age was 37 years (SD: 5.3) were included. Nine patients (42%) had been immunized, but never received a booster dose. The portal of entry was found in 16 patients (76%) - all but one a skin injury. Tetanus was generalized in all patients (Mollaret classification: 76% Stage II, 24% stage III). Twelve (57%) patients were infected with HIV. Their mean CD4 cell count was 157/mm3 (SD: 75/mm3, range: 74-232/mm3). The overall mortality rate was 53%. It was 100% when no portal of entry was found. It was significantly higher among HIV-positive than HIV-negative patients (82 versus 18%). It did not, however, differ significantly between HIV-positive subjects with a CD4 count < 200/mm3 and those with a CD4 count > or = 200 (58 versus 42%). CONCLUSION: HIV and the absence of portal of entry are poor prognostic factors in tetanus. Therefore, a revision of the Dakar International Classification on tetanus should be revised, to score as 1 those patients with HIV infection and no portal of entry.
Subject(s)
HIV Infections/complications , Tetanus/complications , Adult , CD4 Lymphocyte Count , Data Interpretation, Statistical , Female , HIV Infections/diagnosis , HIV Seronegativity , HIV Seropositivity , Humans , Male , Prognosis , Prospective Studies , Tetanus/classification , Tetanus/diagnosis , Tetanus/immunology , Tetanus/mortalityABSTRACT
OBJECTIVE: To determine the effect on clinical progression and mortality during tetanus of intrathecal therapy with 1 500 IU of heterologous antitetanus serum administered with 1.5 g of intravenous metronidazole. METHOD: This prospective study took place from August 1, 2006, to June 30, 2007, and included two groups of patients randomly allocated to treatment by two different techniques. The test group of 17 patients received 1 500 IU of antitetanus heterologous immunoglobulin by the intrathecal route as well as 1.5 g of intravenous metronidazole daily. The control group of 25 patients received the standard treatment of 9 000 IU of heterologous antitetanic serum administered half (4 500 IU) cutaneously and half intramuscularly. Clinical manifestations and mortality were assessed. Mollaret's classification and the Dakar prognosis score were used to classify patients according to severity. RESULTS: Forty-two patients were treated. Their mean age was 29.44 years (standard deviation: 18.3 years) and the M/F sex ratio was 5. Skin wounds accounted for 57.1% of the portals of entry, deep wounds for 26.2%; the rest were unknown. Twenty patients (47.6%) had fever when admitted. Tetanus was generalized in all cases and 76.2% of patients were stage III. Four patients were HIV-positive. Clinical improvement, defined as a decrease in dysphagia, trismus, and paroxysm, was observed more quickly in the test group: 48 hours after treatment began, improvement was seen in more than 76% of the test group compared with 28% in the control group. In the test group, the mean hospitalization period was 7.4 days and mortality was 11.7%, compared with 19 days and a mortality rate of 52% in the control group. CONCLUSION: Prevention through vaccination appears to be the long-term solution for the eradication of tetanus. In the meantime, we can hope for a better clinical response with intrathecal therapy of 1 500 IU of heterologous antitetanus serum and 1.5 g of intravenous metronidazole daily.
