[Localised tetanus with no obvious entry site: about a case in Bamako (Mali)]. / Tétanos localisé sans porte d´entrée apparente: à propos d´un cas à Bamako (Mali).

Tetanus is a major public health problem in sub-Saharan Africa. Localised tetanus is rare, unlike generalized tetanus which has been sufficiently described in the literature. We report a case of localised tetanus with no obvious entry site managed in the Department of Infectious Diseases in Bamako. The study involved a retired nurse aged 59 years who had not undergone tetanus booster immunisation within the last 10 years, corresponding to the date of her last delivery. She was referred to our Hospital with dysphagia associated with inability to open the buccal cavity. Patient's history was characterized by long-term therapy associated with many specialized consultations without any improvement. The diagnosis of localised tetanus with no obvious entry site was retained after having excluded any other local disorder. Outcome was favorable ten days after adequate management. Underdiagnosed or unknown to health-care providers, localised tetanus may mimic other diseases delaying diagnosis and management. Targeted campaign to build awareness should be implemented in order to improve adherence with immunization schedules.

Informe especial: Tétanos otras edades (No neonatal) / Special report: Tetanus other ages (Nonneonatal)

Entre las Semanas Epidemiológicas (SE) 51 del año 2016 y 5 del 2017 (período comprendido entre el 18/12/2016 y el 04/02/2017), la Gerencia Operativa de Epidemiología recibió la notificación de 3 casos de tétanos otras edades a través de alertas del módulo C2 del Sistema Nacional de Vigilancia de la Salud (SNVS). Se trató de 3 pacientes asistidos en el Departamento de Atención Intensiva del Paciente Infeccioso Crítico (D.A.I.P.I.C.), del Hospital de Infecciosas Francisco Muñiz, de la Ciudad de Buenos Aires. Dos casos correspondieron a residentes de Provincia de Buenos Aires y el restante a un residente de la Ciudad. Este informe resume estos tres casos, los cuales destacan la necesidad que los médicos y quienes están encargados de los cuidados de salud, constaten en oportunidad de toda consulta, la cobertura de vacunación antitetánica e indiquen la vacuna a pacientes no vacunados, incompletamente vacunados o con vacunación desconocida.(AU)

Eradication of tetanus.

INTRODUCTION: The causative agent of tetanus, Clostridium tetani is widespread in the environment throughout the world and cannot be eradicated. To reduce the number of cases of tetanus efforts are focussed on prevention using vaccination and post-exposure wound care. SOURCES OF DATA: Medline, Pubmed and Cochrane databases; World Health Organization and United Nations Children's Fund publications. AREAS OF AGREEMENT: The maternal and neonatal tetanus elimination initiative has resulted in significant reductions in mortality from neonatal tetanus throughout the world. AREAS OF CONTROVERSY: Although there are few data available it is likely that large numbers of children and adults, particularly men, remain unprotected due to lack of booster immunization. AREAS TIMELY FOR DEVELOPING RESEARCH: It remains unclear how HIV and malaria affect both responses to vaccination and transplacental transfer of antibodies or how this might affect timing of vaccination doses.

[The hospital-borne tetanus in the reference service of the Donka National Hospital in Conakry (2001-2011)]. / Le tétanos nosocomial dans le service de référence de l'hôpital National Donka à Conakry (2001-2011).

Become almost non-existent in the developed countries, the hospital-borne tetanus always stays of current events in our country in spite of the forensic problem which it puts. The objectives of this study were to determine prevalence of this affection, to describe its clinical picture and to determine its lethality. It is about a retrospective study of a duration of 11 years realized in the service of the infectious diseases of Conakry. Among 8649 hospitalizations from 2001 till 2012 we brought together 239 cases of tetanus (2.7%) among which 60 hospital-borne tetanus (0.7%). Men represented 73% of these cases, with a sex-ratio M/F of 2.7. The age bracket of 20-40 years was the most affected with 32 cases (53.3%). A single patient had begun his vaccinal calendar which had remained incomplete. Both national hospitals of the CHU of Conakry and private hospitals were the biggest suppliers of this hospital-borne tetanus with respectively 22 and 27 cases (36.6 and 45%). Tetanus related to IM of quinine represented 26 cases (43.3%) whereas the hernial cure was found in 16 cases (26.6%). The average duration of invasion and incubation was respectively 1.5 days and 6 days for the dead (n = 45.7%) and 2 days and 10.5 days for the survivors. Three-quarters of 60 patients died. The fight against this type of tetanus passes inevitably by an improvement of the working conditions, a strict application of the rules of asepsis and the in-service training of the medical and paramedical staff.

Tétano em bovinos no sul do Rio Grande do Sul: estudo de 24 surtos / Tetanus in cattle in southern Brazil: study of 24 outbreaks

São descritos vinte e quatro surtos de tétano ocorridos no ano 2009 em bovinos de corte em propriedades situadas na região de influência do Laboratório Regional de Diagnóstico (LRD), sul do Rio Grande de Sul. Todos os rebanhos foram submetidos a procedimentos de vacinação e/ou aplicação de anti-helmíntico entre 8 e 25 dias antes do aparecimento dos primeiros sinais clínicos. O tempo de evolução variou de 12 horas até quatro dias. Os sinais clínicos observados foram: prolapso da terceira pálpebra, andar rígido, dificuldade de flexão dos membros e permanência em decúbito lateral com os membros estendidos e afastados do solo (paralisia espástica), pálpebras muito abertas, sialorréia, hiperexcitabilidade, orelhas eretas, trismo mandibular, acúmulo de alimento na cavidade oral e presença de espuma na boca e narinas em alguns casos. Alguns bovinos apresentavam área de necrose e edema hemorrágico circundada por exsudato purulento nos músculos onde havia sido aplicado algum medicamento. O soro sanguíneo e fragmentos de músculo com lesão de animais afetados foram coletados para posterior inoculação em camundongos. No exame histopatológico não foram evidenciadas alterações. O quadro clínico associado aos dados epidemiológicos e a ausência de lesões histológicas permitiram o diagnóstico de tétano. A infecção, provavelmente ocorreu durante o procedimento de vacinação, através injeções intramusculares utilizando agulhas contaminadas. Apesar do tétano não ser uma clostridiose importante na região fica evidenciado que surtos podem ocorrer em função de condições epidemiológicas adequadas e cuidados devem ser tomados para evitar perdas econômicas importantes como as que ocorreram no ano 2009 na região.

Twenty-four outbreaks of tetanus occurred in 2009 in beef cattle on farms located in the region of influence of the Regional Diagnostic Laboratory (LRD), southern Rio Grande de Sul, are described. All herds were submitted to vaccination and/or application of anthelmintics between 8 and 25 days before the onset of clinical signs of tetanus. Those were prolapse of the third eyelid, stiff gait, recumbency with limbs extended and off the ground (spastic paralysis), very open eyelids, salivation, hyperexcitability, erect ears, mandibular trismus, food accumulation in the oral cavity, and presence of foam in mouth and nostrils in some cases. At postmortem some animals had necrosis, edema and hemorrhage surrounded by purulent exudate in the muscles where some medicine had been applied. Blood serum and muscle fragments of affected animals were collected for subsequent inoculation into mice. No changes were evident in histological examination. The clinical and epidemiological data associated with the absence of histological lesions allowed the diagnosis of tetanus. The infection probably occurred during the vaccination procedure, by intramuscular injections using contaminated needles. Although tetanus is not an important disease in the region, outbreaks could occur depending on epidemiological conditions. Appropriate care should be taken to avoid major economic losses as those that occurred in 2009 in the region.

Postexposure interventions to prevent infection with HBV, HCV, or HIV, and tetanus in people wounded during bombings and other mass casualty events--United States, 2008: recommendations of the Centers for Disease Control and Prevention and Disaster Medicine and Public Health Preparedness.

People wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention's Terrorism Injuries: Information, Dissemination and Exchange project. There recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community.

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 75% of 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.

Tétano

Apresenta informações sobre o tétano como: forma de transmissão da doença, tratamento, manifestações e medidas de proteção individual. Traz tabela sobre número de casos no Brasil no período de 1996 até 2005.

Risk factors for neonatal tetanus--Busoga region, Uganda, 2002-2003.

BACKGROUND: Uganda has not achieved the 2005 neonatal tetanus (NNT) global elimination target set by the World Health Organization (WHO). The Busoga region has the highest recorded level of NNT incidence in Uganda. To understand the reasons for this high incidence, a study was conducted to identify NNT risk factors. METHODS: During March-May 2004, a matched case-control study was conducted in the Busoga region for a 2-year study period (2002-2003). Matching variables were sex, residence, and date of birth. A total of 24 cases of NNT (according to the WHO case definition) were identified from hospital records, and 96 community controls (children who survived the neonatal period) were selected. RESULTS: Bivariate analysis indicated that neonates with NNT were more likely to have been delivered outside a health facility, on an unclean surface, without use of gloves, or by unskilled attendants. Mothers of these neonates were less likely to report vaccination during previous pregnancies, administration of 2 doses of tetanus toxoid (TT) during the study pregnancy, or use of certain intravaginal substances (most commonly, herbs) at onset of labor. Multivariate analysis indicated that unclean delivery surfaces (odds ratio [OR] = 38.8; 95% confidence interval [CI] = 2.9-518.1) and primigravidae mothers (OR = 79.5; CI = 1.8-3,472.2) were associated with NNT. Administration of 2 doses of TT during pregnancy, vaccination during previous pregnancies, and intravaginal application of certain substances were protective against NNT. CONCLUSION: These findings underscore the importance of having clean delivery surfaces and of mothers receiving 2 doses of TT during pregnancy. Implementation of these measures might help eliminate NNT from the Busoga region of Uganda.

[Management of maternal tetanus contracted by an obstetric procedure].

A 34-year-old woman from the Philippines showed difficulty in opening the mouth. She had no wounds in the last one mouth, but was treated with an obstetric procedure after stillbirth 16 days before in the Philippines. She showed trismus, rigidity and muscle pain, but no muscle spasms, dyspnea and autonomic dysfunction. In this case, it is supposed that the obstetric procedure is the origin of the injury. In Japan, this is the first report of maternal tetanus.

[Morbidity and mortality of tetanus in the infectious and tropical diseases department in Abidjan 1985 - 1998]. / Morbidité et mortalité du tétanos dans le service des maladies infectieuses et tropicales d'Abidjan (1985-1998).

UNLABELLED: In spite of the increase of the antitetanus immunization coverage, tetanus is still one of the main causes of morbidity and mortality in Côte d'Ivoire hospitals. OBJECTIVE: The purpose of this study was to analyse the epidemiological, clinical and prognosis aspects of tetanus in the department of infectious diseases in Abidjan. METHODS: A retrospective analysis was carried out from patients files admitted for tetanus in this department from 1985 to 1998. Tetanus diagnosis was based on clinical arguments. RESULTS: Within a period of fourteen years, 1870 cases of tetanus representing 3% of hospitalised cases were admitted in the infectious diseases department. For 1387 patients answering to the inclusion criteria of the study the ratio MIF was 2.5. The median age was 28 years old (1-85 years). The entrance doors were dominated by cuts (49.3%) and intramuscular injections of drugs (18.7%). Despite the complete vaccination, 7 patients have presented tetanus (0.5%). About 17% have presented progressive complications especially cardio-respiratory complications (41.5%). The total lethality was 31.9% and the after- effects rate 2.3%. The factors of poor prognosis were the age > 60 years old, IM injections, generalised aspect, group III of severity and presence of complications. CONCLUSION: Tetanus frequency certainly drops in infectious and tropical diseases department, but the lethality remains high therefore a reinforcement of the vaccination efforts and a management of patients are recommended.