熱帯病と公衆衛生ジャーナル

概要

Complication of Tetanus: Report of 402 Cases at the Fann University Hospital Center of Dakar in Senegal

Fortes Déguénonvo L, Leye MMM, Dia NM, Ndiaye R, Lakhe NA, Ka D, Cisse VMP, Diallo Mbaye K, Diop SA and Seydi M

Objectives: Tetanus is a major health problem in Senegal. The objective of this study was to describe complications related to tetanus and to identify factors associated with their occurrence.

Materials and Methods: We conducted a descriptive and analytical retrospective study including patients hospitalized with tetanus at the Infectious Diseases Department of Fann National University Hospital in Dakar from 2009 to 2012. The diagnosis of tetanus was confirmed based on the presence of clinical signs and the occurrence complications was assessed. Data were collected from medical records. Multivariable logistic regression was used to evaluate potential risk factors for tetanus complications.

Results: We included 402 cases of tetanus. The mean age was 29 ± 21 years and the sex ratio (M/F) 3.06. Skin was the most frequent portal of entry (76%). Overall, 184 patients presented at least one complication (46%). Infectious (127 cases, 69%), cardiovascular (84 cases, 45%) and respiratory (79 cases, 43%) complications were the most common. In multivariable analyses, age> 40 years (p <0.001), presence of co-morbidities (p <0.01), Mollaret stage ≥ II (p = 0.02) and Dakar score ≥ 1 (p <0.001) were factors associated with the occurrence of complications. Mortality was 21%. The circumstances of death were dominated by infections (71%), respiratory distress (45%) and laryngospasm (24%).

Conclusion: We observed high rates of complications and mortality among patients admitted with tetanus. The infection prevention and control in the intensive care unit, the improvement of life-support measures and diagnostic capacities will allow to significantly reduce morbidity and mortality related to tetanus complications.