Minta D K, Traoré A M, Soucko A K, Dembélé M, Coulibaly Y, Dicko M S, Coulibaly I, Diany N, Maboune N G E, Ba-Sall B, Traoré A K, Koné N, Traoré H A
Service de maladies infectieuses et de médecine interne, CHU du Point G, Bamako, Mali.
Bull Soc Pathol Exot. 2012 Feb;105(1):58-63. doi: 10.1007/s13149-011-0204-y. Epub 2012 Jan 5.
Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.
我们的研究目标是确定破伤风的年发病例数，并描述其临床、演变及预后情况。这是一项横断面研究，数据来源于2004年1月1日至2009年12月31日期间在Point G CHU传染病科住院治疗的15岁及以上破伤风患者的数据记录和病历。破伤风的诊断基于临床症状（牙关紧闭、吞咽困难、惊厥以及与损伤相关的体征）和流行病学依据（破伤风免疫接种不正确、感染途径）。在1839例住院病例中，我们共收集到119例破伤风病例，患病率为6.5%。大多数患者的住院时间为5天（73%）。非技术工人和农民最为常见，分别占病例的30.2%和21.8%。破伤风发生在道路交通事故创伤过程中（16%）以及其他创伤原因（48.7%）。94.4%的病例临床类型为全身型。64.7%的患者感染途径为伤口。感染途径位于下肢的时间占49.6%。共记录到合并感染恶性疟原虫（15例，12.6%）和HIV（1例）。医院病死率为46.2%。根据达喀尔评分（P = 0.0005）和莫拉雷分期（P = 0.0001），死亡与临床严重程度在统计学上相关。需要加强沟通以改变行为，从而实现正确且持续的免疫接种。在我们技术条件有限的情况下，基于快速破伤风诊断能力建设和合并症综合治疗的策略可能会降低病死率。
