Prognostic Assessment of Tetanus in Cases of Bacterial Entry Portal Identified, Bamako, Mali
Traoré Abdoulaye Mamadou
Infectious Diseases Department, Point G University Hospital. Bamako, Mali and Faculty of Medicine and Odontostomatology, USTTB, Bamako, Mali.
Dabo Garan
Faculty of Medicine and Odontostomatology, USTTB, Bamako, Mali and Infectious Diseases Unit, Medicine Department, University Hospital ‘Hôpital du Mali’, Bamako, Mali.
Dollo Ibrahim
Medicine Department, Gao Regional Hospital, Gao, Mali.
Dara Charles
Infectious Diseases Unit, Medicine Department, University Hospital ‘Hôpital du Mali’, Bamako, Mali.
Cissé Hamsatou
Medicine Department, Pr Bocar Sall de Kati’ University Hospital, Kati, Mali.
Ouologuem Douro Seydou
Infectious Diseases Department, Point G University Hospital. Bamako, Mali.
Cissé Tidiani
Infectious Diseases Department, Point G University Hospital. Bamako, Mali.
Bah-Sall brahima
Infectious Diseases Department, Point G University Hospital. Bamako, Mali.
Traoré-Menta Djénébou
Faculty of Medicine and Odontostomatology, USTTB, Bamako, Mali and Internal Medicine Department, Point G University Hospital, Bamako, Mali.
Sy Djibril
Faculty of Medicine and Odontostomatology, USTTB, Bamako, Mali and Internal Medicine Department, Point G University Hospital, Bamako, Mali.
Keita Kaly
Faculty of Medicine and Odontostomatology, USTTB, Bamako, Mali and Internal Medicine Department, Point G University Hospital, Bamako, Mali.
Sylla Ousmane
Dermatology Department, Bamako Dermatology Hospital, Bamako, Mali.
Mamadou Cissoko
Internal Medicine Department, Point G University Hospital, Bamako, Mali.
Kaya Assetou Soukho
Faculty of Medicine and Odontostomatology, USTTB, Bamako, Mali and Internal Medicine Department, Point G University Hospital, Bamako, Mali.
Minta Daouda Kassoum
*
Infectious Diseases Department, Point G University Hospital. Bamako, Mali and Faculty of Medicine and Odontostomatology, USTTB, Bamako, Mali.
*Author to whom correspondence should be addressed.
Abstract
Objective: To determine the main types of tetanogenic bacterial portals of entry and assess their involvement in the prognostic and evolutionary factors of tetanus.
Methodology: We carried out a descriptive and analytical cross-sectional study with retrospective data collection at Point-G University Hospital over a period of 22 years. Our study population was made up of tetanus patients whose bacterial portals of entry were sought and found or not found upon admission.
Results: The hospital prevalence of tetanus was 5% of admissions. The portal of entry (POE) was found in 217 cases (84.10%). The most common bacterial portals of entry found (BPOEF) were skin and mucosal wounds (65.4%), open fractures (10.6%), skin lesions (7.8%) and deep wounds (7.4%). The most common anatomical sites were the pelvic limbs (62.2%), thoracic limbs (26.3%), head (5.5%) and uterus (2%). The comorbidities associated with the death were dominated by hypertension (50%), malaria (28.6%), and one case of epilepsy, with (p=0.96) compared to the survivors with comorbidities. The POEs as variable dependent of the Dakar score were: 22 POEs due to open fractures, 6 POEs following surgery, 4 POEs after IM injections, 4 POEs due to uterine invasion, and 2 POEs following burns. Dakar scores 2 and 3 were predominantly recorded in cases of BPOEF respectively 48.8% and 31.8%. Specifically, 41.5% of deaths were recorded in patients with BPOEF versus patients BPOE-NF (46.3%) with p=0.77. The mortality in the group with POEs as variable dependent of tetanus risk factors was 42.1% versus 42.5% in the group with POEs as variable independent of risk factors. The Dakar poor prognosis scores were higher in patients whose BPOEF, with a statistically significant difference (p=0.043).
Conclusion: Tetanus continues to be seen despite the availability of effective preventative measures. Given the multitude of comorbidities and the associated significant mortality rate, there would need to be a review of the prognostic factors for tetanus in healthcare settings.
Keywords: Tetanus, portal of entry, comorbidities, hypertension, diabetes, sickle cell disease, prognostic factor, Bamako