Surgical tetanus in Abidjan, Cote d'Ivoire

Objective. To describe the epidemiological and clinical features and the outcome of tetanus with a surgical wound (open fracture, burn, incision, curettage, etc) as the portal of entry. Methods. Cross-sectional analysis of records of patients hospitalized in the department of infectious and tropical diseases in Abidjan for surgical tetanus from 2003 to 2008. Results. During the 6-year study period, 29 cases were identified. They accounted for 11% of all tetanus cases admitted to the hospital: 8% from 2003 through 2006 and 14% in 2007 and 2008. The patients' average age was 36 years (range: 11-72). Most cases (86%) involved recent surgery, in both public (51%) and private (49%) health facilities. All patients had generalized tetanus at admission, and 24 (86%) paroxysms. Moderate forms predominated (69%). The lethality of tetanus in these surgical wound cases was 45%. The characteristics statistically associated with death were: age > 44 years, time of hospitalization > 4 days, the presence of paroxysms, and a Dakar prognosis score >= 4. Conclusion. The severity of surgical tetanus remains a concern for practitioners. Its high prevalence in recent years demonstrates the need to increase surgeons' awareness of tetanus prevention.