Prognostic Assessment of Tetanus in Cases of Bacterial Entry Portal Identified, Bamako, Mali

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.