Detection of tetanus toxoid with iron magnetic nanobioprobe.

Diagnosis of diseases with low facilities, speed, accuracy and sensitivity is an important matter in treatment. Bioprobes based on iron oxide nanoparticles are a good candidate for early detection of deadly and infectious diseases such as tetanus due to their high reactivity, biocompatibility, low production cost and sample separation under a magnetic field. In this study, silane groups were coated on surface of iron oxide nanoparticles using tetraethoxysilane (TEOS) hydrolysis. Also, NH2groups were generated on the surface of silanized nanoparticles using 3-aminopropyl triethoxy silane (APTES). Antibody was immobilized on the surface of silanized nanoparticles using TCT trichlorothriazine as activator. Silanization and stabilized antibody were investigated by using of FT-IR, EDX, VSM, SRB technique. UV/vis spectroscopy, fluorescence, agglutination test and ELISA were used for biosensor performance and specificity. The results of FT-IR spectroscopy showed that Si-O-Si and Si-O-Fe bonds and TCT chlorine and amine groups of tetanus anti-toxoid antibodies were formed on the surface of iron oxide nanoparticles. The presence of Si, N and C elements in EDX analysis confirms the silanization of iron oxide nanoparticles. VSM results showed that the amount of magnetic nanoparticles after conjugation is sufficient for biological applications. Antibody stabilization on nanoparticles increased the adsorption intensity in the uv/vis spectrometer. The fluorescence intensity of nano bioprobe increased in the presence of 10 ng ml-1. Nanobio probes were observed as agglomerates in the presence of tetanus toxoid antigen. The presence of tetanus antigen caused the formation of antigen-nanobioprobe antigen complex. Identification of this complex by HRP-bound antibody confirmed the specificity of nanobioprobe. Tetanus magnetic nanobioprobe with a diagnostic limit of 10 ng ml-1of tetanus antigen in a short time can be a good tool in LOC devices and microfluidic chips.

Tétanos generalizado en un adolescente / Spread tetanus in an adolescent

Se presenta el caso clínico de un adolescente de 13 años de edad, con antecedentes de buena salud, quien solo recibió inmunización durante la etapa neonatal, el cual sufrió una herida causada por un clavo enmohecido en el dorso del pie derecho y acudió al Hospital Wete de Zanzíbar, Tanzania, por presentar dolores musculares, espasmos generalizados, risa sardónica y trismo, por lo cual se le diagnosticó tétanos generalizado. Se prescribió tratamiento médico con hidratación parenteral, toxina antitetánica, toxoide tetánico, antibióticos, sedantes y curación local de dicha herida. Luego de 2 meses de hospitalización el paciente tuvo una evolución satisfactoria.

The case report of a 13 years adolescent, with history of good health who just received immunization during the neonatal period is presented. He suffered from a wound caused by a rusty nail in the back of the right foot and he went to the Wete Hospital in Zanzibar, Tanzania, presenting muscular pains, spread spasms, sardonic laugh and trismus, reason why he was diagnosed spread tetanus. Treatment was prescribed with parenteral hydration, anti-tetanus toxin, anti-tetanus toxoide, antibiotics, sedative and total cure of this wound. After 2 months of hospitalization the patient had a favorable clinical course.

Tetanus of suspected dental causality.

Tetanus infection by Clostridium tetani is a major health problem in many developing countries, including India. Significant morbidity and mortality is attributed to lack of awareness, hygiene and incomplete vaccination. The most common cause of tetanus infection follows cutaneous injury or infection. However, a localized point of entry cannot always be determined. Tetanus has been associated with tooth extraction, root canal therapy, gross caries, periodontal abscess and intraoral soft tissue trauma. The classic symptoms of trismus and risus sardonicus may result in an initial presentation to an oral and maxillofacial surgeon. Due to the rarity of this infection, the dentist or the health care provider may fail to corroborate the findings and be unsuspecting of the diagnosis. Prompt recognition is the key in such a scenario due to the inherent risk of rapid progress of symptoms, progressive deterioration of the health condition and catastrophic complications. A sound knowledge of the effects of tetanospasmin, the disease process, prevention and vaccination against tetanus with its management is essential for health care workers. The authors hereby present a case of tetanus with a suspected dental etiology to make the dental fraternity aware of this lurking malady.

Tétanos generalizado en adulto. Reporte de caso / Adult generalized tetanus. Case report

RESUMEN Fundamento: El tétanos es una enfermedad infecciosa causada por las esporas de la bacteria Clostridium tetani que afecta el sistema nervioso. La inmunización contra esta enfermedad ha permitido reducir la morbilidad y la mortalidad en Cuba por esa causa. Los pocos casos reportados son pacientes sin previa vacunación contra el tétanos, por lo que constituye de interés para la comunidad científica el reporte de aquellos que desarrollan esa enfermedad después de haber sido vacunados. Objetivo: Describir el caso de un paciente con diagnóstico de tétanos generalizado a pesar de que ya había sido vacunado contra esa enfermedad. Presentación del caso: Paciente de 33 años, con el antecedente de haber sido vacunado contra el tétanos, al cual le diagnosticaron tétanos generalizado, por lo se decidió su ingresó en la unidad de cuidados intensivos. Clínicamente se manifestó por contracciones musculares generalizadas y rigidez, los síntomas y signos neurológicos tuvieron una duración de 4 semanas. A pesar de las complicaciones el paciente egresó con adecuada calidad de vida. Conclusiones: La presentación de este caso busca concientizar en la comunidad científica la importancia de considerar el diagnóstico de tétanos en pacientes ya vacunados, lo cual es poco frecuente y obliga a actuar con prontitud.

ABSTRACT Background: Tetanus is an infectious disease caused by the bacterium Clostridium tetani spores which affects the nervous system. In Cuba, immunization against this disease has made it possible to reduce morbidity and mortality from this cause. The few cases reported are patients without prior vaccination against tetanus, so is the interest to the scientific community the reporting of those who develop this disease after having been vaccinated. Objective: To describe a patient´s case with a generalized tetanus diagnosis despite has already been vaccinated against this disease. Case report: A 33-year-old patient, with a history of has been vaccinated against tetanus, and diagnosed with generalized tetanus, so it was decided he to be admitted to the intensive care unit. Clinically manifested by generalized muscle contractions and stiffness, the neurological symptoms and signs lasted 4 weeks. Despite the complications, the patient discharged from hospital with an adequate life quality. Conclusions: This case presentation searches for raising awareness in the scientific community about the importance of considering the diagnosis of tetanus in previous vaccinated patients, which is rare and requires quickness of action.

Bronchial Visualization of Tetanic Contractions: A Case Report.

BACKGROUND Tetanus is a potentially fatal infectious disease which, during its evolution, creates multiple complications, usually requiring intensive management and care. CASE REPORT We present a clinical case of a 59-year-old male patient with generalized tetanus admitted to the intensive care unit. Flexible bronchoscopy revealed contraction of the bronchial demonstrating that tetany existed at the respiratory level, which rarely becomes evident. The clinical manifestations included trismus, facial paralysis, neck stiffness, and compromised respiratory function. The patient presented a state of respiratory failure that required invasive mechanical ventilation which was evaluated by bronchoscopy and that showed spasms of the bronchial musculature. The patient presented generalized tetanus in which the bronchial affectation was evaluated by bronchoscopy in the intensive care unit. In developed countries, the anti-tetanus toxoid vaccine has ostensibly decreased its incidence, while it is endemic in developing countries, and although there are measures such as vaccination that try to reduce its incidence, in Ecuador there is an increase in incidences. In this patient case, contraction of the bronchial rings was observed, demonstrating that tetany existed at the respiratory level, which rarely becomes evident. CONCLUSIONS Although muscular contractions are widespread, this clinical case evidences bronchial spams reported and visualized by bronchoscopy.

[The Turning Point of Diagnostic Process for Infectious Disease of Nervous System].

Infectious diseases of the nervous system are a group of diseases; timely diagnosis and treatment for these diseases determines the effect of prognosis on life and functions. Diagnosis itself is not very difficult in cases presenting with typical symptoms. However, if mild and atypical symptoms have been present for long, the underlying disease may not be easily recognized as a neurological disease or infectious disorder, and the diagnosis may be delayed. Furthermore, neurologists may not always be able to examine patients from the first visit itself. In this chapter, I present three cases with mild and atypical initial symptoms. The first case involved a patient with tetanus, whose initial symptom was dysphagia, and the onset of trismus was the turning point for diagnosis. The second case involved a patient with herpes simplex encephalitis. Dyshydrosis and dysosmia were the initial symptoms, and the appearance of disorientation, fever, and consciousness disturbance helped in achieving the final diagnosis. The last case was of a patient with Japanese encephalitis, whose initial symptoms were fever and parkinsonism. A recent history of surgery for gastric cancer, disease onset in the summer season, and living with neighbors on pig farms was indicative of Japanese encephalitis.

Forgotten pathogen: tetanus after gastrointestinal surgery.

A previously healthy 79-year-old woman underwent an urgent laparotomy and resection of a strangulated loop of small bowel. On the second postoperative day, she developed symptoms suspicious for postoperative tetanus. A transfer to the intensive care unit was necessary for aggressive supportive therapy. The patient required 5 months of intensive physiotherapy and rehabilitation and was successfully discharged home. New cases of tetanus have become rare in developed countries. This potentially lethal disease affects both non-immunised and inadequately immunised patients. The occurrence of tetanus after gastrointestinal surgery is extremely rare. Prevention is key and can be achieved with correct immunoprophylaxis. Older patients are often inadequately immunised. Should tetanus immunoprophylaxis routinely be checked for elderly patients undergoing gastrointestinal surgery? Or can we limit the immunisation to severe cases of ischaemic bowel injury with necrosis and/or soiling of the abdominal cavity?

[Toxin-infections and toxin-related diseases due to Clostridia other than Clostridium difficile]. / Toxi-infections et maladies toxiniques liées à des clostridies autres que Clostridium difficile.

Clostridia cause severe diseases. Tetanus is rare in Switzerland because of vaccine coverage and the application of guidelines for the management of contaminated wounds. Tetanus requires wound debridement and the administration of antibiotics and anti-tetanus immune. Besides gastroenteritis, infections due to C. perfringens most often require surgery, in addition to antibiotic treatment with penicillin and clindamycin. Botulism is a rare disease caused by a toxin produced by C. botulinum that causes flaccid paralysis. The clinical syndrome must be recognized early in order to administer the antitoxin and improve the prognosis. The other, rarer species of Clostridia require surgical and antibiotic management, but their prognosis remains poor.

Les clostridies causent des maladies graves. Le tétanos est rare en Suisse grâce à la vaccination et à l'application de directives pour la gestion des plaies souillées. Sa prise en charge nécessite un débridement de plaie, l'administration d'antibiotiques et d'immunoglobulines antitétaniques. En dehors des gastroentérites, les infections à C. perfringens nécessitent en règle générale une chirurgie, en sus d'une antibiothérapie par pénicilline et clindamycine. Le botulisme est une maladie rare due à une toxine produite par C. botulinum qui entraîne une paralysie flasque descendante. Le syndrome clinique doit être reconnu précocement afin d'administrer l'antitoxine et améliorer le pronostic. Les infections invasives dues à des espèces plus rares de clostridies nécessitent une prise en charge chirurgicale et l'administration d'antibiotiques, mais leur pronostic est défavorable.

Tétanos secundario a mordedura y arañazo de gato en una paciente previamente vacunada / Tetanus after cat scratch and bites in a previously immunized patient

Tetanus is declining due to vaccination, professional labor management and appropriate wound care. Tetanus cases have been reported despite immunization. We report the case of a previously healthy 21 years old female patient that presented a mild generalized tetanus requiring admission after mild and recurrent cat scratch and bites. She had received six vaccine shots during childhood, and a booster dose five years earlier after a rabbit bite. Symptoms appeared seven weeks after the last contact, and included headache, muscle spasms and mild opisthotonus. Laboratory evaluation, including CSF analysis and microbiological investigation, as well as imaging studies were all normal. The patient received 6,000 IU of human antitoxin immunoglobulin. No autonomic manifestations or respiratory compromise were registered. Symptoms resolved rapidly and she was discharge after seven days with an order to complete a tetanus toxoid immunization schedule with three doses. Conclusions. Tetanus is possible in urban settings with a declining epidemiologic curve of disease in previously immunized patients. Severity of disease is modulated by previous vaccination.

El tétanos está en declinación gracias a la vacunación, manejo profesional del parto y el cuidado apropiado de las heridas. Se han reportado casos a pesar de la inmunización. Presentamos el caso clínico de una mujer previamente sana de 21 años que presentó un tétanos generalizado leve, luego de repetidas mordeduras y arañazos de su gato. Había recibido su esquema completo de seis dosis de vacuna antitetánica en la infancia y un refuerzo hacía cinco años luego de una mordedura por conejo. Los síntomas aparecieron siete semanas después del último contacto e incluyeron cefalea, espasmos musculares y opistótonos leve. La evaluación de laboratorio, incluyendo un estudio del LCR e imágenes fueron normales. La paciente recibió inmunoglobulina humana antitetánica. No hubo manifestaciones autonómicas ni compromiso respiratorio. Los síntomas regresaron rápidamente y se dio de alta a los siete días con indicación de completar tres dosis de vacuna antitetánica. Conclusiones: El tétanos es posible en ambientes urbanos con una curva epidemiológica en descenso en pacientes previamente inmunizados. La gravedad del cuadro es modulada por la vacunación previa.

Tétanos, una enfermedad vigente en población pediátrica: Reporte de un caso / Tetanus, a current disease in pediatric population: Case report

Introducción: El tétanos es una enfermedad aguda causada por una toxina producida por Clostridium tetanii. La enfermedad puede afectar a personas de cualquier edad, y la tasa de letalidad es alta. Gracias a la inmunización se ha logrado reducir el número de casos de la enfermedad, aunque se siguen presentando casos sobre todo en países con rezago social y económico. Objetivo: Describir caso clínico de un paciente pediátrico con tétanos generalizado, para reforzar la importancia de la profilaxis y diagnóstico precoz. Caso clínico: Escolar femenina de 6 años de edad con antecedente de esquema de inmunizaciones incompleto (una dosis de pentavalente), quien 10 días después de hacerse una herida cortopunzante por astilla de madera en brazo derecho, evolucionó con fiebre, dolor muscular y contracciones generalizadas, diagnosticándose tétanos generalizado en base a los antecedentes y el cuadro clínico. El tratamiento se estableció en base a las últimas recomendaciones de la Organización Mundial de la salud (OMS): esquema antibiótico Penicilina-Metronidazol, toxoide tetánico y gammaglobulina antitetánica a dosis altas. Se da de alta con secuelas motoras leves, las que se remitieron luego de 2 años de seguimiento y terapia de rehabilitación. Conclusión: El tétanos se sigue presentando en la población pediátrica principalmente asociado a falta de vacunación, es necesario conocer la enfermedad para hacer diagnóstico temprano y ofrecer manejo acorde a recomendaciones internacionales.

Introduction: Tetanus is an acute disease caused by a toxin produced by Clostridium tetanii. The disease can affect people of any age, and the fatality rate is high. Thanks to immunization the number of cases of the disease has decreased, although they are still present in isolation in countries with social and economic backwardness. Objective: To describe a case of a pediatric patient with generalized tetanus to reinforce the relevance of prophylaxis and early detection. Case Report: 6 years old female patient, with only one dose of pentavalent vaccine, 10 days after sharps injury by wood chips, starts with fever, muscle pain and generalized contractions, Tetanus was diagnosed by clinical symptoms and history. The management was based on the latest recommendations of the World Health Organization (WHO): Penicillin-Metronidazole antibiotic regimen, tetanus toxoid and tetanus high-dose gammaglobulin. After 2 years of follow-up under physiotherapy support, slight motor sequelae were observed. Conclusion: Tetanus is still presented in the pediatric population, associated with lack of vaccination. It is necessary to know the disease to provide proper diagnosis and management according to international lineaments.

[A case of tetanus originating from ulcerated breast cancer].

We report herein on a rare case of tetanus originating from ulcerated breast cancer. A 60-year-old homeless woman was admitted to our hospital because of lockjaw. On admission, a physical examination revealed tachypnea, trismus, opisthotonus and an ulcerated right breast. There was no other skin soft tissue damage. A diagnosis of tetanus was entertained from the lockjaw and opisthotonus. Tetanus globulin, tetanus toxoid, penicillin and respiratory support were initiated. Later, a right total mastectomy was performed, and the diagnosis of breast cancer was made, however, gram positive bacilli were not detected and Clostridiuum tetani (C. tetani) was not cultured. It is conceivable that the ulcerated breast was contaminated with C. tetani due to the patients living conditions.

Estudo de 119 casos de tétano ocorridos num hospital de referência na Bahia entre 2004 e 2010 / Study of 119 cases of teta nus ocurred in a reference hospita l of Bahia / Estudio de 119 casos de téta no ocurridos en un hospital de referencia em la bahia entre 2004 y 2010

O tétano é uma doença que ainda representa um grave problema de saúdepública no Brasil, apesar dos avanços na assistência hospitalar, sendo altos os níveis de morbidade e mortalidade. Os objetivos deste trabalho são identificar os fatores associados a óbito em pacientes com tétano acidental e neonatal e descrever as características clínicas da doença. Trata-se de estudo descritivo analítico de corte transversal, utilizando dados secundários. Os resultados evidenciaram que, nos 119 casos de tétano generalizado e neonatal internados no período de janeiro de 2004 a dezembro de 2010 num hospital de referência no estado da Bahia, 32 (26,5por cento) evoluíram para óbito, sendo 4 dos 5 casos de tétano neonatal. Em relação à situação vacinal, 22 (19,7por cento) pacientes tinham história de uso da vacina contra tétano antes do internamento hospitalar. Concluiu-se que a doença predominou no sexo masculino e nas faixas etárias entre 20 e 60 anos de idade. A quase totalidade dos pacientes não referiu vacinação ou usou esquema vacinal incompleto. A letalidade entreos casos de tétano neonatal foi extremamente elevada. A internação na UTI melhorou o prognóstico.

Tetanus is a disease that still represents a severe problem for Public Health in Brazil. Besides the improvement of therapies, the levels of morbidity and mortality are still high. The objectives of this study are to identify death associated factors and lethality causes in patients with generalized and neonatal tetanus and to describe clinical characteristics of the disease. This is a cross-section descriptive and analytic study with use of secondary data. The results showed that out of the 119 cases of hospitalized patients with generalized and neonatal tetanus in a reference hospital of Bahia from January 2004 to December 2010, 32 (26.5percent)died in which four out of the five were neonatal tetanus. According to the immunization situation 22 (19.7percent) patients were vaccinated against tetanus before the hospitalization. The results show that the majority of cases of tetanus was found in males aged from 20 to 60 yearsold. The vast majority of patients was not vaccinated or barely completed the immunization schedule. The lethality of neonatal tetanus was extremely high. The treatment in a ICU improves the prognosis.

El tétano es una enfermedad que, a pesar de las mejoras en la atenciónhospitalaria, todavía representa un grave problema de salud pública en Brasil, pero sus elevados niveles de morbilidad y mortalidad. Los objetivos de este estudio son identificar los factores asociados al óbito en pacientes con tétano accidental y neonatal y describir las características clínicas de la enfermedad. Estudio analítico descriptivo de enfoquetransversal, utilizando datos secundarios. Resultados: Se demostró que en 119 casos de tétano generalizado y neonatal ingresados, entre enero de 2004 a diciembre de 2010, en un hospital de referencia en el estado de Bahia, 32 (26,5por ciento) evolucionaron para óbito siendo, de los cinco casos, cuatro de tétano neonatal. En relación al estado de vacunación, 22 (19,7por ciento) de los pacientes tenían antecedentes del uso de la vacuna contra el tétano antes del ingreso hospitalario. Se concluye que la enfermedad predominó entre los hombres y en los grupos de edad entre 20 y 60 años. Casi todos los pacientes no hicieron referencia a la vacunación o inmunización incompleta. La tasa de letalidad entre los casos de tétano neonatal fue extremadamente alta. El ingreso en la UCI ha mejorado el pronóstico.

Changes in electromyography and F wave responses in two cats with presumed local tetanus: implications for diagnosis and prognosis.

Two cases of focal tetanus in the cat are described. Clinical findings included severe muscular spasms of the pelvic limbs in one cat, and involvement of the thoracic limbs and muscles of the neck and face in the other. Electromyography in both cats showed spontaneous activity characterised by the presence of motor unit potentials. F waves, never previously reported in focal tetanus in animals, showed significantly increased F/M amplitude ratio in both cats and increased F wave duration in one cat. The electrodiagnostic findings provided relevant diagnostic and, possibly, prognostic information.

Tétanos generalizado: caso clínico y revisión del tema / Generalized tetanus: clinical case report and review of the literature

Tetanus is a severe and potentially mortal disease, which affects the Nervous System, caused by the bacteria Clostridium tetani. It's endemic in developing countries, presenting in Chile with a rate of 0,02 cases per 100.000 habitants, but the antitetanic vaccine has reduced its incidence in developed countries. We present here a case report of a patient with generalized tetanus from our hospital. The clinical presentation was characterized by generalized increased muscle tone and trismus, and the patient was hospitalized in the Intensive Care Unit. The neurologic manifestations were important for a period of 3 weeks, but then they started decreasing until the patient was discharged, without complications and being able to sit and walk with assistance. In relation to this case, we will review the actualizations in the subject of Tetanus. The recommended treatment includes support therapy, prevention of complications, antibiotics, muscle relaxants and anti-tetanospasmin immunoglobulin; all therapies that our patient received partially. The disease has a mortality that reaches the 50 percent in some series, but the ones who survive have a good prognosis and full recovery. This is why the presentation of this case is important, being an infrequent disease that must be diagnosed timely and be treated adequately.

Introducción: El tétanos es una enfermedad grave y potencialmente mortal, que afecta al sistema nervioso y causada por la bacteria Clostridium tetani. Es endémica en países en desarrollo, teniendo en Chile el año 2007 una tasa de 0,02 casos por cien mil habitantes. La vacuna con el toxoide antitetánico ha disminuido ostensiblemente su incidencia en países desarrollados. Caso clínico: Se presenta el caso clínico de un paciente de 18 años con tétanos generalizado ingresado a nuestro hospital. Clínicamente se manifestó con un aumento del tono muscular generalizado y trismo. Se hospitalizó en la Unidad de Cuidados Intensivos. Los síntomas y signos neurológicos tuvieron una máxima intensidad de aproximadamente cuatro semanas; posteriormente fueron disminuyendo sin presentar complicaciones severas. Al alta el enfermo lograba sentarse y caminar con ayuda. Discusión: A propósito de este caso se hace una revisión de la literatura y actualización de esta grave enfermedad. El tratamiento recomendado incluye terapia de soporte, prevención de complicaciones, antibioterapia, relajantes musculares e inmunoglobulina antitetánica; terapias que este paciente recibió. Si bien esta enfermedad tiene una letalidad promedio de un 50 por ciento, los pacientes que sobreviven tienen buen pronóstico y recuperación completa. Por ello, la presentación de este caso clínico es importante, sobre todo siendo una condición poco frecuente, que debe diagnosticarse con prontitud y, así, recibir el tratamiento adecuado.

[Surgical tetanus in Abidjan, Cote d'Ivoire]. / Tétanos à porte d'entrée chirurgicale à Abidjan, Côte 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.

Perfil epidemiológico dos pacientes com tétano acidental em unidade de terapia intensiva / Perfil epidemiológico de pacientes con tétano accidental en la unidad de cuidados intensivos / Epidemiological profile of patients with accidental tetanus in the intensive care unit

A tendência dos casos de tétano acidental é para uma redução, entretanto a doença apresenta-se ainda com alto índice de letalidade. Diante dessa situação, objetivou-se descrever o perfil epidemiológico e clínico dos casos de tétano acidental internados em uma Unidade de Terapia Intensiva (UTI) em Fortaleza, Ceará, e levantar a incidência de óbitos pela doença. Estudo descritivo, retrospectivo, tipo série de casos, com 94 pacientes internados na UTI entre 2003 e 2009. Os dados foram coletados em formulário previamente elaborado. A análise foi univariada. Houve predomínio do sexo masculino (83), na faixa etária adulta jovem(20 a 49 anos), procedentes da capital, casados (55) e com ensino fundamental completo e incompleto. Em 47 casos a lesão ocorreu em membros inferiores e em 52 casos a injúria foi ocasionada por ferimento perfurante. As manifestações clínicas mais presentes foram: trismo,77 casos, e disfagia, 57 casos. Dos avaliados, 39 evoluíram a óbito. Concluiu-se que o tétano acidental, no Ceará, apresenta letalidade elevada.

The trend of cases of neonatal tetanus is assumed to reduce, however, the disease still presents a high mortality rate. Given this situation, the objective of this study was to describe the clinical and epidemiological profile of cases of tetanus admitted to an intensive care unit (ICU) in the northeastern state of Ceará, Brazil and to raise the incidence of deathsfrom the disease. This is a descriptive study, retrospective case series of 94 patients admitted between 2003 and 2009. The data was collected through a form previously elaborated. At unvaried analysis, there was male predominance (83), aged young adults (20 to 49 years), coming from the capital, married (55) and with complete primary education and incomplete. In 47 cases the injury occurred in the lower limbs and in 52 cases the injury was caused by puncture wound. The clinical present features were: trismus, and dysphagia in 77 cases, 57 cases. Of the studied 39 died. It was concluded that the tetanus, in Ceará, presents highmortality rate.

La tendencia de casos de tétano accidental indica una reducción, sin embargo, la enfermedad todavía presenta una alta tasa de mortalidad. Ante esta situación, se objetivó describir el perfil clínico y epidemiológico de los casos de tétano accidental ingresados en una unidad de cuidados intensivos (UCI), en Fortaleza, Ceará y registrar la incidencia de muertes por la enfermedad. Estudio descriptivo, retrospectivo de series de casos, con 94 pacientes ingresados en una UCI entre 2003 y 2009. Los datos fueron recolectados a través de un formulario previamente elaborado. El análisis fue univariado. Hubo predominio de varones (83), congrupo de edad adulta joven (20 a 49 años), procedente de la capital, casados(55) y con educación primaria completa e incompleta. En 47 casos se produjo la lesión en las extremidades inferiores y en 52 casos la lesión fue causada por herida penetrante. Las manifestaciones clínicas más presentes fueron: el trismo, en 77 casos, y la disfagia, en 57 casos. De los evaluados, 39 fueron a óbito. Se concluye que el tétano occidental, en Ceará, presenta alta tasa de mortalidad.

[Clinical features of tetanus: a review with case reports].

Tetanus is a CNS disorder characterized by muscle spasms that is caused by the exotoxin of an anaerobic bacterium, Clostridium tetani. This disease is killing tens of thousands of neonates in developing countries. Although the incidence and mortality of tetanus has dramatically dropped in developed countries due to effective vaccination, appropriate wound management, and recent advances in intensive care, treatments remain difficult. From among developed countries, Japan has had a relatively high incidence of tetanus, and prevention is the problem especially in the elderly. We analyzed the data from 12 patients admitted to our hospital during 1997-2010. Their age ranged from 50-82 years; median 72 years with male to female ratio 5: 7, and all patients lacked a reliable history of toxoid immunization. Five patients out of 12 had history of cancer and one each had diabetes mellitus, pulmonary emphysema and Sjogren syndrome. In some cases, the patients had been initially misdiagnosed with ENT disorders, dental problems, or psychosis. Therefore to date, observation of clinical symptoms such as difficulty in mouth opening is considered the most crucial for diagnosis. The shorter was a period from onset to generalized convulsion (onset time), the longer was a duration of hospital stay. A notable complication was intramuscular hemorrhage in the lumbar muscles, which occurred in 2 patients. No patients died due to ICU managements, in which the most useful were propofol for spasm control and sedation, and magnesium sulfate for autonomic overactivity. Retrospectively, the Tetanus Severity Score (TSS) for mortality proposed by Thwaites et al (2006) is considered a useful tool also for predicting the clinical outcome at discharge. Although tetanus has been traditionally classified into the generalized, local, and cephalic types, a simpler severity-based classification into "severe", "moderate", and "mild" types may be more practical with regard to disease management.

[Rotary C1-C2 dislocation: a case report]. / La luxation rotatoire C1-C2 : à propos d'une observation.

The atloid-axoid rotatory slipped disc is a rare pathology with still uncertain etiology. Many situations can be factors of this disease. We report a case in a child who was admitted to the hospital for a stiff neck that had been evolving for 1 month. The clinical examination found an irreducible angular deformity of the neck and multiple cervical adenopathies. The ORL examination was normal, the biological tests showed no disorders, and the X-ray examinations were also normal. Unexpected admission features were also disconcerting. The child suddenly presented a stiff neck on waking 2 days after a traditional circumcision at home, which might have been traumatizing. The mother also reported fever a few days before, attributed to rhinopharyngitis. Before his referral to the Rabat Children's Hospital, the child had received an anti-inflammatory treatment without any improvement. He had also been considered to have an opisthotonos on admission and was treated for suspected tetanus. Finally, the rotatory dislocation of C1-C2 was suggested, and a cervico-occipital junction scanner with three-dimensional reconstructions confirmed the diagnosis. The child was treated with cranial traction with good progression. This case opens the discussion of this rare disease, often unrecognized, which requires a multidisciplinary approach.