[Efficacy and tolerance of tenofovir-lamivudine-efavirenz combination in HIV-1 patients in Fann Teaching Hospital in Dakar]. / Efficacité et tolérance de l'association ténofovir-lamivudine-éfavirenz chez les patients VIH-1 à la clinique des maladies infectieuses du CHNU de Fann à Dakar.

We conducted a study to evaluate the efficacy and tolerance of the tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving TDF-3TC-EFV combination between 2007 and 2011. Collected data was analysed using EpiInfo™ version 6.04. One hundred patients were included, with an average follow-up duration of 27 months and 19 days (± 21 months and 14 days).We observed an average increase in body weight of about 8 kg per annum, with an average rise in CD4 count of 100/mm(3) by the end of the second year. A reduction in viral load with 71% of patients in therapeutic success at 24 month of treatment was noted. Ninety-two patients presented with at least one side effect, mostly being Grade 1 or 2 (96.36%). Neurological (24 patients) and digestive (20 patients) complaints comprised the commonest reported side effects. Four patients had adverse effects severe enough to warrant a change in treatment regimen, principally due to renal insufficiency. Thirteen subjects died. Patients receiving TDF-3TC-EVF combination therapy need rigorous surveillance because this combination, although efficient, is not without significant adverse effects.

[Human rabies: diagnostic pitfalls]. / La rage humaine, un diagnostic parfois difficile.

The purpose of this report is to describe two cases of human rabies in Senegal that illustrate possible diagnostic and therapeutic pitfalls even in an endemic area. Although outcome is almost always fatal and interhuman transmission is uncommon, prompt diagnosis of rabies is important since delay increases the risk of exposure to the virus for the entourage.

[Maternal tetanus in Dakar from 2000 to 2007]. / Tétanos maternel à Dakar de 2000 à 2007.

The objective of this study conducted between January 2000 and December 2007 was to assess the current epidemiological, clinical and outcome features of maternal tetanus (MT) observed in the Infectious Diseases Clinic of Fann University Hospital in Dakar, Senegal. A total of 1156 patients were admitted for tetanus during this period including 9 (0.8%) presenting MT. A progressive decrease in the annual number of MT cases was observed. The mean age of MT patients was 28.3 years [range, 18 to 40 years]. Most cases (n=6) involved persons living in suburban areas, as did tetanus in women of childbearing age (WCBA) (51.9% of 129 cases) and in neonates (63.1% of 103 cases) admitted during the same period. All patients had fallen behind the vaccination schedule. Septic abortion (n=7) was the main etiological factor. Although tetanus was graded as moderate in 8 patients (Mollaret stage 2), the death rate was high (44.4%) due to infectious and obstetric complications. This rate was similar to that associated with tetanus in newborns (48.5%), but higher than that associated with tetanus in WCBA (25.6%). The incidence of life-threatening MT is declining in the Infectious Diseases Clinic of Fann University Hospital in Dakar. A systematic immunization program along with campaigns to prevent unwanted pregnancy in women of childbearing age will be needed to eliminate maternal and newborn tetanus in Dakar.

[Tetanus in women of childbearing age at the infectious diseases clinic in Dakar]. / Le tétanos de la femme en age de procréer a la clinique des maladies infectieuses de Dakar.

The objective of this article was to describe the epidemiological and outcome features of tetanus in the woman of childbearing age (WCBAT) and compare them with neonatal tetanus (NT) and other tetanus cases in a hospital department in Dakar from 1998 to 2007. A retrospective study was conducted using the files of WCBAT (15 to 49 years old), NT (3 to 28 days old) and other tetanus cases admitted at the Infectious Diseases Clinic, in Fann University Hospital, from 1998 to 2007. 1484 cases of tetanus were admitted in 10 years, with 176 cases of tetanus of WCBAT (11.8%) and 178 cases of NT (11.9%). In comparison with WCBAT the NT annual hospital rate significantly decreased during the study period whereas other tetanus cases rate remained stable. The average age of WCBAT was 26.1 year old and 57.9% were between 15 and 25 years old. The geographical origin was identical for all patients, with more than 71% coming from suburban areas. Most of the WCBAT cases were housewives (50.9%), single women (75%) without updated tetanus immunization (92%). The main portals of entry of WCBAT were injuries and wounds (67.4%) and maternal tetanus cases were rare (8%), mainly post-abortum. At admission, WCBAT cases were less severe than NT cases but more severe than other tetanus cases. The lethality rate of WCBAT cases (28.4%) was significantly lower than NT cases (50%, p = 0.00003), but higher than the other tetanus cases (22.2%; NS). Prognostic factors were: non-identified or intramuscular injection portal of entry and a Mollaret state III at admission. An intensification of the extended immunization program associated with supplementary immunization campaigns targeting women of child bearing age in high risk districts, are necessary to eradicate neonatal and maternal tetanus in Dakar.

[Late diagnosis of HIV infection in the Fann, Dakar clinic of infectious diseases: testing circumstances, therapeutic course of patients, and determining factors]. / Dépistage tardif de l'infection à VIH à la clinique des maladies infectieuses de Fann, Dakar: circonstances de diagnostic, itinéraire thérapeutique des patients et facteurs déterminants.

BACKGROUND AND METHODOLOGY: The delay in the diagnosis of HIV infection is a major obstacle to optimal care for this disease. To deal with this problem, we conducted this study among newly diagnosed HIV patients hospitalized in the Fann University Hospital Infectious Diseases Clinic in Dakar. The epidemiological, clinical, biological and outcome aspects are described and patient history reviewed. A qualitative socio-anthropological study was made to understand and describe the logic of the decision processes in the patient's search for treatment. RESULTS: One hundred patients were included, with a mean age of 39.5+/-11.1 years and a sex-ratio: 1.08. The transmission was mainly heterosexual (90%), and chronic diarrhea (64%) and/or chronic cough (66%) were the principal symptoms leading to diagnosis. The mean delay before diagnosis was 5+/-4.27 months. The major opportunistic diseases were tuberculosis (44 cases) and infectious diarrhea (23 cases). Most patients were diagnosed at the AIDS stage (97%) and the death rate was 30% among hospitalized patients after admission. Sixty-eight percent of patients had consulted at least three times, generally a "traditional practitioner", at first and 43% had been hospitalized at least once. The qualitative investigation revealed that the "representation" or the "feeling of severity" of the disease were the principal justifications for consulting the "traditional practitioner" or the physician, respectively. CONCLUSION: Better information for health workers and global population is necessary for an earlier diagnosis of HIV infection in Dakar.

[Post-circumcision tetanus in Dakar, Senegal]. / Le tétanos post-circoncision a Dakar, Sénégal.

This study aimed at describing the epidemiology, clinical features and prognosis of post-circumcision tetanus at the infectious diseases clinic in Fann Hospital in Dakar. Data were collected retrospectively for analysis from patients' files recorded from January 1, 1999 to December 31, 2006. 54 cases were included, accounting for 4% of all tetanus cases admitted to the clinic during the study period (54 cases/1291). The patients' average age was 9 +/- 3.7 years old (range = 1-17 years) and 52% of them were schoolboys. In most cases (76%), tetanus symptoms occurred beyond 7 days after circumcision. The average delay from onset of the disease to admission was 2.3 days (range = 0-6 days). The circumcision took place at home in 39% of cases, in health center in 35% of cases and in unspecified area in 26% of cases. The majority of patients (85%) had never received tetanus vaccine and, in 72% of the cases, the circumciser was designated as a male nurse. Generalized tetanus was observed in all cases, most of which was a mild form of the disease (63%). During hospitalisation, thirteen patients (24%) had complications among which diaphragmatic and intercostal muscle spasms (3 cases), bacteraemia (5 cases), respiratory infection (4 cases), urinary tract infection (4 cases), and fracture of the vertebrae (1 case). The case fatality rate was 7.4% (4 deaths). Vaccination together with health education of the population as well as a better sensitization of the practitioners are necessary to eradicate tetanus after circumcision.

[Cholera in Senegal from 2004 to 2006: lessons learned from successive outbreaks]. / Le choléra au Senegal de 2004 à 2006: les enseignements d'épidémies successives.

Between October 2004 and March 2006, a series of cholera outbreaks occurred in the West African nation of Senegal. The purpose of this study was to describe and analyze these outbreaks as a basis for prevention and control. A total of 29556 cases were reported during the 18-month epidemic. The attack rate ranged from 0.6 to 100 per 10(4) inhabitants depending on region. The epidemic unfolded in three phases. The first phase (11 weeks) was promptly contained using basic control measures such as public information campaigns and environmental hygiene. The second and longest phase (12 months) was marked by two outbreaks caused by massive religious gatherings and severe flooding. Cities particularly the capital Dakar (25.5% of cases) and the religious district of Touba in the north (41.1% of cases) were most affected due to the many social and environmental problems related to poor urban infrastructure. The isolated strains of Vibrio cholerae O1, biotype El Tor, were susceptible to doxycycline and fluoroquinolones (100%) but resistant to cotrimoxazole (90.3%). The overall death rate was 1.38%. Unfavorable prognostic factors included age over 60 years, delayed treatment and severe dehydration at the time of admission. Despite lower mortality this cholera epidemic was more widespread and longer than the previous outbreaks in Senegal and was associated with a trend to endemicity in urban areas.

[Adult purulent meningitis caused by Streptococcus pneumoniae in Dakar, Senegal]. / Les méningites purulentes à Streptococcus pneumoniae de l'adulte à Dakar.

The purpose of this retrospective study was to describe epidemiological, clinical, bacteriological and outcome features of purulent meningitis caused by Streptococcus pneumoniae in adult patients hospitalized in the infectious diseases clinic of the Fann University Hospital in Dakar, Senegal from 1995 to 2004. A total of 73 cases of pneumococcal meningitis were recorded during the study period. Streptococcus pneumoniae was the second cause of purulent meningitis after meningococcal infection. Sickle-cell disease (n=3) and HIV infection (n=9) were the main underlying factors and pneumonia was the main portal of entry into the CNS (51.8%). Coma was a frequent complication (61.6%). Penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) accounted for 27.3% of isolated strains. However strains were sensitive to third-generation cephalosporin (100%) and chloramphenicol (68.2%) which were the most frequently used antibiotics. The mortality rate was 69.8% and neurological complications occurred in 13.7% of patients. The main unfavorable prognostic factors were cardiovascular collapse and/or coma at the time of admission and detection of pneumococcal strains by direct examination of CSF. The high mortality of pneumococcal meningitis in adult patients in Dakar shows the need to improve intensive care facilities and the growing incidence of PNSP underlines the requirement for better control of antibiotic prescription.

[Prevalence of nosocomial infections in a university hospital (Dakar, Senegal)]. / Résultats de l'enquête de prévalence des infections nosocomiales au CHNU de Fann (Dakar, Sénégal).

UNLABELLED: Nosocomial infections constitute today a great public health problem that is still ignored or poorly mastered in our health institutions. METHOD: A prevalence study initiated by the CLIN (committee for the prevention of nosocomial infections) was recently conducted at the Fann teaching hospital. A questionnaire was prepared and submitted to all patients that were hospitalized on the day of the study; the questionnaire allowed gathering a lot of information on exposure factors and clinical and microbiological arguments in favor of nosocomial infections. RESULTS: One hundred and seventy-five patients (59.9% of all available beds) participated in the study. Nosocomial infections were found mostly among people between 20 and 44 years of age and predominantly in women. Fifty-eight percent of those cases were found in the neurology unit. The infections were mostly urinary (40%) and pulmonary (25%). The germs responsible were multiresistant bacteria: Enterobacter cloacae secreting broad-spectrum betalactamase, methicillinresistant Staphylococcus aureus, and Pseudomonas aeruginosa. The infected patients were usually under antibiotic treatment (80%) with various protocols, mainly monotherapy. The antibiotics used were betalactams, fluoroquinolones, and nitroimidazoles.

[Hand washing at Fann hospital: investigation among health workers]. / Lavage des mains au chnu de Fann: enquête auprès du personnel de soins.

INTRODUCTION: Handwashing is usually neglected in hospital settings. The objective of this study was to draw attention of health workers in Fann hospital as part of the prevention of hospital-acquired infections. MATERIALS AND METHODS: This study was carried out prospectively from April 26h to May 25th. An anonymous questionnaire was administered by 20 formed investigators to health workers, along with an inventory of available resources for hand washing in the study site allowing to collect the data by interview. RESULTS: A total of 256 health workers were investigated. The mean age was 35.3 +/- 9.4 years [range = 20-71] with a sex ratio of 0.62. As for the education level, the secondary and university predominated. The concept of Manu carrying was ignored by 59.3% of the personnel. This proportion was higher among people with low education level. Possibility of resident and transitional floras in the hand was ignored by most of the investigated personnel. The hand washing technique to be applied while putting vesicle probe was ignored by 59% of the personnel, and 34% declared using hand towel to dry hands. Half of the personnel ignored that bread soap was not recommended. The availability of hydro alcoholic solutions was variable according to the hospital wards. The lavabo/bed ratio was 1/7 and was unacceptable. CONCLUSION: In Fann hospital, the importance and the techniques of hand washing are not well known, that's why a training of the hospital's Personnel and an improvement of resources for handwashing are necessary for a good hospital's hygiene.

[The point on human rabies in Senegal from 1986 to 2005]. / Le point sur la rage humaine au Sénégal de 1986 à 2005.

Between 1986 and 2005, 54 patients were hospitalized for rabies in the infectious diseases clinic, with an average of 3 cases a year. The patients came from almost all regions of Senegal, Dakar (11 cases), Thiès (9 cases), and Fatick (9 cases). They were native of rural and suburban zones. The median age was 19 years (range 5-72). Children and teenagers between 5 and 15 years of age were the most concerned (53.7%). Stray dogs were the main vector (75% of cases) but a case of bite by a puppy and a case of bite by a jackal were noted. Bites were mostly located in limb extremities (98%). Only 12 patients consulted a health institution after the bite and among these cases, 4 were referred to the Dakar Pasteur Institute but consulted late. Incubation was 45 days on average (range 25 to 90 days). All our patients presented a furious form of rabies. The average duration of hospital stay was 6 days (range 1-15 days). The local investigation proved an under reporting of cases in a proportion of 1 case reported for 4 non-reported cases.

[Cholera and pregnancy: epidemiological, clinical, and evolutionary aspects]. / Choléra et grossesse: aspects épidémiologiques, cliniques et évolutifs.

OBJECTIVES: This descriptive study had for objective to describe the epidemiological, clinical, therapeutic, and evolutionary aspects of the association cholera and pregnancy during the cholera epidemic in Senegal in 2004 and 2005. MATERIAL AND METHOD: We analyzed the files of pregnant women admitted in the infectious diseases department of the Fann national University Hospital for suspicion of cholera, from October 11, 2004 to December 31, 2005. RESULTS: Fifty-two pregnant women were hospitalized and accounted for 1.76% of the patients admitted for cholera in the department. They were an average of 24+/-4.9 years of age and came from the Dakar suburbs in 60% of cases. The source of contagion was food and/or water in 70% of cases. These patients contracted the disease during the summer term of the pregnancy in 31% of cases. Clinically, they presented with a typical choleriform syndrome in 90% of cases, emesis in 100% of cases, and severe dehydration in 27% of cases. The coproculture for 14 women was positive for Vibrio cholerae in 12 cases. For treatment, these patients benefited from intravenous rehydration in 75% of cases and antibiotherapy with doxycyclin 300 mg in unidose. The following complications were noted: 6 abortions, 2 premature childbirths, and a maternal death. CONCLUSION: The association cholera and pregnancy presents high risks for the fetus and for the mother, requiring a fast and adequate management.

[Interest of ambulatory simplified acute physiology score (ASAPS) applied to patients admitted in an intensive care unit of an infectious diseases unit in Dakar]. / Intérêt de l'indice de gravité simplifié ambulatoire (IGSA) appliqué à des patients admis dans l'unité de soins intensifs (USI) d'un service de pathologie infectieuse à Dakar.

The evaluation of patients by a scale of gravity allows a better categorization of patients admitted in intensive care unit (ICU). Our study had for objective to estimate interest of Ambulatory Simplified Acute Physiologic Score (ASAPS) applied to patients admitted in ICU of infectious diseases department of FANN hospital. It was about a descriptive and analytical retrospective study, made from the data found in patients' files admitted into the USI infectious diseases department of FANN hospital in Dakar, from January 1(st), 2009 till December 31st, 2009.The data of 354 patients' files were analyzed. The sex-ratio was 1.77 with an average age of 37.6 years ± 19.4 years old [5-94 years]. The majority of the patients were unemployed paid (39.6%). The most frequent failures were the following ones: neurological (80.5%), cardio-respiratory (16.7%). The average duration of stay was 6.2 days ± 8.2 days going of less than 24 hours to more than 10 weeks. The deaths arose much more at night (53.1%) than in the daytime (46.9%) and the strongest rate of death was recorded in January (61.5%), most low in October (26.7%). The global mortality was 48.3%. The rate of lethality according to the highest main diagnosis was allocated to the AIDS (80.5%). The average ambulatory simplified acute physiology score was 5.3 ± 3.6 with extremes of 0 and 18. The deaths in our series increased with this index (p = 0.000005). The female patients had a rate of lethality higher than that of the men people, 55.5% against 44.2% (p = 0.03). In spite of a predictive score of a high survival (ASAPS < 8), certain number of patients died (n = 105) that is 61.4% of the deaths. The metabolic disturbances, hyperleukocytosis or leukopenia when realised, the presence of a chronic disease, seemed also to influence this lethality. ASAPS only, although interesting, would not good estimate the gravity of patients, where from the necessity thus of a minimum biological balance sheet. It seems better adapted for patients with a high value (ASAPS≥8). This score when it is low, is not correlated, in our study, at a high survival rate as waited in this population.

[Bacterial diversity during the cholera epidemic in Dakar, Senegal (1995-1996)]. / Diversité bactérienne au cours de l'épidémie de choléra à Dakar, Sénégal (1995-1996).

Vibrio cholerae O:1, serotype Ogawa and biotype El Tor (76.1%) was responsible of the outbreak of cholera in Dakar, Senegal (1995-1996). However, other bacteria were isolated, particularly Vibrio cholerae non O:1/non O:139, Vibrio fluvialis, Vibrio alginolyticus. Vibrio parahaemolyticus, Salmonella sp.p, Shigella sp.p (23.9%). The Vibrio cholerae O:1 strains are multiresistant to sulfonamide, cotrimoxazole and chloramphenicol. 97% were also resistant to O/129 compound. Fluoroquinolone and 3rd generation cephalosporins were the more efficient antibiotics (100%).

[Methicillin-resistant Staphylococcus aureus in Dakar]. / Staphylococcus aureus résistants à la méticilline à Dakar.

This study was carried out at the Fann University Hospital Center in Dakar, Senegal between 1994 and 1996. The purpose was to assess the prevalence of methicillin-resistant Staphylococcus aureus and to propose alternative treatments. A total of 149 stains of Staphylococcus aureus were isolated from a variety of clinical specimens. Sensitivity to various antibiotics was tested by the disc diffusion technique (anti-biogram). Resistance to methicillin was evaluated by the oxacillin disc diffusion technique on Mueller-Hinton agar containing 5% NaCl. The prevalence of methicillin resistance was 66.4%. All strains of Staphylococcus aureus were sensitive to vancomycin. Other highly effective antibiotics included fucidic acid (94%), aminoglycosides (91%), cotrimoxazol (89.6%), and norfloxacin (84.5%). Most strains (70.6%) presented a wide profile against macrolides and related groups. The LSa phenotype (resistance to lincosamines and streptogramines) was the predominant resistant phenotype. The results of this study indicate that the prevalence of methicillin-resistant Staphylococcus aureus is increasing in Senegal. Since these strains respond well to chloramphenicol and cotrimoxazole, clinicians are advised to use these drugs as an alternative first-line treatment.

[Clinical, bacteriological and therapeutic aspects of meningococcal meningitis in Dakar in 1999]. / Aspects cliniques, bacteriologiques et therapeutiques des meningites cerebro-spinales a Dakar en 1999.

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

[Tetanus: epidemiological aspects at the Infectious Disease Clinics at the Fann University Hospital Center in Dakar]. / Le tétanos: aspects épidémiologiques à la Clinique des Maladies Infectieuses du CHU de Fann à Dakar.

This retrospective study was carried out to assess the recent epidemiological aspects of tetanus in Senegal. Based on the records of tetanus cases admitted at the Infectious Diseases Clinic in Dakar over a 7-year periode (1990-1996), this study showed that tetanus is still a major public health concern in Senegal. A global prevalence rate of 18.8% was found. Portals of entry were noticed to be: dirty wounds (48%), the umbilical stumps (19%), non sterile intra-muscular injections (4.5%), surgery (3.3%) and traditional practices (4.2%). Nevertheless, in a high proportion of cases (13.3%), the portal of entry was not found. A 30.3% case fatality rate was observed, that varied significantly according to portals of entry, reaching 60.4% in umbilical tetanus. It is recommended here that the immunization programme against tetanus be reinforced and supported by I E C Strategies together with retraining of medical personnel.

[Place and resistance of epidemic strains of Shigella dysenteriae-1 isolated at the Fann Hospital from 1995 to 1999]. / Place et résistance de souches épidémiques de Shigella dysenteriae-1 isolées au Chu de Fann de 1995 a 1999.

Shigella dysenteriae-1 (S.d-1) takes a more and more important place in intertropical countries, with multiresistant strains to antibiotics. the objectives of the study is to determine the prevalence of S.d-1 among bacterial isolations at Fann Hospital at Dakar, and to identify the resistant profiles of the strains. This retrospective study was conducted on the strains isolated between 1995 and 1999 by examination of faeces for bacterial pathogens. the susceptibility of the strains to antibiotics was studied by disc diffusion test with Mueller Hinton agar, and detection of extended broad spectrum beta-lactamase. Shigella dysenteriae-1 represented 45.18 % of Shigella strains and was particularly isolated in winter season (from August to September), more frequently in men (sex ratio: 2 / 1). Among the strains, 72 % were resistant to beta-lactams, and the ratio of multiresistant strains represented 42 %, concerning cotrimoxazol, chloramphenicol, tetracyclin and aminopenicillins. Only one strain produced extended broad spectrum beta-lactamase. Quinolons were the most active antibiotics but have to be used rationally.

[Nosocomial Klebsiella pneumoniae infections at the Fann University Hospital Center, Dakar]. / Infections nosocomiales à Klebsiella pneumoniae au CHU de Fann, Dakar.

Twenty one (21) strains of Klebsiella pneumoniae are isolated from patients hospitalized since 48 hours for neurological affections, and from medical staff hands. Eighteen (18) other strains isolated from other clinics were studied for comparison. The identification used API20 E system (BioMérieux), and the susceptibility to antibiotics was tested by disc diffusion test (antibiogram). Production of extended-spectrum beta-lactamase was studied by synergy test method. Arbitrarily primed Polymerase Chain Reaction (AP-PCR) was used to compare the electrophoretic profiles of the strains. Nosocomial strains are more resistant than the other: 57.14% vs 16.67% (p = 0.02) and 28.57% among them are extended-spectrum beta-lactamase positive. Amikacin (87.5%) and Ciprofloxacin (100%) are the most efficient antibiotics, when Cotrimoxazole inhibits 31.25% of the strains. The electrophoretic profiles show an important diversity of strains and suggest an external contamination.

[Tetanus osteoarticular complications in Dakar]. / Les complications ostéo-articulaires du tétanos à Dakar.

To assess the epidemiological and clinical features of osteoarticular symptoms during tetanus infection, we carried out a retrospective study in infectious Diseases Ward of the University Teaching Hospital in Dakar (Senegal). Over a period of 7 years (1990-1996), 1, 199 cases of tetanus of more than 1 month of age were diagnosed. Among those who survived (n = 948), 18 cases of osteo-articular manifestations were observed (1.8%): 15 presented with vertebral fracture located within the thoracical part T4-T8 (83.3%) while 3 patients had para-articular osteoma in the elbows (16.7%). These complications occurred on stage II (89%) and stage III (11%) of Mollaret's classification of tetanus infection. Males were more represented than females (sex-ratio = 5) and the median age was 13 years (range = 6-45 years). The mean hospitalisation duration was significantly higher for patients with para-articular osteoma (6 weeks) than for those with vertebral fracture (3 weeks). No major functional impairment was noticed during hospitalisation and patients required only physiotherapy and clinical and radiological surveillance. Although not frequent and of some little functional consequence, osteoarticular complications of tetanus, should invite to improve the antitetanic immunization strategies in developing countries.