Focused tetanus:: a retrospective study of 12 cases.

Objective - This study had for aim to describe recent epidemiological aspects of focused tetanus, its clinical features, and its course in patients admitted to the Infectious Diseases Clinic, in the Fann Teaching Hospital, Dakar; from January 1990 to December 1996. Material and methods - We retrospectively evaluated patients hospitalised during the study period. Results - Twelve cases of focused tetanus were diagnosed, representing 0.85% of all tetanus cases and accounting for a prevalence rate of 0.15%. 58.3 percent of the patients were 20 years old or less. Skin injuries were the most common portal of entry (eight cases) with cephalic wounds as the most frequent (five cases). Other portals of entry were. intramuscular injections (two cases), denture trauma (one case), suppurative otitis (one case). None of the patients was reported to have completed a full course of tetanus toroid and only one of them had received tetanus antiserum after an injury. In all cases, the incubation period exceeded seven days. Seven cephalic tetanus cases were reported, out of which three presented with facial palsy including ophtalmoplegia in one case. The five remaining cases were initially confined to one limb. Only one death occurred (case fatality rate 8.3%). Conclusion - Growing public awareness, consolidation of the EPI program, and better patient care should further reduce tetanus-related morbidity and mortality. (C) 2000 Editions scientifiques et medicales Elsevier SAS.