Current Prognostic Factors of Tetanus in Abidjan: 2005-2014

Objective: To describe the epidemiological, clinical and prognosis aspects of tetanus in patients hospitalized at the Infectious and Tropical Diseases Unit of Treichville Teaching Hospital. Methods: A retrospective study of the medical records of all patients hospitalized between 2005 and 2014. The “Dakar prognosis score” was established on the basis of six parameters: incubation period, duration of invasion, site of entry, presence of paroxysms, body temperature and pulse rate. A logistic regression model was used to identify the factors associated with death. Results: Overall, 455 cases of tetanus were included, with a predominance of males (86%). Most patients lived in Abidjan (77%). A very high proportion of cases were generalized tetanus (96%), and 137 patients (30%) died. The factors associated with death were age >60 years (aOR 2.76; 95% CI 1.07 to 9.91), being a labourer (aOR 2.83 95% CI 1.07-9.39), a severe Dakar prognostic score (aOR 5.76; 95% CI 2.26-14.72), no intrathecal serotherapy (aOR = 15.6; 95% CI 5.40- 44.84), no penicillin-therapy (aOR 2.33; 95% CI 1.11-4.87) and the presence of complications (aOR 8.53, 95% CI 4.83-15.09). Conclusion: This study identifies a number of factors for a poor prognosis among patients with tetanus admitted to our hospital, indicating that measures to reduce morbidity and mortality due to tetanus should be strengthened and prevention improved in resource limited settings. The prognostic parameters in “the Dakar score” should therefore be adapted to the current epidemiological and clinical contexts in Cote d’Ivoire.