Les portes d’entrée tératogènes identifiées chez les tétaniques au centre hospitalier universitaire du point-g. Bamako. Mali

Abstract

Objective: To determine the frequency,the main types of tetanogenic EP, to describe their topography and to evaluate the progressive factors associated with them Patients and Method We conducted descriptive and cross-sectional study with retrospective collection to CHU du Point G over a period of 17 years. Study population consisted tetanus patient whose PED was found at admission.The analyzed variations were collected from complete and analysable hospital records.The expected significance threshold has been set at p<0,05. Results: we recorded 258 tetanus patients, 4,99% of hospitalizations. EP was found in 217 cases (84,10%) with a sex ratio (M/W)= 9,85 and an average age of 35,94=15,58 years. The majority occupations were manual workers (32,7%), peasants (25,8), pupils/students (10,1%) and housewives (5,1%) significant statistic in cases with EP not found (p=0,63).The main EPs were skin and mucosal injuries (65,4%), open fractures (10,6%), skin lesions (7,8%) and deep wounds (7,4%) . The most important anatomical sites were the lower limbs (62,2%), the upper limbs (26,3%), the head (5,5%), the uterus (2%). The generalized forms appeared more important with the anatomical seats located on the lower limbs and above with no statiscal difference as to the genesis of the clinical form (p=0,45). Hypertention (50%), malaria (28,6%) and one case of epilepsy were the major comorbidities noted in patients with PEBR and with no significant statistical difference with those with EP not found (p=0,97). The classically known EP risk factors were (42,1%) versus the other EP (42,5%) with p>0,05. Dakar’s poor prognosis scores were mostly noted in PEBR patients with 48,8% (score 2), 31,8% (score 3), 7,4% (scores 4), and 0,5 (scores 5 and 6) with a significant statistical difference (p=0,043). The overall lethality is 42,2%. Specifically 41,5% of deaths were noted in patients with PEBR versus EP not found (46,3%) with p=0,77. Conclusion: Tetanus remains a reality despite the availability of effective means of prevention. The implementation of good practices for the primary management of bacterial entry proteins was an important contribution to tetanus elimination strategies.