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Zegeye AF, Tamir TT, Mekonen EG, Ali MS, Gonete AT, Techane MA, Wassie M, Kassie AT, Ahmed MA, Tsega SS, Wassie YA, Tekeba B, Workneh BS. Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression. Hum Vaccin Immunother 2024; 20:2352905. [PMID: 38772729 PMCID: PMC11110706 DOI: 10.1080/21645515.2024.2352905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/04/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND In low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries. METHODS Data from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study. RESULTS In low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women. CONCLUSIONS AND RECOMMENDATIONS This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Medina Abdela Ahmed
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Abebaw Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Wakatsuki M, Yamamoto K, Kawashima A, Sakurai A, Kurokawa M, Mizushima R, Okumura N, Yamada G, Nomoto H, Ohmagari N. Autopsy of tetanus with foot gangrene as portal of entry. J Infect Chemother 2024; 30:450-453. [PMID: 37944699 DOI: 10.1016/j.jiac.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/26/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
Non-traumatic chronic skin lesions are the second most common cause of tetanus. Herein, we describe an 85-year-old woman who presented with a chronically infected skin lesion. She developed tetanus while in hospital and died of respiratory failure, after refusing mechanical ventilation. Routine immunization against tetanus began in Japan during 1968; hence many people born before 1968 are unvaccinated. Mortality due to tetanus is high and the proportion with protective antibodies is low in older adults. Therefore, we recommend tetanus vaccination for older persons in Japan who have chronic skin lesions and have never been vaccinated.
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Affiliation(s)
- Miyu Wakatsuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Akira Kawashima
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Ayana Sakurai
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Masami Kurokawa
- Clinical Laboratory, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Ryo Mizushima
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Nobumasa Okumura
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Gen Yamada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Hidetoshi Nomoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Do patients with diabetic foot ulcer need booster dose of tetanus vaccine? J Diabetes Metab Disord 2022; 21:1023-1027. [PMID: 35673424 PMCID: PMC9167406 DOI: 10.1007/s40200-021-00966-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
Purpose Diabetic foot ulcer is a public health concern around the world. These wounds are prone to a variety of infections including Clostridium Tetani that may lead to tetanus. The aim of this study was to evaluate the immunity status as a result of tetanus vaccination and other preventive measures in these patients. Methods We conducted a narrative review of previous studies which were related to the risk of tetanus infection in diabetic foot patients by searching electronic databases. Results It was found that usually tetanus antibody titers in diabetic patients are below the protective level and they are not appropriately vaccinated. Therefore, diabetes and lack of immunity, put diabetic foot ulcer patients more at risk of tetanus. But this problem is not given serious attention in diabetes care. Conclusions Thus, it is recommended to provide specific guidelines for tetanus vaccination and prophylaxis in diabetic patients. These recommendations can play a vital role in the prevention of diabetic foot ulcers complication.
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Carvalho LCD, Marques CPC, Rodrigues VP. Temporal trends in tetanus incidence and lethality in Brazil: analysis of the national database from 2009 to 2018. Rev Assoc Med Bras (1992) 2021; 67:1804-1809. [PMID: 34909953 DOI: 10.1590/1806-9282.20210736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the epidemiological and hospital characteristics of cases and deaths due to accidental tetanus in Brazil. METHODS A time-series study with secondary data extracted from the Department of Informatics of the Brazilian Unified Health System. The time series were evaluated by linear regression parameters, considering a significance level of 1%. RESULTS A total of 2,772 cases were reported between 2009-2018. Predominant cases were men and aged between 40-59 years old, with incomplete 1st-4th grade. The lethality rate was found to be predominant in women, whites, illiterates, and those who aged above 80 years. The overall lethality was 32.5%. The incidence rate reduced from 1.6 in 2009 to 0.95 per million inhabitants in 2018, but lethality increased from 30.77-40.70%. The highest rate of incidence and lethality occurred in the elderly people and in the northern region. CONCLUSION The high cost and lethality of tetanus configure it as a public health problem. The demonstration of the epidemiology of patients who most evolve to death can help to contribute to a reduction in lethality, which shows an increase in the analysis period. Finally, special attention should be given to the elderly people and those living in the northern region.
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Nomura K, Sakawaki E, Sakawaki S, Yamaoka A, Aisaka W, Okamoto H, Takeyama Y, Uemura S, Narimatsu E. Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review. BMC Infect Dis 2021; 21:37. [PMID: 33413196 PMCID: PMC7792315 DOI: 10.1186/s12879-020-05739-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/26/2020] [Indexed: 11/11/2022] Open
Abstract
Background Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer. Case presentation An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient’s symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to. Conclusion This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient’s active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.
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Affiliation(s)
- Kazuhito Nomura
- Department of Emergency Medicine, Sapporo Medical University, Minami 1-jo, Nishi 16-chome, 291, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan.
| | - Eiji Sakawaki
- Department of Emergency Medicine, Hakodate Municipal Hospital, 1-chome 10-1, Minato-cho, Hakodate-shi, Hokkaido, 041-8680, Japan
| | - Sonoko Sakawaki
- Department of Emergency Medicine, Hakodate Municipal Hospital, 1-chome 10-1, Minato-cho, Hakodate-shi, Hokkaido, 041-8680, Japan
| | - Ayumu Yamaoka
- Department of Neurosurgery, Sunagawa City Medical Center, 3-chome1-1 Nishi 4-jo Kita, Sunagawa-shi, Hokkaido, 073-0196, Japan
| | - Wakiko Aisaka
- Department of Emergency Medicine, Sapporo Medical University, Minami 1-jo, Nishi 16-chome, 291, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Hiroyuki Okamoto
- Department of Emergency Medicine, Teine Keijinkai Hospital, 12-chome 1-40, Maeda 1-jo, Teine-ku, Sapporo-shi, Hokkaido, 006-0811, Japan
| | - Yoshihiro Takeyama
- Department of Emergency Medicine, Hakodate Municipal Hospital, 1-chome 10-1, Minato-cho, Hakodate-shi, Hokkaido, 041-8680, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University, Minami 1-jo, Nishi 16-chome, 291, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Minami 1-jo, Nishi 16-chome, 291, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
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Abstract
RATIONALE Tetanus is usually caused by wound infection with Clostridium tetani after acute injuries. Skin cancer wound is a rarely reported cause of tetani infection. It is difficult to be diagnosed and mistaken for other brain lesions. PATIENT CONCERNS A 49-year-old man presenting with the only symptom of repeated convulsions was admitted to our department. He had an ulcerated skin cancer on the right buttock that had been excised in another hospital 1 month before admission, leaving the wound unhealed. He was suspected of having a metastatic brain tumor early, but exhibited a negative cranial CT-scan. DIAGNOSIS Tetanus was diagnosed when he was observed to have sudden convulsions after sensory stimulation such as noise, light, or touch. INTERVENTIONS Despite administration of a high dose of diazepam and phenobarbitone, continuous generalized rigidity with laryngospasm still occurred. Instead, when propofol was intravenously infused, the spastic convulsion completely stopped. Tracheotomy and mechanical ventilation were performed. OUTCOMES The patient gradually recovered in 2 weeks. LESSONS Tetanus is rarely infected through the wound of an ulcerated skin cancer. Early diagnosis can only be based on accurate assessment of clinical manifestations, and propofol infusion appears to be more effective in anti-convulsion management for patients with tetanus. Routine vaccination to prevent tetanus in patients with ulcerated skin cancer should be considered in the future clinical work.
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Affiliation(s)
- Jin Wang
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Ying Yang
- Department of Pediatrics, Futian Women and Children Health Institute, Shenzhen, China
| | - Chao Yang
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Wen Lv
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Shihai Xu
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Fei Shi
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
| | - Aijun Shan
- Department of Emergency, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology
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Özdemir G, Yılmaz B, Kömür B, Şirin E, Karahan N, Ceyhan E. Treatment preferences in Turkey for open fracture of the tibial diaphysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:133-137. [PMID: 28131638 PMCID: PMC6197301 DOI: 10.1016/j.aott.2016.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 08/24/2016] [Accepted: 11/11/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate different treatment methods employed by orthopedic surgeons for open tibial fracture in adults. METHODS Survey of 12 questions regarding treatment of open tibial fracture was conducted with 285 orthopedics and traumatology specialists in Turkey in personal interviews and using web-based technique. RESULTS Of all survey participants, 99.6% responded that tetanus prophylaxis is necessary emergency procedure in cases of adult open tibial diaphysis fracture. In addition, 96.5% considered antibiotics administration necessary, 85.6% also selected irrigation with saline, 55.4% included debridement, and 45.3% temporary fixation. Only 4 (1.3%) respondents did not use aminoglycoside antibiotics. While 29.8% of those surveyed preferred external fixator as a definitive treatment method, 75.8% use intramedullary nail and 13.7% preferred plate method. CONCLUSION A wide variation was observed among orthopedics and traumatology specialists in Turkey regarding treatment of open tibial diaphysis fracture in adults. Data obtained from this study together with the available literature may be useful to further develop therapeutic approaches.
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Affiliation(s)
- Güzelali Özdemir
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Barış Yılmaz
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Baran Kömür
- Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Evrim Şirin
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Nazım Karahan
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Erman Ceyhan
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Tekin F, Sürmeli M, Çizmeci Z, Tekin Ö, Işik E, Taner ÖF, Ertuğrul DT. Is there any difference in tetanus IgG levels of diabetic patientswith respect to the presence of foot ulcers? Turk J Med Sci 2017; 47:34-39. [PMID: 28263513 DOI: 10.3906/sag-1511-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/21/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to reveal the tetanus immunization status of diabetic patients and to determine whether diabetic patients with foot ulcers have different TIG levels. MATERIALS AND METHODS A cross-sectional study was designed that included diabetic patients with foot ulcers (n = 30) and diabetic patients without ulcers (n = 30). The groups were compared for serum TIG levels along with total serum protein, albumin, C-reactive protein (CRP), and total immunoglobulin G (Ig G). RESULTS For diabetic patients without foot ulcers, 17 of 30 (56.6%) patients were found to have nonprotective TIG levels whereas for diabetic patients with foot ulcers, 28 of 30 (93.3%) patients were found to have nonprotective TIG levels. The mean value of TIG for diabetic patients without foot ulcers was 0.345 ± 0.281 IU/mL and for diabetic patients with foot ulcers the mean TIG value was 0.055 ± 0.033 IU/mL. Statistically significant differences were observed in TIG (P = 0.008), total protein (P < 0.001), albumin (P < 0.001), and CRP levels (P < 0.001) between the two groups. CONCLUSION The majority of the diabetic patients had low TIG levels and they were significantly lower in diabetic patients with ulcers. A booster dose of tetanus vaccine should be considered for diabetic patients with and without diabetic foot ulcers.
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Affiliation(s)
- Fatih Tekin
- Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Mehmet Sürmeli
- Department of Plastic and Reconstructive Surgery, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Zeynep Çizmeci
- Department of Microbiology and Clinical Microbiology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Özlem Tekin
- Department of Dermatology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Ergin Işik
- Department of Plastic and Reconstructive Surgery, Muş State Hospital, Muş, Turkey
| | - Ömer Faruk Taner
- Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Derun Taner Ertuğrul
- Department of Internal Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
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Diabetic foot infections: what have we learned in the last 30 years? Int J Infect Dis 2015; 40:81-91. [DOI: 10.1016/j.ijid.2015.09.023] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/29/2015] [Accepted: 09/30/2015] [Indexed: 12/21/2022] Open
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Nicolaï D, Farcet A, Molines C, Delalande G, Retornaz F. Évaluation du risque tétanique chez les sujets âgés en médecine ambulatoire : intérêt du « Tétanos Quick Stick® » ? Rev Med Interne 2015; 36:307-11. [DOI: 10.1016/j.revmed.2014.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 06/11/2014] [Accepted: 10/06/2014] [Indexed: 11/26/2022]
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Torrez PPQ, Quiroga MM, Said R, Abati PAM, França FOS. Tetanus after envenomations caused by freshwater stingrays. Toxicon 2015; 97:32-5. [PMID: 25576234 DOI: 10.1016/j.toxicon.2014.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
Injuries caused by freshwater stingray are common in several regions of South America, although they are underreported. The riverside inhabitants are the main victims in the Amazonian and Midwest regions of South America. The fishermen are injured mainly in the new focus of colonization of the rivers by freshwater stingrays. With the increasing population in these regions, where freshwater stingrays are found, there has been a significant increase in injuries within the general population. The highest increase occurred among tourists from other regions, where these animals are not known, when visiting these areas. The envenomations from the stingray causes prolonged and intense pain, both local and regionally. Generally these are associated with other local inflammatory manifestations, such as swelling and erythema. The injury often progresses to necrosis and it is considered potentially tetanogenic. A secondary infection is also a frequent local complication and most frequently is caused by Aeromonas species, usually Aeromonas hydrophila. Herein we report the first 2 cases of tetanus after freshwater stingray injuries: a 51-year-old men who had tetanus and recovered without sequel and the second a 67-year-old men who had severe tetanus and a deep, necrotizing soft-tissue infection with sepsis, septic shock and evolution to death.
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Affiliation(s)
- Pasesa P Q Torrez
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| | - Mariana M Quiroga
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Renato Said
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Paulo A M Abati
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Francisco O S França
- Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil; Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Boyanova L, Mitov I. Antibiotic resistance rates in causative agents of infections in diabetic patients: rising concerns. Expert Rev Anti Infect Ther 2013; 11:411-420. [DOI: 10.1586/eri.13.19] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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