title: [Tetanus in Ho Chi Minh City, Vietnam: epidemiological, clinical and outcome features of 389 cases at the Hospital for Tropical Diseases].
abstract: The objective of this study is to describe the different aspects of tetanus during the past recent years in southern Vietnam: epidemiology, clinical picture, management, and death risk factors. It is a retrospective study concerning 389 cases admitted in 2007 and 2008 at the reference Hospital for Tropical Diseases in Ho Chi Minh City. 93% of all cases were generalized tetanus, and 50% were severe cases. A majority of patients were adult males (medium age 43, M/ F sex-ratio 2.9). Half of them underwent tracheotomy and 39% assisted ventilation. Case fatality rate was 6.4%, the lowest reported rate worldwide in the last ten years. Fatalities resulted mainly from neuro-vegetative disorders, essentially cardiogenic shock (28% of all deaths) [OR = 16.95; p < 0.001], sepsis (24%) [OR = 3.25; (p < 0,114], and acute renal failure (16%) [OR = 7,22; p < 0.004]. Age over 60-year [OR = 4.53; p < 0.0001] and a leukocyte count>12.000/mm(3) [OR = 2.32; p < 0.020] were significantly associated with fatal outcome, contrarily to incubation and extension phase durations, or delayed serum administration. Systematic extension of vaccination to all adult males, and improved access to post exposure sero-immunization at all levels of health centres throughout the country may further reduce tetanus burden in Vietnam.
authors.affiliation: Institut de la francophonie pour la médecine tropicale, Rue Samsènethai, BP 9519, Vientiane, Laos.
authors.forename: V T
authors.initials: VT
authors.lastname: An
authors.affiliation: Université de médecine et de pharmacie de Haiphong, 72A, Nguyen Binh Khiem, Ngo Quyen, Hai Phong, Vietnam. pmkhue@hpmu.edu.vn.
authors.forename: P M
authors.initials: PM
authors.lastname: Khue
authors.affiliation: Hôpital des maladies tropicales 190, Ben Ham Tu, Quartier 1, Dist. 5, Hô-Chi-Minh-Ville, Vietnam.
authors.forename: L M
authors.initials: LM
authors.lastname: Yen
authors.affiliation: Hôpital des maladies tropicales 190, Ben Ham Tu, Quartier 1, Dist. 5, Hô-Chi-Minh-Ville, Vietnam.
authors.forename: N D
authors.initials: ND
authors.lastname: Phong
authors.affiliation: Institut de la francophonie pour la médecine tropicale, Rue Samsènethai, BP 9519, Vientiane, Laos.
authors.forename: M
authors.initials: M
authors.lastname: Strobel
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality; D000328:Adult; D003017:Clostridium tetani / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007408:Intestinal Absorption; D007422:Intestines / Q000382:microbiology; D008297:Male; D008666:Metalloendopeptidases / Q000493:pharmacokinetics; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D013742:Tetanus / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D013744:Tetanus Toxin / Q000493:pharmacokinetics; D014140:Tracheotomy; D016896:Treatment Outcome; D014744:Vietnam / Q000453:epidemiology; D014946:Wound Infection / Q000453:epidemiology
chemical_list: D013744:Tetanus Toxin; C035979:tetanospasmin; D008666:Metalloendopeptidases
keywords: Clostridium tetani; Ho Chi Minh City; Hospital; South East Asia; Tetanus; Vietnam