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Chronic ulcers and myasis as ports of entry for Clostridium tetani
J B Greco1, E Sacramento, J Tavares-Neto
1Bahia School of Medicine and Public Health, Hospital Couto Maia, School of Medicien, Federal University of Bahia, Salvador, Bahia, Brazil. greco@e-net.com.br
Insights
Tetanus infection can enter through chronic skin ulcers, especially in older adults with incomplete vaccination. Increased tetanus vaccination coverage is crucial for preventing severe outcomes in at-risk populations.
Area of Science:
- Infectious Diseases
- Public Health
- Immunology
Background:
- Tetanus immune status evaluation is not standard for patients with chronic ulcers or myiasis.
- Chronic skin lesions, including ulcers and sites of Tunga penetrans larvae extraction, serve as entry points for Clostridium tetani.
- Predisposing factors for tetanus in these cases include venous insufficiency, sickle cell anemia, Hansen's disease, malnutrition, diabetes mellitus, and trauma.
Purpose of the Study:
- To evaluate the role of chronic skin lesions as tetanus entry points.
- To assess tetanus vaccination status in patients with chronic ulcers.
- To highlight the need for improved tetanus prevention strategies.
Main Methods:
- Retrospective analysis of 858 tetanus patients at Hospital Couto Maia.
- Identification of cases where chronic ulcers or myiasis were the port of entry for Clostridium tetani.
- Review of patient demographics, predisposing factors, and vaccination history.
Main Results:
- Out of 858 tetanus patients, 25 cases (2.9%) had chronic skin ulcers or myiasis as the entry point.
- The majority of these 25 patients (68%) were over 40 years old.
- All 25 patients had incomplete or unknown tetanus toxoid vaccination histories.
- Over half (52%) of these patients died.
Conclusions:
- Tetanus prevention should be integrated into the management of chronic skin ulcer patients.
- There is a critical need to increase tetanus vaccination coverage, particularly among older adults.
- Current vaccination strategies require review to improve coverage across all age groups.
Abstract:
Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil) aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6), sickle cell anemia (n=2), Hansen s disease (n=1), malnutrition (n=1), diabetes mellitus (n=1), trauma (n=1) and unknown factors (n=7). In 6 other cases, in addition to the Hansen s disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68%) were over 40 years old (17/25) and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25), or had partially completed such a regimen, or did not give precise information (6/25). Among the same series studied, over half (52%) of the patients died (13/25). We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.
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