[Tetanus: a serious toxic infection still present in southern Tunisia]

Although there has been a significant decline in tetanus cases thanks to vaccination, it remains a public health problem, particularly in developing countries. The epidemiology of tetanus in Tunisia has not been updated in over 20 years. Our study aims to examine the epidemiological, clinical, paraclinical, therapeutic, and evolutionary characteristics of patients with severe tetanus in intensive care.

This retrospective study was conducted in the multi-purpose intensive care unit at Habib Bourguiba University Hospital in Sfax. It spanned 19 years. We included all suspected cases of severe tetanus according to the WHO definition, which includes trismus and/or generalized contractures and/or paroxysms in an unvaccinated or poorly vaccinated patient.

Sixteen patients were included. The frequency was 0.84 cases per year, and the patients' average age was 61.6 ± 10.1 years. There was a predominance of males, with a sex ratio of 2.2. Half of the patients were manual laborers who worked in rural areas during the hot seasons. The most common symptom was a skin wound with traumatic inoculation in the lower limbs (10 patients), with 14 patients presenting with this symptom. None of the patients had been vaccinated. According to Ablett's classification, half of our patients had severe or very severe forms of the disease. All patients had generalized tetanus with trismus, neck stiffness, dysphagia, and generalized muscle contractures. Thirteen patients experienced paroxysms, and fourteen had dysautonomic disorders, the most common of which were tachycardia episodes (six patients). Fifteen patients required mechanical ventilation, with an average duration of 24.9 ± 15.8 days. The total length of stay was 29.7 ± 16.5 days, and five patients died during hospitalization.

Despite advances in intensive care in Tunisia, tetanus remains a serious disease with high morbidity and mortality rates. Prevention is the most effective way to eradicate it.