Influence of Age on the Clinical and Prognostic Features of Tetanus in Mali

M. Kaboré, I. Konaté, Y. Cissoko, J. Dembélé, M. Soumaré, A. Fofana, D. Sogoba, O. Magassouba, H. Meli, Abdoulaye Zaré, Mohamed Cissé, B. Coulibaly, H. Issa, Fodé Kouyaté, J. Dembele, S. Dao
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Abstract

Background: The regression of post-vaccination immunity with age exposes elderly subjects to certain infectious diseases, in particular tetanus. The aim was to compare the clinical and prognostic features of tetanus according to the age of patients. Methodology: Analytical study of the files of patients hospitalized for tetanus in the Infectious Diseases Department at Point “G” University Teaching Hospital from 2013 to 2019 with retrospective collection. According to age, three groups of patients were formed: group I (<18 years), group II (18 - 59 years) and group III (≥60 years). The study variables were socio-demographic, clinical and prognostic. The One-way ANOVA and Chi-square statistical tests were applied with a significance level p = 0.05. Results: In total, 202 cases of tetanus were recorded or 7.3% of admissions. The mean age was 41.9 ± 15.6 years (range, 6 and 85 years) with a sex ratio of 19.2. According to the age grouping, group II was predominant (79.2%) followed by group III (14.9%) with respective mean ages of 39.2 ± 10.6 and 67.3 ± 6.5 and sex ratio of 39 and 29. Workers (33.3%), farmers (25.8%), traders (19.7%) and drivers (7.1%) represented the most important occupations most at risk. Clinically, bad general condition (p < 0.001), trismus (p = 0.001), dysphagia (p = 0.009) and complications during hospitalization (p = 0.028) were seen more frequently in group III patients compared to younger ones. From a prognostic point of view, patients in group III were at greater risk to develop a severe form of tetanus (p = 0.021) with higher mortality compared to other age groups (p < 0.001). Conclusion: Tetanus is more prevalent in men. Complications and mortality increase with age. It is important to include booster immunization of adults in existing national programs in order to reduce disease-related morbidity and mortality in this age group.
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年龄对马里破伤风临床及预后特征的影响
背景:随着年龄的增长,疫苗接种后免疫力的回归使老年人暴露于某些传染病,特别是破伤风。目的是根据患者的年龄比较破伤风的临床和预后特征。方法:对2013 - 2019年G点大学教学医院感染性疾病科收治的破伤风患者档案进行回顾性收集分析。根据患者年龄分为三组:I组(<18岁)、II组(18 ~ 59岁)和III组(≥60岁)。研究变量包括社会人口学、临床和预后。采用单因素方差分析和卡方统计检验,显著性水平p = 0.05。结果:本院共收治破伤风202例,占入院率的7.3%。平均年龄41.9±15.6岁(范围6 ~ 85岁),性别比19.2。按年龄分,以II组(79.2%)居多,其次为III组(14.9%),平均年龄分别为39.2±10.6和67.3±6.5,性别比分别为39和29。工人(33.3%)、农民(25.8%)、贸易商(19.7%)和司机(7.1%)是最重要的高危职业。临床中,III组患者一般状况不良(p < 0.001)、唇腭裂(p = 0.001)、吞咽困难(p = 0.009)和住院期间并发症(p = 0.028)发生率高于年轻组。从预后角度来看,与其他年龄组相比,III组患者发生严重破伤风的风险更大(p = 0.021),死亡率更高(p < 0.001)。结论:破伤风以男性为主。并发症和死亡率随年龄增长而增加。重要的是,在现有的国家规划中纳入成人加强免疫,以减少这一年龄组的疾病相关发病率和死亡率。
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