Perfil clínico-epidemiológico dos casos de tétano acidental ocorridos em Ribeirão Preto, Estado de São Paulo, no período de 1990 a 2009

Abstract

INTRODUÇÃO: O tétano continua sendo um grave problema de saúde pública nos países em desenvolvimento. No Brasil, apesar dos avanços tecnológicos, não houve um decréscimo significativo da taxa de letalidade nos últimos anos. Nesta casuística, foram analisados dados clínicos e epidemiológicos dos pacientes diagnosticados em Ribeirão Preto, nas últimas duas décadas. MÉTODOS: Este é um estudo retrospectivo que analisou dados dos pacientes internados por tétano acidental no Hospital das Clínicas de Ribeirão Preto, entre 1990 e 2009. O diagnóstico do tétano foi realizado segundo critérios do Ministério da Saúde do Brasil. RESULTADOS: Onze (47,8%), casos positivos, dos 23 suspeitos de tétano, foram incluídos neste estudo. Não houve mortes, mas dois (18,2%) pacientes apresentaram déficit neurológico permanente. O indicador prognóstico Tetanus Severity Score variou entre 0 a 8 pontos. A mediana da permanência hospitalar foi de 17 dias, variando de 6 a 98 dias. A ausência de óbitos pode ser explicada pelo diagnóstico clinico precoce da doença com instituição imediata de terapia. CONCLUSÕES: Ribeirão Preto é uma área onde o tétano não é um relevante problema de saúde pública.

An Epidemiological Profile of Accidental Tetanus Cases in a Referral Hospital, 2007-2013

“…As the most common type of injury, perforation has been described in most of the cases studied, similar to other national studies [1,2]. It was also observed that the bruises and lacerations were gateways to the disease, corroborating data found in the southern region of the country [9].…”

“…Any solution of continuity with the presence of necrotic tissue, contaminated with soil, dust, and feces, favors the colonization of the bacterium after spore deposition, justifying the occurrence of cases resulting from burns, surgical wounds, infected abortion, dental caries and leg ulcers. The lower limbs were also the topography of the most affected wound, corroborating with other casuistics [1,2,7,9].…”

“…There is evidence that tetanus reaches a higher proportion of the most productive age group, and can be justified by the greater exposure of this group to traumatic injury, and there is a greater easiness of infection in the work exercise [7]. Also, the elderly population was affected by the disease significantly, reiterating the results found in other studies [2,4,9]. The risk of major involvement in this group is justified by the decrease in immunity, as levels of tetanus protective antibodies decrease with advancing age [12].…”

“…The results of this research point to a predominance of cases in males. Other similar Brazilian studies have shown that this part of the population is the most affected by the disease [1,2,4,7]. This situation has been explained by the fact that men are more numerous in the labor market and, consequently, more exposed to occupational accidents risks, as well as the health strategies directed to this public are still incipient in the country [8].…”

“…It is estimated that the worldwide incidence of this disease is one million cases per year and occur predominantly in Africa, Asia and Latin America [2].…”