TITLE:
Complications of Acute Generalized Tetanus: Prevalence and Associated Factors at the Infectious and Tropical Diseases Department of the Fann Hospital, Dakar, Senegal
AUTHORS:
Khardiata Diallo Mbaye, Ndeye Aissatou Lakhe, Ndéye Fatou Ngom, Amady Waly Ba, Aminata Massaly, Ndeye Maguette Fall, Aboubakar Sidikh Badiane, Assane Diouf, Viviane Marie Pierre Cisse, Daye Ka, Daouda Thioub, Cheikh Tidiane Ndour, Moussa Seydi
KEYWORDS:
Tetanus, Complications, Associated Factors, Fann
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.15 No.4,
December
15,
2025
ABSTRACT: Introduction: Tetanus is a life-threatening toxi-infection, preventable by vaccination. In developing countries, it remains a leading cause of mortality. The associated factors related to the occurrence of complications are poorly investigated. In developing countries, it remains a major cause of death. Objective: To identify the different complications of tetanus and to assess the factors associated with their occurrence among patients hospitalized for acute generalized tetanus in the Department of Infectious and Tropical Diseases (SMIT) at Fann Teaching Hospital, from January 2018 to December 2023. Patients and Methods: we conducted a prospective, descriptive, and analytical study. Factors associated with the occurrence of complications were initially investigated using bivariate analysis with Pearson’s chi-square test (or Fisher’s test), then multivariate analysis using logistic regression. The probabilities of complications were expressed as adjusted odds ratios (ORa) with their confidence intervals. A p-value Results: A total of 343 cases of acute generalized tetanus were recorded over six years, representing a hospital prevalence of 8.42%. The age group under 15 years was the most represented (30.6%), with a sex ratio of 5.47. The most common comorbidities were hypertension (7.0%) and diabetes (3.5%). A gateway was identified in the majority of patients (92.13%), mainly cutaneous (84.26%) and post-surgical (11.37%). The incubation period was ≥7 days in 54.52% of cases, with a mean of 6.23 ± 2.49 days. The invasion period was less than 48 hours in most cases (78.13%). The average consultation time was 5.72 ± 33.25 days in 90.38% of cases. Clinical signs were dominated by contractures (100%), trismus (96.21%), dysphagia (77.55%), and paroxysms (83.7%). Patients were mostly classified as Stage II (70.3%) and IIIa (24.8%) following the Mollaret’s classification. Based on the Dakar score classification, in 64.9% of cases tetanus was moderate with a score between 2 and 3. The average hospital stay was 11.30 ± 7.32 days. Complications, present in 66.18% of cases, were cardiovascular (40.52%), infectious (34.40%), respiratory (32.65%), and metabolic (29.45%). Sequelae were observed in 19 patients, with vertebral deformities and compressions found in 26.32% of cases. Hospital lethality was 25.7%. In multivariate analysis, four risk factors for complications were identified: the period 2020-2021 (OR = 0.46 [0.25 - 0.834], p = 0.010), being > 60 years of age (OR = 4.45 [1.76 - 13.7], p = 0.004), a Dakar score between 4 - 6 (OR = 2.80 [1.09 - 7.73], p = 0.038), and the presence of tonic-clonic paroxysms (OR = 1.91 [1.03 - 3.63], p = 0.043). Conclusion: This study highlighted the significant impact of tetanus on morbidity and mortality among hospitalized patients. Moreover, significant risk factors for complications, such as advanced age, delayed consultation, and associated comorbidities, are not integrated into prognostic tools. Hence, it is necessary to set up large-sacle multicenter prospective samples and to consider these parameters or develop new scores for a better prediction of tetanus-related prognosis.