[Knowledge, behaviors and practices among ironworkers about tetanus in Senegal]

Tetanus is still a major health problem in Sénégal. In order to understand some of these reasons, we conducted a study. The aim of this study is to assess ironworkers' knowledge, behaviors and practices about tetanus. This knowledge, behaviors and practices survey was carried out in ironworks of two neighborhoods of Dakar from April 5 to May 10, 2008. 41 ironworks were identified and 32 agreed to participate in the study. In this ironworks, 120 ironworkers were interviewed. Their average age was 29 years +/- 15, education in French schools was low and 78.3% of them had a source of information. Despite some inaccuracies, most ironworkers were aware of tetanus (97.5%), severity (93.3%), causes (89.2%). However 35% did not evaluate the risk of tetanus and almost all the ironworkers or 96.7% had no preventive measures after injury. Moreover, no ironworker was fully immunized against tetanus. In some occupations at risk, awareness of tetanus should be increased by all available channels and methods emphasizing the importance of prevention.

Therapy and epidemiology of autism--clostridial spores as key elements

This manuscript reviews evidence indicating that intestinal bacteria, specifically clostridia, may play a role in certain cases of autism and hypothesizes that the clostridial spores (which are notably resistant to antimicrobial agents and commonly used germicides) are involved in: (1) relapse in the autistic subject after a response to an agent such as oral vancomycin, after the drug is discontinued, (2) the unexplained increased incidence of autism in recent years, and (3) the unexplained increase in numbers of multiple cases in the same family. Hypothesis (1), if established as valid, would spur research to find well-tolerated and safe agents that could be given together with vancomycin (or other appropriate antimicrobial agent) to eliminate spores; this would revolutionize the therapeutic approach. Hypotheses (2) and (3) relate to widespread use of antimicrobial agents, poor hygiene in young autistic children, and difficulty in removing spores from the home environment. These latter two hypotheses have major implications with regard to the epidemiology of this important and distressing disease and would encourage research into methods to eliminate clostridial spores from the home and other environments.

Autism and Clostridium tetani

Autism is a severe developmental disability believed to have multiple etiologies. This paper outlines the possibility of a subacute, chronic tetanus infection of the intestinal tract as the underlying cause for symptoms of autism observed in some individuals. A significant percentage of individuals with autism have a history of extensive antibiotic use. Oral antibiotics significantly disrupt protective intestinal microbiota, creating a favorable environment for colonization by opportunistic pathogens. Clostridium tetani is an ubiquitous anaerobic bacillus that produces a potent neurotoxin. Intestinal colonization by C. tetani, and subsequent neurotoxin release, have been demonstrated in laboratory animals which were fed vegetative cells. The vagus nerve is capable of transporting tetanus neurotoxin (TeNT) and provides a route of ascent from the intestinal tract to the CNS. This route bypasses TeNT's normal preferential binding sites in the spinal cord, and therefore the symptoms of a typical tetanus infection are not evident. Once in the brain, TeNT disrupts the release of neurotransmitters by the proteolytic cleavage of synaptobrevin, a synaptic vesicle membrane protein. This inhibition of neurotransmitter release would explain a wide variety of behavioral deficits apparent in autism. Lab animals injected in the brain with TeNT have exhibited many of these behaviors. Some children with autism have also shown a significant reduction in stereotyped behaviors when treated with antimicrobials effective against intestinal clostridia. When viewed as sequelae to a subacute, chronic tetanus infection, many of the puzzling abnormalities of autism have a logical basis. A review of atypical tetanus cases, and strategies to test the validity of this paper's hypothesis, are included.

Tetanus: critical implications for nursing

In the United States today, tetanus is a rare disease. However, when it occurs, it can be a highly challenging situation for all members of the healthcare team. The majority of care during the course of the disease is supportive. The availability of personnel trained in managing cardiorespiratory emergencies and sustained mechanical ventilation in the ICU environment can have a beneficial effect on patients' outcomes. An awareness of the potential complications of tetanus can hasten recovery and maintain the patient's preexisting quality of life.

A handout about tetanus immunisation: influence on immunisation rate in general practice

OBJECTIVE

To assess the influence of giving patients a handout about tetanus immunisation on the rate of immunisation against tetanus among adults in a general practice.

DESIGN

Monthly tetanus immunisation rates were audited before and after the handout was introduced.

SETTING

A practice with six doctors and a list of 11,000 patients in an urban area of Hertfordshire.

INTERVENTIONS

In the first month reception staff were instructed to give a handout about tetanus immunisation to all adults presenting at the reception desk. In the next seven months the doctors used the handouts opportunistically during consultations.

RESULTS

No significant change in immunisation rate was detected in the first month in which the handouts were used. During the next seven months the median monthly rate rose threefold.

CONCLUSION

Handouts given to patients can increase the uptake of preventive services in general practice.

Long-term recovery from tetanus: a study of 50 survivors

A follow-up study of 50 patients treated in the tetanus unit of the General Infirmary at Leeds from 1961 to 1977 showed that 29 patients had regained normal health, nine were still improving, but 12 considered that their health had been permanently impaired. In only two of these 12, however, was the deterioration serious and unequivocally linked to their illness and treatment. All but five of those previously working had returned to full employment. Sixteen patients had unpleasant memories of the illness and treatment, 19 had psychological after effects, and one suffered serious damage to mental function. Little evidence was found of pulmonary dysfunction after the disease and its treatment, and although all the patients showed a tracheal stricture of some degree, few had directly associated disabilities. The cause of stricture is multifactorial, the surgical technique being only one. A formal surgical closure of the trachea (if a flap has been used) and of the tissue of the neck in layers should lessen residual disability from the scar and strictured areas.

Tetanus and psychiatry: unexpected bedfellows

Six patients who were admitted with the initial diagnosis of tetanus to a general hospital serving 130 000 people over a 10-year period are reviewed. In three of these patients psychogenic factors played a major part in the presenting pictures. These cases followed a markedly different course from the others. Guidelines to the early differentiation of such atypical cases, and to the way psychogenic factors can be identified and their importance evaluated, are discussed.