[Tetanus and HIV: a fortuitous association?].

OBJECTIVES

To describe the relation between HIV infection and tetanus.

METHODS

This prospective study includes all patients admitted to our infectious diseases department with tetanus between July 15 and December 31, 2007, who underwent screening for HIV-1 and 2.

RESULTS

The study included 21 patients (sex-ratio = 9.5). Their mean age was 37 years (SD: 5.3) were included. Nine patients (42%) had been immunized, but never received a booster dose. The portal of entry was found in 16 patients (76%) - all but one a skin injury. Tetanus was generalized in all patients (Mollaret classification: 76% Stage II, 24% stage III). Twelve (57%) patients were infected with HIV. Their mean CD4 cell count was 157/mm3 (SD: 75/mm3, range: 74-232/mm3). The overall mortality rate was 53%. It was 100% when no portal of entry was found. It was significantly higher among HIV-positive than HIV-negative patients (82 versus 18%). It did not, however, differ significantly between HIV-positive subjects with a CD4 count < 200/mm3 and those with a CD4 count > or = 200 (58 versus 42%).

CONCLUSION

HIV and the absence of portal of entry are poor prognostic factors in tetanus. Therefore, a revision of the Dakar International Classification on tetanus should be revised, to score as 1 those patients with HIV infection and no portal of entry.