Acute renal failure and other clinical features in tetanus patients from northeastern Brazil

Abstract

Context: Tetanus is a disease caused by Clostridium tetani . Acute renal failure (ARF) can occur in patients with tetanus and a number of mechanisms may contribute to this, including rhabdomyolysis and autonomic nervous system overactivity. Aims: To investigate the occurrence of ARF and other clinical features in patients with tetanus in Brazil. Settings and Design: Retrospective study of patients with tetanus admitted to Sao Jose Infectious Diseases Hospital, in Fortaleza City, Brazil. Materials and Methods: All patients admitted from January 1999 to December 2003 were included, except those with previously diagnosed renal insufficiency, diabetes mellitus, systemic arterial hypertension, systemic lupus erythematosous, or any other factors not associated with tetanus that could lead to renal dysfunction. We compared survivors with non survivor patients in order to investigate the differences in clinical manifestations and laboratory tests. Statistical Analysis Used: Statistical analysis was performed using SPSS 10.0 for Windows® . Results: A total of 85 patients were included. The mean age was 52 ± 16 years and 82% were male. The main symptoms and signs presented at admission were trismus (68.2%), dysfagia (50.6%), and neck stiffness (41.2%). AFR was found in 10 patients (11.8%). Death occurred in 8 cases (9.4%). Hyperglicemia (OR = 1.014, p = 0.03), hyperkalemia (OR = 3.2, p = 0.04), and thrombocytopenia (OR = 1.000, p = 0.03) were associated with increased mortality. ARF was not associated with death (p>0.5). Conclusions: ARF is an important complication of tetanus, which was not associated with death. Hyperglicemia, hyperkalemia, and thrombocytopenia seem to increase mortality.