02333nas a2200433   4500000000100000008004100001260001300042653001500055653001000070653000900080653002200089653002400111653001200135653001400147653001000161653002100171653002000192653002300212653001100235653001100246653001100257653001200268653001000280653001400290653001200304653000900316653001600325653001200341653001900353653001200372100001400384700001700398700001900415245007200434300001100506490000600517520136200523022001401885       2001                            d  c2001 Dec10aAdolescent10aAdult10aAged10aAged, 80 and over10aAnemia, Sickle Cell10aAnimals10aCausality10aChild10aChild, Preschool10aChronic Disease10aClostridium tetani10aFemale10aHumans10aInfant10aInsecta10aLarva10aLeg Ulcer10aleprosy10aMale10aMiddle Aged10aMyiasis10aPressure Ulcer10aTetanus1 aGreco J B1 aSacramento E1 aTavares-Neto J00aChronic ulcers and myasis as ports of entry for Clostridium tetani.  a319-230 v53 a<p>Evaluating tetanus immune status is not yet the usual clinical practice regarding patients with chronic ulcers or myasis. However, of 858 tetanus patients at Hospital Couto Maia (Salvador, Bahia, Brazil) aged 1 year or above, 2 had pressure ulcers and 17 had chronic ulceration of the lower limbs where these skin lesions were the ports of entry for Clostridium tetani. In these 19 cases, the following predisposing factors were described: venous insufficiency (n=6), sickle cell anemia (n=2), Hansen s disease (n=1), malnutrition (n=1), diabetes mellitus (n=1), trauma (n=1) and unknown factors (n=7). In 6 other cases, in addition to the Hansen s disease patient, the port of entry for tetanus was the site of extraction of Tunga penetrans larvae. In these 25 cases, the majority of patients (68%) were over 40 years old (17/25) and all of these patients stated that they had either not followed a tetanus toxoid vaccination regimen (19/25), or had partially completed such a regimen, or did not give precise information (6/25). Among the same series studied, over half (52%) of the patients died (13/25). We conclude that tetanus prevention must be included in the treatment of chronic skin ulcer patients, vaccination coverage should be increased among older people, and strategies aimed at improving coverage for all age groups must be reviewed.</p>  a1413-8670