Infección por Clostridium tetani: sospecharla para diagnosticarla

La infección por Clostridium tetani es una patología con un amplio periodo de incubación, que posee diversos modos de presentación clínica. Este hecho, junto con la baja incidencia de esta infección en los países industrializados, así como no poseer una técnica diagnóstica precisa que podamos obtener en un corto período de tiempo, dificultan el diagnóstico. Por tanto, es importante no olvidarnos de esta patología ante un paciente con espasmos musculares y ausencia o historia incompleta de vacunación. PALABRAS CLAVE: Clostridium tetani; Inmunización; Risa sardónica; TrismusClostridium tetani infection is a pathology with a changing incubation period and different clinical features. Fathermore, the incidence of tetanus is very low in developed countries, in association with there isn´t a fast and precise diagnostic test, make mor difficult de diagnosis. Because of that, it is important that we don,t forget this infecction when we have a patient who suffers from spasms and inadequate immunization KEYWORDS: Clostridium tetani; Immunization; Sardonic smile; Lockja

Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain

Objectives: To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain. Methods: A retrospective observational study was performed of the first consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 2020. We collected demographic, clinical, laboratory, treatment and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death. Results: Of the 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them including advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein and lower estimated glomerular filtration rate. Conclusions: Our findings provide comprehensive information about characteristics and complications of severe COVID-19, and may help clinicians identify patients at a higher risk of death.Fundación SEIMC/GeSIDAPlan Nacional de I+D+i 2013-2016Instituto de Salud Carlos III (ISCIII)Ministerio de Ciencia, Innovación y UniversidadesEuropean Regional Develpment Fund (ERDF)Operative Program Intelligent Growth 2014-2020Spanish AIDS Research Network (RIS)Spanish Network for Research in Infectious Disease