Cephalic tetanus following minor facial abrasions: Report of a case

Paz, Arturo De; Izquierdo, M.; González, Luis Miguel Redondo; Verrier, A.

doi:10.1053/joms.2001.24296

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…Few cases attributable to the head injury usually were secondary to small scalp lacerations of the frontal temporal regions as a result of minor trauma. Cases secondary to open depressed skull fracture, such as our case, are almost unknown [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. A study from Ethiopia demonstrated that trauma to be the most common portal of entry in children.…”

Section: Discussionmentioning

confidence: 83%

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Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

et al. 2021

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Background Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. Case presentation We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed. Conclusion The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

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Section: Discussionmentioning

confidence: 83%

“…Generalized spasms occur frequently, induced by sensory stimuli. History of an injury or apparent portal of entry may be lacking [1,5,6,8].…”

Section: Discussionmentioning

confidence: 99%

Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

et al. 2021

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“…[5] Subsequently, if they encounter an anaerobic environment (more common in contaminated open trauma), they germinate into the vegetative form of the organism, the toxin-producing bacilli. [4,6,7] Thus, the clinical form of a particular case—that is, either general or local tetanus—is determined based on various factors, including the age of patients, immunization status, and, importantly, site of entry. [8] Although tetanus is an uncommon disease in the developed world due to vaccination coverage, it is still a concern due to high mortality rates of up to 90%.…”

Section: Discussionmentioning

confidence: 99%

Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea

2019

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Rationale: Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani . The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory failure, laryngeal spasm, seizure, chest pain, nausea/vomiting, opisthotonus, back pain, and rigid abdominal wall can also be observed during progression of the disease. However, there has been no report of periocular discomfort as an initial manifestation after endoscopic sleep surgery in a patient with tetanus. Here, we report a patient who underwent endoscopic sleep surgery with a concurrent diagnosis of tetanus infection presenting with atypical periocular discomfort as the initial symptom. Patient concerns: A 63-year-old man complaining of sleep apnea, snoring, and daytime sleepiness visited our department. He subsequently underwent sleep surgery (anterior pharyngoplasty with tonsillectomy, septoplasty, microdebrider-assisted inferior turbinoplasty, and an endoscopic sinus surgery) for the treatment of his newly diagnosed obstructive sleep apnea. After 3 weeks of surgery, he visited the outpatient clinic of our department with right side periocular discomfort. Diagnoses: Four days after presenting with periocular discomfort, he was diagnosed with tetanus by presenting trismus, jaw pain, dysphagia, and ptosis at an emergency department of a different hospital. Interventions: Tetanus immunoglobulin and antibiotics were administered. Outcomes: His symptoms then resolved after a month without sequelae. Lessons: Although periocular discomfort is atypical and is not uncommon after nasal and oral surgeries, care should be taken when patients present with periocular pain because it could be a rare initial symptom of tetanus.

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“…An initial dose of 5,000 units of TIG was ordered, however with uncertain evidence supporting this dosing regimen, the dose was reduced to 500 units and administered. Dosing regimens documented in published case studies range from 500 to 10,000 units [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Based on the symptomatic resolution observed in this patient with low-dose therapy and the evidence presented herein, it seems likely that the lowest recommended dose may be sufficient to provide optimal patient outcomes.…”

Section: Patient Discussionmentioning

confidence: 99%

Tetanus: A Case Report following an Upper Extremity Injury

Hill¹

2016

Clin Med Rev Case Rep

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Cephalic tetanus following minor facial abrasions: Report of a case

Cited by 8 publications

References 4 publications

Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

Tetanus presenting primarily as periocular discomfort in a patient who underwent surgery for sleep apnea

Tetanus: A Case Report following an Upper Extremity Injury

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