Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

Abstract

IntroductionThe low incidence of tetanus in developed countries has resulted in a decreased vigilance of this disease. This raises concern, as the prodromal stadium of a generalized tetanus infection may lack the characteristic paroxysmal muscle spasms. Tetanus can rapidly progress into life-threatening muscle spasms accompanied by respiratory insufficiency and/or autonomic dysfunction. This emphasizes the need for early diagnosis and treatment.Case presentationA 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration. Due to parental concerns about the boy's refusal of fluids, a pediatrician was consulted. At that time of presentation he showed signs of trismus and muscle rigidity. Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection. After sedation, endotracheal intubation and ventilation, passive immunization and initiation of antimicrobial treatment, he was immediately transferred to a pediatric intensive care unit (PICU) for further treatment. The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved.ConclusionTetanus infection remains a rare but potentially lethal disease in developed countries. As the full scope of classical symptoms may be absent at first presentation, tetanus should always be considered in non-immunized patients with an acute onset of dysphagia and trismus.

Unvaccinated child tetanus from nasal toy battery

“…Child tetanus cases in developed countries were rare in the past 20 years. We have found nine published cases (2-7), four were from Europe (2)(3)(4)(5). The mean age of all cases was 4.7 years ranging from 16 months to 9 years.…”

Tetanus in a child as a result of the vaccination schedule violation – a case report

“…Despite the fact that tetanus has become a rare pathology in developed countries due to successful implementation of the primary immunization programme, the risk of its development is still high because of low specific immunity in elderly people and persons not vaccinated due to religious or philosophical beliefs [6]. That is why some cases of tetanus are still registered in the United States of America.…”

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