A Meningeal Syndrome Revealing A Tetanus in A Togolese: Case Report and Review of the Literature

Agba Léhleng,Guinhouya K Mensah,Balogou K Agnon,Awidina-Ama Awissoba,Apetse Kossivi,Djalogue Lihanimpo,Anayo K Nyinèvi,Kombate Damelan,Belo Mofou,Kumako V Kodzo,Pengcheng Han

doi:10.14302/issn.2470-5020.jnrt-19-2983

Agba Léhleng, Guinhouya K Mensah + Show 9 more

Open Access

https://doi.org/10.14302/issn.2470-5020.jnrt-19-2983

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Abstract

Although it is a vaccine-preventable disease, tetanus is frequently found in sub-Saharan Africa. Because of its rarity, this disease poses two problems for doctors of the 21st century: to make early diagnosis in order to refer patients to appropriate care structures, and to continue to ensure correct prevention of an affection that few current doctors have met. In it generalized form, the diagnosis of tetanus is easy, but when the beginning is localized, tetanus can be change with other diseases leading to a diagnostic wandering and a delay of adequate management. We report a case of tetanus in an 18-year-old male, who was received for neck pain and stiffness of the neck with a positive Kernig sign associated to fever since 48 hours. Initially treated for meningitis, the patient will develop at day 3 of hospitalization, the signs of generalized tetanus which led to evoked the diagnosis of tetanus. This diagnosis was reinforced by the notion of a rusty nail injury to the soles of the right foot 3 weeks before hospitalization and the absence of anti-tetanus vaccination. After using tetanus serum and vaccination with antibiotics (Metronidazole and Penicillin) and Diazepam in association with stripping of the wound under the foot, the patient was improved. This case illustrates that any neurological sign with the first trismus must evoke until proof of the contrary, a tetanus especially in case of association with a wound even if the immunization schedule is up to date.

Highlights

It is a vaccine-preventable disease, tetanus is frequently found in sub-Saharan Africa [1]
We report a case of tetanus whose onset mimicked meningitis, and in this case we will review the literature of this rare but potentially life-threatening condition
The main mode of contamination in third world countries differs greatly from that of industrialized countries: in the latter, injuries are related to domestic activities or gardening, while in developing countries, injuries result from contempt or lack of knowledge of the basic rules of asepsis, as a result of neglected foot injuries or certain traditional practices [10; 11]

Summary

Introduction

It is a vaccine-preventable disease, tetanus is frequently found in sub-Saharan Africa [1]. Examination of cerebrospinal fluid (CSF) showed pleocytosis, normal glycorrhachia and slight high of proteins (0.60 mg / l) These results conducted to suspect a viral meningitis the patient was referred to Teaching Hospital Center of Kara, 48 hours later. In his medical story before this hospitalization, he has no known personal or family disease he has never been hospitalized or operated. These new signs, supported the diagnosis of a generalized tetanus in the state phase This diagnosis was reinforced by the notion of a rusty nail injury to the soles of the right foot 3 weeks before hospitalization and the absence of anti-tetanus vaccination. The patient is released without sequelae after 25 days of hospitalization with a well-established vaccination schedule

Discussion

Findings

Conclusion