Generalized Tetanus in an 8-Years-Old Boy: A Case Report

Abstract

Nowadays tetanus is a rare disease in developed countries due to the success of immunization, but children who were not immunized are still at risk. Awareness of early clinical symptoms of tetanus is crucial since the diagnosis is based on clinical symptoms. Severe tetanus can occur and lead to sequelae if there was no timely diagnosis and proper treatment. This case report aimed to emphasize the importance of recognizing early symptoms of tetanus and immunization. An 8 year old boy complained stiffness all over his body since 4 days before admission to hospital. Stiffness was started with pain on his back and stomach since 7 days before admitted, 3 days later his neck and back became stiff and got worsen until his mouth became stiff too. His left toe was pricked by a plant thorn about 3-4 weeks before admission. Physical examination showed risus sardonicus, trismus, stiff hands and opisthotonus. He didn’t get complete immunizations. He was admitted in Pediatric Iintensive Care Unit (PICU) with Human Immunoglobulin, metronidazole, and diazepam. He was treated for 14 days and given Td vaccine before discharged. He underwent physiotherapy in medical rehabilitation department for 1 month because of persisting stiffness in his legs and arms. The diagnosis of tetanus was made based on clinical findings. There was no laboratory test to confirm it. Without timely diagnosis and proper treatment, severe tetanus can be fatal causing sequelae. Tetanus treatment follows several principles such as initial stabilization, maintainance of airway, prevent absorption of tetanospasmin, eradicating organism and supportive therapy. Management of tetanus takes a long time because the irreversible bound of toxin to tissues. It takes 4-6 weeks for the growth of new nerve terminal which is required in recovery period. So it is very important to recognize the symptoms of tetanus and treat it immediately to prevent more toxin bind to neuron.