Abstract
Background
In the post-vaccination era, as it is today, generalized tetanus is a rare diagnosis, although mortality and morbidity continue to increase significantly throughout the world. Infection occurs when the Clostridium tetani spores are introduced into wounds, skin lesions and infections. The symptoms often begin with stiffness or spasms in the jaw muscles; they are called trismus or “lockjaw” and/or then spread to the neck and abdominal muscles.
Case presentation
This is a report of a 42-year-old man who was referred to the hospital with dysphagia, rigidity and trismus. He was diagnosed with generalized tetanus with a Philips score of 15. The patient was admitted to the isolation unit, received treatment that included procaine penicillin, metronidazole, diazepam, human tetanus immunoglobulin (TIG) and anti-tetanus serum (ATS). Treatment was considered according to the guidelines of the World Health Organization, and also, the drug dose has no adverse event reaction during the treatment.
Conclusion
The therapeutic response is related to the identification and appropriate treatment, especially in hospitalized patients with inadequate immunization so that patients recover soon.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: Research involving human subjects complied with all relevant national regulations and institutional policies, is in accordance with the tenets of the Helsinki Declaration (as revised in 2013).
References
[1] Centers for Disease Control and Prevention. Manual for the Surveillance of Vaccine-Preventable Disease. Chapter 16: Tetanus. Centers for Disease Control and Prevention National Center for Immunization and Respiratory Disease 2019, vol. 1:7, Atlanta: Centers for Disease Control and Prevention. 2017. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html. July 28 2019.Search in Google Scholar
[2] Sutiono AB, Qiantori A, Suwa H, Ohta T. Characteristic tetanus infection in disaster-affected areas: case study of the Yogyakarta earthquakes in Indonesia. BMC Res Notes 2009;2:34.10.1186/1756-0500-2-34Search in Google Scholar PubMed PubMed Central
[3] World Health Organization. WHO Communicable Diseases Working Group on Emergencies, Communicable Diseases Surveillance and Response and WHO Regional Office for the Americas. Current Recommendations for Treatment of Tetanus During Humanitarian Emergencies, 2010. WHO/HSE/GAR/DCE/2010. 2 2010 January; 4. https://www.who.int/diseasecontrol_emergencies/who_hse_gar_dce_2010_en.pdf. July 28 2019.Search in Google Scholar
[4] Sexton JD. Tetanus. https://www.uptodate.com/contents/tetanus, August 2018.Search in Google Scholar
[5] Manual for the Surveillance of Vaccine-Preventable Diseases. Centers for Disease Control and Prevention website. http://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html 2017.Search in Google Scholar
[6] Aceh Epidemiology Group. Outbreak of tetanus cases following the tsunami in Aceh Province, Indonesia. Glob Public Health 2006;1:173–7.10.1080/17441690600652803Search in Google Scholar PubMed
[7] Afshar M, Raju M, Ansell D, Bleck TP. Narrative review: tetanus – a health threat after natural disasters in developing countries. Ann Intern Med 2011;154:329–35.10.7326/0003-4819-154-5-201103010-00007Search in Google Scholar PubMed
[8] WHO. 2019 global summary: incidence time series for Indonesia (IDN). Tetanus (total) Global Case: WHO vaccine-preventable diseases: monitoring system. Last update 15 July 2019. https://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencettetanus.html. 2015. Oct 05 2019.Search in Google Scholar
[9] Ministry of Health Republic of Indonesia. 2015 Indonesia Health Profile: Chapter V Health of Indonesian Families: Annex 5.12 and Annex 5.13. Jakarta: Ministry of Health of Repubic Indonesia. http://www.depkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/indonesian%20health%20profile%202015.pdf 2016 August978-602-235-911-1. Oct 05 2019.Search in Google Scholar
[10] Wadiah AA, Mohammed AS, Mohammed AA, Nazeh EF. Severe generalized tetanus: a case report and literature review. Saudi J Med Medical Sci 2015;3:167–9.10.4103/1658-631X.156437Search in Google Scholar
[11] Darraj M, Stone J, Keynan Y, Thompson K, Snider C. A case of tetanus secondary to an odontogenic infection. Can J Emerg Med 2017;19:497–9.10.1017/cem.2016.390Search in Google Scholar PubMed
[12] Chaturaka R, Deepika F, Senaka R. Pharmacological management of tetanus: an evidence-based review. Crit Care Mar 2014;18:10.10.1186/cc13797Search in Google Scholar
[13] Leman MM, Tumbelaka RA. Penggunaan anti tetanus serum dan human tetanus immunoglobulin pada tetanus anak, laporan kasus. Sari Pediatri Des 2010;12:283–8.10.14238/sp12.4.2010.283-8Search in Google Scholar
© 2019 Walter de Gruyter GmbH, Berlin/Boston