American Journal of Pediatrics

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

Received: 21 September 2020    Accepted: 07 October 2020    Published: 23 October 2020
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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.

DOI 10.11648/j.ajp.20200604.16
Published in American Journal of Pediatrics (Volume 6, Issue 4, December 2020)
Page(s) 428-432
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Tetanus, Diagnosis, Incompleted Immunization, Management, Recovery Time

References
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[2] Cherry JD, Harrison GJ, Kaplan SL, Hotez PJ, Steinbach WJ. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia: Elsevier; 2014.
[3] Sumarmo SPS, Garna H, Hadinegoro SR, Satari HI. Buku Ajar Infeksi dan Penyakit Tropis: Tetanus. Edisi 2. Jakarta: IDAI; 2008.
[4] Mandell G, Bennett J, Dolin R. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia: Churchill Livingstone; 2000: 2537-43.
[5] Roper MH, Vandelaer JH, Gasse FL. Maternal and neonatal tetanus. Lancet. 2007; 370: 1947-59.
[6] Centers for Disease Control and Prevention (CDC). Tetanus surveillance-United States, 2001-2008 [cited 2020 Jan 12]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml.
[7] Lestar W, Widyaningrum D, Sumarno, Siburian F. Immunnity to diptheriae and tetanus of primary school dropout children in North Jakarta Municipality. Buletin Penelitian Kesehatan. 2002; 202: 152-6.
[8] Cook TM, Protheroe RT, Handel JM. Tetanus: A review of the literature. Br J Anaesth. 2001; 87: 477-87.
[9] Kementrian Kesehatan Republik Indonesia. [Profile of Indonesia Health 2017] Profil Kesehatan Indonesia tahun 2017. [cited 2020 Jan 12]. Available from: https://www.kemkes.go.id/resources/pusdatin/profil-kesehatan-indonesia-tahun-2017.
[10] Edmund M, Fountain MD. The early symptoms of tetanus with a review of 22 cases. Canad. M. A. J. 1951; 64: 58-60.
[11] Ernest ME, Michael EK, Michael F, Markos NM. Tetanus: Pathophysiology and management. Ann Pharmacother. 1997; 31: 1507-13.
[12] Thwaites CL, Loan HT. Eradication of tetanus. British Medical Bulletin. 2015; 116: 69-77.
[13] Hsu SS, Georgina G. Tetanus in the emergency department: A current review. The Journal of Emergency Medicine. 2001; 20: 357-65.
[14] Rodrigo C, Deepika F, Senaka R. Pharmacological management of tetanus: Evidence-based review. Critical care. 2014; 18: 1-10.
[15] Kabura L, Ilibagiza D, Menten J, Van den Ende J. Intrathecal vs intramuscular administration of human antitetanus immunoglobulin or equine tetanus antitoxin in the treatment of tetanus: A meta-analysis. Tropical Medicine and International Health. 2006; 2: 1075-81.
[16] Ahmadsyah I, Agil S. Treatment of tetanus: An open study to compare the efficacy of procaine penicillin and metronidazole. British Medical Journal. 1985; 291: 648-50.
[17] Lisboa T, Li Ho Y, Henriques Filho GT, Brauner JS, Valiatti dos Santos JL, Verdeal JC, Machado FR. Guidelines for the management of accidental tetanus in adult patients. Rev Bras Ter Intensiva. 2011; 23 (4): 394-409.
[18] Barkin RM, Michael EP, Joel SS, Suzanne ZB. Pediatric diphtheria and tetanus toxoids vaccine: Clinical and immunologic response when administered as primary series. The Journal of Pediatrics. 1985; 106: 779-81.
[19] Fair E, Murphy T, Golaz A, Wharton M. Philosophic objection to vaccination as a risk for tetanus among children younger than 15 years. Pediatrics. 2002; 109 (1): 1-3.
[20] Departemen Kesehatan RI. [Management of Tetanus in Children]. Penatalaksanaan Tetanus pada Anak [cited 2020 Jan 12]. Available from: https://www.academia.edu/Departemen+Kesehatan+RI.+Penatalaksanaan+Tetanus+pada+Anak.2008.
[21] Jozani Z, Ahmad S, Agha S. Tetanus in an unvaccinated child: A case report. Asian Pacific Journal of Tropical Disease. 2012; 2 (4): 335-6.
Author Information
  • Department of Child Health, Medical Faculty of Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia

  • Department of Child Health, Medical Faculty of Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia

  • Department of Child Health, Medical Faculty of Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia

Cite This Article
  • APA Style

    Katharina Yosephin Lakonawa, I Made Gede Dwi Lingga Utama, I Wayan Gustawan. (2020). Generalized Tetanus in an 8-Years-Old Boy: A Case Report. American Journal of Pediatrics, 6(4), 428-432. https://doi.org/10.11648/j.ajp.20200604.16

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    ACS Style

    Katharina Yosephin Lakonawa; I Made Gede Dwi Lingga Utama; I Wayan Gustawan. Generalized Tetanus in an 8-Years-Old Boy: A Case Report. Am. J. Pediatr. 2020, 6(4), 428-432. doi: 10.11648/j.ajp.20200604.16

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    AMA Style

    Katharina Yosephin Lakonawa, I Made Gede Dwi Lingga Utama, I Wayan Gustawan. Generalized Tetanus in an 8-Years-Old Boy: A Case Report. Am J Pediatr. 2020;6(4):428-432. doi: 10.11648/j.ajp.20200604.16

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  • @article{10.11648/j.ajp.20200604.16,
      author = {Katharina Yosephin Lakonawa and I Made Gede Dwi Lingga Utama and I Wayan Gustawan},
      title = {Generalized Tetanus in an 8-Years-Old Boy: A Case Report},
      journal = {American Journal of Pediatrics},
      volume = {6},
      number = {4},
      pages = {428-432},
      doi = {10.11648/j.ajp.20200604.16},
      url = {https://doi.org/10.11648/j.ajp.20200604.16},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20200604.16},
      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.},
     year = {2020}
    }
    

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    T1  - Generalized Tetanus in an 8-Years-Old Boy: A Case Report
    AU  - Katharina Yosephin Lakonawa
    AU  - I Made Gede Dwi Lingga Utama
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    DO  - 10.11648/j.ajp.20200604.16
    T2  - American Journal of Pediatrics
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    AB  - 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.
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