Recurrent generalized tetanus: a case report

Tetanus in Animals — Summary of Knowledge

Tetanus is a neurologic non-transmissible disease (often fatal) of humans and other animals with a worldwide occurrence. Clostridium tetani is the spore producing bacillus which causes the bacterial disease. In deep penetrating wounds the spores germinate and produce a toxin called tetanospasmin. The main characteristic sign of tetanus is a spastic paralysis. A diagnosis is usually based on the clinical signs because the detection in the wound and the cultivation of C. tetani is very difficult. Between animal species there is considerable variability in the susceptibility to the bacillus. The most sensitive animal species to the neurotoxin are horses. Sheep and cattle are less sensitive and tetanus in these animal species are less common. Tetanus in cats and dogs are rare and dogs are less sensitive than cats. Clinically two forms of tetanus have been recognized, i. e. localized and generalized. The available treatment is not specific because the toxin in neuronal cells cannot be accessed by antitoxin antibodies. The aim of the therapy is to: neutralise the unbound neurotoxin, inhibit C. tetani growth in the wound, and provide supportive care to mitigate the effects of the neurotoxin. The treatment is difficult with an unclear prognosis.

Non-accidental broom sticks injury as a cause of post-neonatal tetanus

Introduction

Non accidental injury sustained following deliberate self-harm or inflicted by parents or caregivers for disciplinary, traditional and therapeutic measures have grave consequences including exposing the incompletely child to post neonatal tetanus. This contributes to the continuing high incidence of post neonatal tetanus in developing countries.

Methods

A 12 year retrospective review of all children admitted into the children’s ward of the University of Calabar Teaching Hospital with diagnosis of post neonatal tetanus was carried out. The demographic characteristics of the children were documented. Immunization status, possible portal of entry and outcome status were also recorded. Data obtained was analysed using SPSS version 22.

Results

There was a male preponderance of 70.5% amongst the 44 children with post neonatal tetanus. Non-accidental injuries accounted for 20(45.5%). Broom stick injury sustained during corporal punishment was responsible for 60% of tetanus from the non-accidental injury group. Low socio economic class and Inadequate or no immunizations are major risk factors for tetanus infection.

Conclusion

Non accidental injuries inflicted on children as disciplinary measures accounted for about half of children with post neonatal tetanus. Broom stick injury was a major contributory factor. Lack of immunization and low social class remains major risk factors for post neonatal tetanus. Post neonatal tetanus presents another reason for sustained campaign against physical abuse of children.

Tetanus following tongue bite from repeated convulsions: a case report

This report details a case of generalized tetanus with the added complication of tongue bite following the repeated convulsions of a six-year-old unimmunized girl. It highlights the fact that tongue bite is an unusual portal of the entry of tetanus and emphasizes the need for proper oral care of an unconscious patient and the importance of the immunization of children.

Cephalic tetanus: a case report

A case report of cephalic tetanus in a 2-year-old girl who was not immunized against tetanus following suppurative otitis media (SOM) is presented. This case is reported because of the rarity of cephalic tetanus associated with high mortality, to highlight the risk of cephalic tetanus as sequelae of SOM and the need for proper aural care and prompt treatment of SOM. Primary immunization of all eligible children as well as booster vaccination at appropriate time as an effective management strategy for tetanus is emphasized.