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An interesting presentation of pediatric tetanus

Published online by Cambridge University Press:  21 May 2015

Brian E. Grunau  and
Joshua Olson
Brian E. Grunau*
Affiliation:
Department of Family Medicine, University of British Columbia, Vancouver, BC
Joshua Olson
Affiliation:
Department of Family Medicine, University of British Columbia, Vancouver, BC Department of Family Medicine, University of British Columbia, Vancouver, BC, Emergency Department, Chilliwack General Hospital, Chilliwack, BC
*
Chilliwack General Hospital, 45600 Menholm Rd., Chilliwack BC V2P 1P7; fax 604 795-4133; [email protected]

Abstract

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Despite successful large-scale immunization programs in North America, there remains a significant population without active immunity to tetanus toxins because immunizations have been refused or delayed, and because of waning immunity. We report the case of a 7-year-old boy who presented to the emergency department with a chin laceration and a 7-day history of repeated falls of increasing frequency. We found this case to be associated with dysphagia and facial spasm, and we learned that the child had dropped a brick on his foot 2 weeks previously. The patient was subsequently diagnosed with tetanus and treated accordingly. Tetanus presentations to emergency departments may vary from mild muscular rigidity to advanced respiratory failure and thus clinicians should consider the diagnosis in various clinical presentations, especially in areas remote from advanced supportive care.

Résumé

RÉSUMÉ

Malgré le succès qu’ont connu les programmes de vaccination à grande échelle en Amérique du Nord, il y a encore un important segment de la population sans immunité active contre la toxine du tétanos en raison d’un refus ou d’un report de la vaccination ou d’une baisse d’immunité. Nous présentons le cas d’un garçonnet de 7 ans qui s’est présenté à l’urgence avec une lacération au menton et des antécédents sur 7 jours de chutes répétées de fréquence croissante. Nous avons déterminé que ce cas était associé à une dysphagie et à des spasmes du visage et avons appris que l’enfant avait laissé échapper une brique sur son pied 2 semaines auparavant. Le patient a ensuite reçu un diagnostic de tétanos et a été traité en conséquence. Les présentations cliniques du tétanos à l’urgence peuvent varier de la rigidité musculaire bénigne à une insuffisance respiratoire aiguë. Les médecins devraient envisager le diagnostic d’après diverses présentations cliniques, tout particulièrement dans les régions éloignées des soins de soutien avancés.

Keywords

tetanuspediatricimmunization
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 1 , January 2010 , pp. 69 - 72
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1. 2008 British Columbia annual summary of reportable diseases. Vancouver (BC): BC Centre for Disease Control; 2009.Google Scholar
2. Canadian immunization guide. 7th ed. Ottawa (ON): Ministry of Public Works and Government Services; 2006. Available: http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php (accessed Nov 23).Google Scholar
3. WHO vaccine-preventable diseases: monitoring system (2008 global summary). Geneva (Switzerland): World Health Organization Department of Immunization, Vaccines and Biologicals; 2008.Google Scholar
4. Canada national report on immunization. Canada Communicable Disease Report 2006;32S3:1–44.Google Scholar
5. Kondro, W. Progress report on the national immunization strategy. CMAJ 2007;176:1811–3.Google Scholar
6. Orenstein, WA, Hinman, AR. The immunization system in the United States – the role of school immunization laws. Vaccine 1999;17(Suppl 3):S19–24.Google Scholar
7. Salmon, DA, Moulton, LH, Omer, SB, et al. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Arch Pediatr Adolesc Med 2005;159:470–6.Google Scholar
8. Omer, SB, Salmon, DA, Orenstein, WA, et al. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med 2009;360:1981–8.Google Scholar
9. Thwaites, CL, Farrar, JJ. Preventing and treating tetanus. BMJ 2003;326:117–8.Google Scholar
10. McQuillan, GM, Kruszon-Moran, D, Deforest, A, et al. Serologic immunity to diphtheria and tetanus in the United States. Ann Intern Med 2002;136:660–6.Google Scholar
11. Gergen, PJ, McQuillan, GM, Kiely, M, et al. A population-based serologic survey of immunity to tetanus in the United States. N Engl J Med 1995;332:761–6.Google Scholar
12. Atabek, ME, Pirgon, O. Tetanus in a fully immunized child. J Emerg Med 2005;29:345–6.Google Scholar
13. Farrar, J, Newton, C. Neurological aspects of tropical disease. J Neurol Neurosurg Psychiatry 2000;68:135–6.Google Scholar
14. Cook, TM, Protheroe, RT, Handel, JM. Tetanus: a review of the literature. Br JAnaesth 2001;87:477–87.Google Scholar
15. Ahmadsyah, I, Salim, A. Treatment of tetanus: an open study to compare the efficacy of procaine penicillin and metronidazole. Br Med J (Clin Res Ed) 1985;291:648–50.Google Scholar
16. Yen, LM. Management of tetanus: a comparison of penicillin and metronidazole. Proceedings of the Symposium of Antimicrobial Resistance in Southern Viet Nam; 1997.Google Scholar
17. Trujillo, MH, Castillo, A, Espana, J, et al. Impact of intensive care management on the prognosis of tetanus. Analysis of 641 cases. Chest 1987;92:63–5.Google Scholar