An Emblematic Case of Tetanus in a Young Adult Vaccinated

Abstract

Tetanus remains a major public health problem in developing countries. The annual number of cases in Morocco is relatively low. The prognosis for this disease is as severe as ever, and all the gloomier as the diagnosis and treatment are late. Despite the improvement in intensive care, its lethality is still high, especially due to respiratory complications, Managing injuries is a major tetanus prevention strategy. Failure to manage injuries places victims dangerously at risk of disease. It is important to also assess tetanus immunization through the health or vaccination record. Symptomatic treatment is based on the use of muscle relaxant and sedative therapy, in which diazepam is the leader. Barbiturates, in particular phenobarbital, can be used alone or in combination with diazepam in severe forms. Central analgesics, and sometimes curares, are used in the sedation of patients placed on mechanical ventilation through a tracheal intubation tube, or secondarily through a tracheostomy tube which is often necessary. The specific treatment consists of antibiotic therapy (Peni G or Metronidazole), serotherapy, and tetanus vaccination as well as the management of tetanus-prone wounds. Vaccination should be routine to prevent recurrence, because tetanus is not an immunizing disease. We report a case of tetanus following a puncture wound to the soles of the feet by a rusty nail. The objective is to remind clinicians of the importance of this prophylaxis in any injured person who is not vaccinated or has a questionable immune status. Our Patient is a 28-year-old vaccinated against tetanus but without a booster for more than 5 years, was admitted to intensive care at the Avicenna military hospital in Marrakech, for neck pain, difficulty walking and opening the mouth(masseter muscle spasm, or lockjaw), abdominal contracture and para-vertebral muscles. In his history, he points to a perforating wound on the sole of the foot with a rusty nail that was treated without tetanus prophylaxis about two weeks ago. The examination on admission noted a trismus, abdominal contracture, and a puncture scar on the soles of the feet. The diagnosis of a generalized tetanus at portal of entry a puncture plantar wound was retained. Under treatment the initial evolution was favorable and he was released from the hospital onAugust 04, 2021.He was readmitted eight days later for the reappearance of neck stiffness, pain in back, painful tonic contractions and spasms and thoracic rigidity, the course was characterized by the occurrence of a spectacular opisthotonus particularly triggered by light stimuli. The introduction of phenobarbital with gradual reduction in dose of diazepam allowed a remarkable reduction in the frequency of spasm and paroxysms, he was discharged from the hospital on August 20, 2021 on Phenobarbital 50 mg twice a day in the morning and in the evening.