Generalised Tetanus in a Two-Month-Old Child: A Preventable Cause of Morbidity and Mortality

Abstract

Background: Generalized Tetanus is a vaccine-preventable fatal infectious disease, yet it remains an important cause of death worldwide and is associated with a high case mortality, particularly in the developing world. Case: A two-month-old male infant presented with features of generalized tetanus: trismus, rigidity, reflex spasticity, and apnoeic attacks. The child had a tiny necrotic area involving the tip of his right big toe. The patient responded poorly to cardiothoracic resuscitation with 100% oxygen. His short hospital stay was characterized by a recurrence of apnoea and active resuscitation. The patient’s delivery was at home, unsupervised. He had yet to receive any dose of any vaccine. Mother is a 26-year-old woman, para5, 2 alive, who has never received tetanus toxoid in this pregnancy or previously. The patient received only the first dose of Intravenous (IV) metronidazole 100mg. Anti-tetanus immunoglobulin administration after a test dose, IV diazepam, Chlorpromazine, and Phenobarbitone were given to neutralize the toxins, control convulsion, spasticity, and to relieve symptoms. The patient was commenced on 10% intravenous glucose in 0.9 normal saline at 150mls/kg/day. The patient responded poorly despite interventions and died 6 hours into admission. Conclusion: Morbidity and Mortality in infants resulting from tetanus are highly preventable through vaccination of both mothers and newborns. There is therefore a need to double our efforts to ensure that the general populace acquires adequate knowledge on the fatality and prevention of tetanus through vaccination. There is a need to scale up our immunization coverage.