Successful ICU Management of Generalized Tetanus Arising from Minor Trauma Without Booster Immunization in a Third Category Hospital in Cameroon

Abstract

Although the incidence of tetanus has dramatically declined due to widespread vaccination, it remains a significant public health concern in underdeveloped regions. We report the case of a 20-year-old man, single, university student, incompletely immunized, who presented with generalized tetanic spasms following a neglected wound on the left hallux. He was referred to Limbe Regional Hospital for advanced management. On examination, the patient exhibited dysautonomia with blood pressure of 170/98 mmHg, temperature of 40 °C, pulse rate of 140 bpm, trismus, generalized clonic spasms, and a necrotic wound on the dorsal aspect of the left hallux. A diagnosis of generalized tetanus was established. Additional investigations included full blood count, blood culture, renal function tests, malaria parasite screening, and lumbar puncture. Management in the intensive care unit focused on controlling spasms and autonomic dysfunction, neutralizing the toxin, eradicating the causative organism, and initiating tetanus vaccination. The patient's clinical course was favorable, with recovery achieved without adverse events. This case underscores the persistent problem of inadequate immunization against tetanus among young adults in our setting and highlights the critical role of intensive care in the management of severe tetanus.