An interesting presentation of pediatric tetanus Brian E. Grunau, MD; - PDF document

C ASE R EPORT • R APPORT DE CAS An interesting presentation of pediatric tetanus Brian E. Grunau, MD; * Joshua Olson, MD *† S EE RELATED ARTICLE ON PAGE 14 INTRODUCTION ABSTRACT Despite successful large-scale immunization programs in T etanus, a disorder of intensive muscular spasms caused North America, there remains a significant population with- out active immunity to tetanus toxins because immuniza- by the toxins of Clostridium tetani , has been recognized tions have been refused or delayed, and because of waning since the ancient Egyptians and Greeks in terms of its immunity. We report the case of a 7-year-old boy who pre- association with traumatic injuries and potential for sented to the emergency department with a chin laceration lethal complications. It has only been since the 1940s, and a 7-day history of repeated falls of increasing frequency. with the development of the tetanus immunization and We found this case to be associated with dysphagia and subsequent immunization campaigns, that there has facial spasm, and we learned that the child had dropped a brick on his foot 2 weeks previously. The patient was subse- been a dramatic decline in tetanus presentations. A quently diagnosed with tetanus and treated accordingly. significant population of susceptible people remains in Tetanus presentations to emergency departments may vary the developed world, however, because of the refusal or from mild muscular rigidity to advanced respiratory failure delay of childhood or booster immunizations, and and thus clinicians should consider the diagnosis in various because of waning immunity. Immunization refusal may clinical presentations, especially in areas remote from ad - vanced supportive care. be a result of a number of factors, such as a fear of adverse reactions, or religious and other philosophical Keywords: tetanus, pediatric, immunization views. RÉSUMÉ CASE REPORT Malgré le succès qu’ont connu les programmes de vaccina- tion à grande échelle en Amérique du Nord, il y a encore un A 7-year-old previously healthy boy presented to the important segment de la population sans immunité active emergency department with the triage complaint identi- contre la toxine du tétanos en raison d’un refus ou d’un report de la vaccination ou d’une baisse d’immunité. Nous fied as “laceration on his chin.” The mother of the présentons le cas d’un garçonnet de 7 ans qui s’est présenté patient stated that the child had fallen and cut his chin, à l’urgence avec une lacération au menton et des antécédents and remarked that he had been falling unexpectedly for sur 7 jours de chutes répétées de fréquence croissante. Nous the past week. During the first few days, the boy had avons déterminé que ce cas était associé à une dysphagie et fallen only about once per day, which was unwitnessed, à des spasmes du visage et avons appris que l’enfant avait although during the 2 days preceding the visit there laissé échapper une brique sur son pied 2 semaines aupara- vant. Le patient a ensuite reçu un diagnostic de tétanos et a were 2 to 3 witnessed falls per day. As the mother été traité en conséquence. Les présentations cliniques du described, the boy would just fall without any apparent tétanos à l’urgence peuvent varier de la rigidité musculaire reason and that he would not reach out his hands to bénigne à une insuffisance respiratoire aiguë. Les médecins break his fall. He was described as “falling like a statue.” devraient envisager le diagnostic d’après diverses présenta- On further questioning, the boy apparently had experi- tions cliniques, tout particulièrement dans les régions éloignées des soins de soutien avancés. enced mild difficulty eating ice cream 1 week previously, *Resident and †Clinical Instructor, Department of Family Medicine, University of British Columbia, Vancouver, BC, and †Emergency Physician, Emergency Department, Chilliwack General Hospital, Chilliwack, BC Submitted Jun. 8, 2009; Revised Oct. 5, 2009; Accepted Oct. 8, 2009 This article has been peer reviewed. CJEM 2010;12(1):69-72 CJEM • JCMU 2010; 12 (1) 69 Downloaded from https://www.cambridge.org/core. IP address: 192.151.151.66, on 12 Aug 2020 at 09:59:15, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1481803500012070