An Unusual Case of Chronic Relapsing Tetanus Associated with Mandibular Osteomyelitis

Wakasaya, Yasuhito; Watanabe, Mitsunori; Tomiyama, Masahiko; Suzuki, Chieko; Jackson, Mandy; Fujimuro, Masahiro; Kimura, Takuma; Seino, Yusuke; Kawarabayashi, Tatsuhiko; Yamamoto-Watanabe, Yukiko; Matsubara, Etsuro; Shirahama, Ikumi; Takamura, Ayumi; Nakahata, Naoko; Shoji, Mikio

doi:10.2169/internalmedicine.48.2136

Cited by 11 publications

(6 citation statements)

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“…The incubation period for tetanus is usually between 7 and 21 days in equids although incubation periods of as short as 1 day have been reported (Ribeiro et al, 2018) and incubation periods of as short as 36 h are common in humans (Vakil et al, 1964); therefore, both the first and second episode could be related to the recent shoeing. Given the absence of any detectable wounds at presentation, and the fact that the animal was clinically well and in work for the intervening 9 months, and that at second presentation there was a history of recent shoeing, it is perhaps most likely that this second episode of tetanus was indeed the result of a new and different insult, albeit also in the hoof, as is more common in the few reported cases of human recurrent or relapsing tetanus (Wakasaya et al, 2009).…”

Section: Discussionmentioning

confidence: 97%

“…Little or no active immunity develops as a result of clinical tetanus in people (Turner et al, 1957;Vakil et al, 1964), yet despite this, reports of relapsing or recurrent tetanus in people are very rare and non-existent amongst equids. In a review of the human literature, the first recurring case was reported by Whittemore et al in 1918 and this has been followed by other isolated single cases (Lemere et al, 1941;Vakil et al, 1964;Spenney et al, 1971;Bhatt et al, 1981;Lindley-Jones et al, 2004;Wakasaya et al, 2009 andAlhaji et al, 2011). In addition, three case series are described in the human literature (Garcia-Palmieri & Ramirez, 1957 reported on 5 cases; Patel et al 1961 on 17 cases andVakil et al, 1964 on 11 cases).…”

Section: Discussionmentioning

confidence: 99%

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Recurrent tetanus in a donkey

Kay

Souhail

Mazan

2021

Equine Veterinary Education

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Summary This report describes a case of a non‐lethal tetanus in a donkey that re‐presented 9 months after discharge with a second episode of tetanus. This is the first time “recurrent” tetanus has been reported in equids, although it is a recognised, albeit rare occurrence in humans. This case illustrates the fact that natural infection did not confer immunity in this particular donkey. This highlights the importance of tetanus toxoid vaccination even for animals that recover from the disease.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Recurrent tetanus in a donkey

Kay

Souhail

Mazan

2021

Equine Veterinary Education

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“…Nevertheless, a case of malignant tumor-associated tetanus, in which three inoculations of toxoid failed to activate immunity, likely due to the effect of cancer-induced immunodeficiency, has been reported [27]. At present, these is no clear evidence on how many toxoid inoculations should be given to cancer-bearing patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, as tetanus is prone to recurrence, the acquisition of active immunity is essential to prevent recurrence after remission. Multiple doses of vaccination may be required to ensure adequate antibody titers and immunity to tetanus are achieved in cancer patients [17,[25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review

Nomura

Sakawaki

et al. 2021

BMC Infect Dis

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Background Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer. Case presentation An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient’s symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to. Conclusion This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient’s active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.

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“…However, surgical revision, notably the ablation of this defect, should have facilitated the recovery and decreased bacterial concentration. In the literature, 3 cases of relapsing C. tetani infections have been reported, but those patients had not received antitetanus vaccine and they did show signs of tetanus ( 4 , 5 ); 1 of these patients with mandible necrosis experienced relapse 8 months after discontinuation of metronidazole. …”

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confidence: 99%