An Unusual Case of Tetanus Masquerading as an Acute Abdomen: A Case Report

Abstract

Introduction: Tetanus is an acute onset neurological disease that is often lethal. It has a high disease burden in low and middle-income countries. Tetanus is caused by a toxin made by spores of the bacterium Clostridium tetani, which are found in soil, dust, and animal feces. The toxin impairs the motor neurons leading to muscle stiffness. However, with the development of a toxoid vaccine, the incidence has sharply declined and is now categorized as a vaccine-preventable disease. The treatment of tetanus is primarily supportive and focuses on managing the complications until the effects of toxins resolve. Case Report: We report the case of a 67-year-old farmer who previously sustained a laceration injury approximately 45 days prior to presenting to the emergency department with abdominal pain and rigidity. After a comprehensive evaluation to rule out other items in the differential diagnoses, he was diagnosed with tetanus based on clinical symptoms and ultimately required mechanical ventilation. The patient was then managed in the intensive care unit and later made an uneventful recovery. Conclusion: This case illustrates an uncommon presentation of tetanus and the latency of the infectious process. Often when patients present with atypical symptoms, it poses a diagnostic dilemma to the clinicians. Thus, it is very important to carefully elicit a history of contaminated injury. This case also highlights the importance of prophylactic vaccine in low and middle-income countries, which can reduce disease-related mortality and morbidity.

Current prevention and treatment of posttraumatic tetanus in Ningxia

“…The research results of Dai Cheng [12] showed that the mortality rate of patients who underwent standard wound debridement was signi cantly lower than that of those who did not. A common feature can also be found in many reports of tetanus: the wounds after contamination were not treated with timely standard debridement [13][14][15][16][17] . Therefore, standardized wound management is very necessary.…”

“…Among them, 40.2% (153/381) were male and 59.8% (228/381) were female; 46.7% (178/381) were nurses, 53.3% (203/381) were physicians; Junior professional title accounted for 49.9% (190/381), intermediate professional title accounted for 33.9% (129/381), senior professional title accounted for 16.3% (62/381); Among the working experience, 14.4% (55/381) were less than 5 years, 51.4% (196/381) were 5-14 years, 13.6% (52/381) were 15-50 years, and 20.5% (78/381) were more than 20 years. Among the working departments, gynecology and obstetrics accounted for 15 The quali ed rate of nurses was 2.81% (5/173) and that of physicians was 14.29% (29/174). There were statistical differences in the knowledge level of tetanus prevention among different professions (χ 2 = 15.37, P < 0.01), doctors' professional cognition of tetanus prevention and treatment was higher than that of nurses.…”

Localized tetanus mimics acute perforated viscus: A diagnostic challenge and review of case reports

“…Radiographic imaging may rule out serious causes of acute abdomen. [ 5 ] However, a thorough history of traumatic injuries, wounds, or infection and vaccination history should be obtained in a patient presenting with abdominal rigidity. Arching of the back may be an associated feature, and excluding other etiologies is essential.…”

“…All of the cases were male, and most of them did not have any vaccination history. [ 5 7 9 10 11 ] Most of the patients have successful recovery with tetanus toxoid and/or tetanus immunoglobulin, except for two cases that succumbed to death due to atypical presentation and late diagnosis. [ 6 10 ] Moreover, the presentation of abdominal tetanus varies at presentation.…”

“…[ 6 10 ] Moreover, the presentation of abdominal tetanus varies at presentation. [ 5 6 7 8 9 10 11 ]…”