Poverty-Related Diseases Attack Simultaneously

Barogui, Yves Thierry; Stienstra, Ymkje

doi:10.4269/ajtmh.15-0823

Cited by 1 publication

(1 citation statement)

References 3 publications

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“…Barogui et al reported a case of tetanus infection from a Bruli ulcer, which is an endemic disease in the tropics. The patient was cured of tetanus via debridement performed for the treatment of a Bruli ulcer [ 23 ]. Evidence suggests that active debridement of the infection site is important for the treatment of tetanus [ 1 , 3 , 19 – 21 ].…”

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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