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Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

  • Hakim, Dzulfikar D. L.1
  • Faried, Ahmad2
  • Nurhadiya, Adila1
  • Laymena, Ericko H.2
  • Arifin, Muhammad Z.2
  • Imron, Akhmad2
  • Abdulrachman, Iwan2
  • 1 Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Bandung, Indonesia , Bandung (Indonesia)
  • 2 Faculty of Medicine, Universitas Padjadjaran - Dr Hasan Sadikin Hospital, Bandung, Indonesia , Bandung (Indonesia)
Published Article
International Journal of Emergency Medicine
Springer Berlin Heidelberg
Publication Date
Apr 23, 2021
DOI: 10.1186/s12245-021-00346-9
Springer Nature


BackgroundTetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group.Case presentationWe report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed.ConclusionThe pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

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