Neonatal Tetanus in a Paediatric Patient in Sub-Saharan Africa.
A’s mother brought her to the local health clinic after noticing increased irritability, stiffness, and difficulty feeding. A has been having episodes of muscle spasms that began around day 8 of life.
A was born at home with the assistance of a traditional birth attendant. The umbilical cord was cut with a non-sterile instrument, and the stump was treated with herbal remedies, a common practice in the community. A was born at full term and had no complications during delivery. Her mother did not receive any vaccinations during pregnancy, and there was no prenatal care.
Vitals: Temperature 39.0°C, heart rate 180 bpm, respiratory rate 60 breaths per minute.
General Appearance: A appears lethargic and irritable, with muscle stiffness evident in her limbs. She exhibits opisthotonos (arching of the back) during spasms.
Neurological Exam: A has a high-pitched cry and exhibits hypertonia with exaggerated reflexes. She has difficulty opening her mouth (trismus) and shows signs of distress with bright lights and sounds.
Other Systems: The umbilical stump is dry but has surrounding redness and purulent discharge. There are no signs of organomegaly or respiratory distress.
Laboratory tests are limited in the rural setting, but based on the clinical presentation, the healthcare provider strongly suspects neonatal tetanus due to the unsanitary conditions of cord care.
No specific blood tests are conducted, as the diagnosis is primarily clinical.
Diagnosis: Neonatal tetanus, likely caused by Clostridium tetani infection following improper cord care.
- Antibiotic Therapy: A was started on intravenous penicillin to combat the tetanus infection.
- Tetanus Immunoglobulin (TIG): Administered to neutralize the tetanus toxin and provide passive immunity.
- Muscle Relaxants: Diazepam was given to help manage the severe muscle spasms and prevent respiratory distress.
- Supportive Care: A was placed in a quiet, darkened room to minimize stimuli that could provoke spasms. Intravenous fluids were initiated for hydration and nutritional support.
- Referral: Given her critical condition, A was referred to a regional hospital for intensive monitoring and possible advanced interventions.
Neonatal tetanus carries a high mortality rate, especially in rural areas with limited healthcare access. Prompt treatment can improve survival chances, but Amina remains at risk for long-term neurological complications. Early maternal vaccination and proper neonatal care are crucial in preventing future cases in the community.
a). Infected animal contact
b). Unsanitary umbilical cord care
c). Maternal infection during pregnancy
d). Hospital-acquired infection
a). High fever and irritability
b). Trismus and generalized muscle stiffness
c). Increased feeding and activity
d). Abdominal distension
a). Antipyretics
b). Intravenous fluids
c). Broad-spectrum antibiotics and tetanus immunoglobulin
d). Oral rehydration solution
a). Antenatal care and maternal tetanus vaccination
b). Proper hand hygiene
c). Institutional deliveries
d). Early initiation of breastfeeding
