Abstract Ref Number = APCP967
NEONATAL TETANUS: A CASE SERIES FROM WEST BORNEO
Felicia Dewi,Stella Vindy Surjadi,Angelia Rachma Dewi
RS Fatima RS Fatima
Background : Tetanus is an acute, spastic paralytic illness with high morbidity and mortality especially in developing countries. It is caused by neurotoxin (tetanospasmin) produced by Clostridium tetani. It can rapidly progress into life-threatening muscle spasms accompanied by respiratory insufficiency and autonomic dysfunction. Neonatal tetanus has become a rare disease nowadays. Infants with inadequate tetanus toxoid immunization mothers, an umbilical stump cut with a nonsterile instrument and inappropriate postnatal cord care are at high risk. As neonatal tetanus become less common, cases are likely to be unrecognized and decreased vigilance of this disease.
Case Presentation Summary : There were 3 full-term infants, 2 were males, diagnosed with neonatal tetanus during January to December 2016. The range of presenting age was 4-9 day old. They came with poor feeding, low-grade fever, muscle rigidity, and episode of convulsions. All patients came from mother with low socioeconomic and educational background with no history of tetanus toxoid immunization and unknown antenatal care history. All mothers delivered at home with the assistance of an untrained birth attendant and nonsterile substance given to umbilical cord such as herbs, honey, and ash. Physical examination showed generalized muscular rigidity, trismus, and continuing refractory convulsion within five days of admission. All patients were treated with human tetanus immunoglobulin 250 IU, intravenous phenytoin or phenobarbital, cefotaxime, metronidazole, oxygen and orogastric feeding. One patient was taken home forcibly by his parents and the others were referred to another hospital due to financial problem. One patient survived after 43 days of intense treatments and the other one died after 3 days hospitalization.
Learning Points/Discussion : Neonatal tetanus is potentially lethal disease, thus early diagnosis and prompt treatment are crucial. The only effective prevention strategy against this infection is maternal vaccination and hygienic delivery by well-trained assistance.
Keywords: convulsion generelized tetanus neonatal tetanus trismus