Generalized tetanus as a complication of closed fracture of the tibia and the fibula

Abstract

Introduction: Tetanus is a preventable infectious disease that can cause death. The clinical manifestations are due to a powerful toxin secreted by Clostridiumtetani, a Gram-positive bacillus that penetrates through losses of skin continuity, regardless of the wound's size.
Objective: To present the clinical evolution of a female patient living in a rural area in Latacunga, Cotopaxi, Ecuador.
Development: Patient with no history of previous immunization who went to the emergency room due to a closed fracture of the tibia and the fibula in the left lower limb as a result of a traffic accident. The clinical diagnosis of generalized tetanus was based on the appearance on the ninth day of dysphagia´s trauma, trismus, nuchal rigidity, and later on: generalized contractures with opistho-tonus, cardiorespiratory arrest, and autonomic dysfunction. With a prolonged hospital stay of 82 days, she received anesthesia under critical conditions in 15 occasions, and suffered serious complications. She remained for 46 days in the intensive care unit.
Conclusions: This case emphasizes the permanent threat of tetanus in this environment, as well as the need to implement immunization schemes in a more comprehensive and constant manner.