Rare Survival of a 9-Year-Old Boy Managed for Post-Neonatal Tetanus Without Intensive Care at Soroti Regional Referral Hospital, Uganda: A Case Report.

BACKGROUND: Tetanus is a vaccine-preventable disease caused by neurotoxin from Clostridium tetani bacteria. Although neonatal tetanus has declined in many settings, post-neonatal tetanus continues to occur in low-resource countries where vaccination coverage and booster implementation remain suboptimal. Mortality in post-neonatal tetanus remains high, particularly where intensive care services are limited.

CASE PRESENTATION: We report a 9-year-old African boy who presented three days after a minor toe injury with generalized painful muscular spasms, trismus, and hypertonia consistent with generalized tetanus (Ablett classification- Grade 3). He neither received the tetanus vaccine during infancy nor any boosters prior to this injury. He was managed on the general paediatric ward in a dark, quiet room without access to intensive care. He was hospitalized for 25 days and his treatment included wound care, antibiotics, nasogastric feeding, bladder catheterization, and alternating sedation with diazepam and chlorpromazine. Due to limited availability, human tetanus immunoglobulin was administered 10 days after hospital admission. The child recovered and was discharged alive.

CONCLUSION: Post-neonatal tetanus can be successfully managed in low-resource settings with strong supportive care even in the absence of intensive care services. Human tetanus immunoglobulin may still improve outcomes even when administered several days after exposure.