Did we forget tetanus?

Abstract

Introduction. Currently, in our country (Republic of Serbia) tetanus is a rarely occurring disease, mainly affecting people older than 65 years of age. A small number of reported cases is mainly due to appropriate immunization. Therefore, each case of tetanus may be considered as failure of health care system to provide adequate immunization. Case outline. A 71-year-old woman was injured in her garden. She sustained laceration in the left coccygeal region. The next day the wound was treated by a surgeon, but tetanus postexposure prophylaxis was not administrated. On the fifth day following the incident, the symptoms and signs of tetanus became apparent, and the patient died two days later. Postmortem examination revealed the wound that was not adequately treated, since there was a foreign body and a dressing inserted in the wound. Signs of acute (aerobic) infection were also present. Conclusion. Tetanus is a severe, potentially lethal disease that is absolutely preventable. Mistakes in immunization and surgical treatment of the wound can be considered as medical malpractice.Uvod. U Srbiji se tetanus kao bolest danas javlja retko, uglavnom kod osoba starijih od 65 godina. Mali broj registrovanih slucajeva oboljenja rezultat je odgovarajuce imunizacije, pa se pojava tetanusa stoga moze smatrati propustom zdravstvene sluzbe da obezbedi adekvatnu imunizaciju. Prikaz bolesnika. Zena stara 71 godinu povredila se u basti zadobivsi ranu u predelu levog kuka. Rana je obradjena narednog dana, ali kod povredjene zene nije primenjena postekspoziciona profilaksa tetanusa. Petog dana od povrede javili su se simptomi i znaci tetanusa, a dva dana kasnije zena je umrla. Obdukcijom je ustanovljeno da povreda nije adekvatno obradjena - u rani je bila strajfna, uocena su i zaostala strana tela, kao i znaci akutne (aerobne) infekcije. Zakljucak. Tetanus je teska i potencijalno smrtna bolest koja se potpuno moze spreciti. Propusti u imunizaciji i hirurskoj obradi rana, ukoliko dodje do razvoja tetanusa, mogu predstavljati elemente nesavesnog lecenja bolesnika.