Atypical presentations in children with post-neonatal tetanus in Ibadan, Nigeria

In a retrospective review of 73 children with post-neonatal tetanus seen over an 11-year period at University College Hospital, Ibadan, Nigeria, atypical portals of entry of the causative agent were recorded in nine and five developed unusual complications during the course of treatment for tetanus. Localized tetanus was encountered in seven children; this involved the cephalic region in one and one lower limb in each of the remaining six. Among these six children, the portal of entry of the organism included intramuscular injections into the buttock in five and an infected insect bite on the buttock in one case. Another unusual portal of entry, observed in two children, was through an impacted foreign body in the ear in the absence of otitis media. Arthritis of large joints was encountered in three children and two had episodes of severe bronchospasm which responded to bronchodilator treatment. The findings in this study significantly widen the reported spectrum of presentations and complications of tetanus in third-world children.