A fifteen-year-old boy presented with a complex of clinical symptoms and signs of severe malaria; fever, convulsions, loss of consciousness, severe anaemia, hypoglycaemia and that of generalised tetanus; trismus, rigidity, reflex spasticity, tiny necrotic area on the plantar surface of the foot. The patient responded very poorly to intravenous artesunate, and blood transfusion among other measures for the management of severe malaria. A history of tetanus immunization could not be established. The patient was commenced on Intravenous (IV) metronidazole 500 mg 6 hourly after the wound was debrided and dressed uncovered. Anti-tetanus immunoglobulin was administered after a test dose. IV diazepam, Chlorpromazine, and Phenobarbitone were given to control convulsion and spasticity and to relieve symptoms. The glucose flow rate was strictly maintained via the IV route for the first 24 hours and subsequently, the Nasogastric (NG) tube was passed with the introduction of feeds. The patient responded drastically and was discharged after 15 days to complete his medication on an outpatient basis and tetanus immunization.
Cite this paper
Ajetomobi, A. , Olanrewaju, P. O. , Owa, J. A. , Adedigba, E. O. and Oladipe, T. T. (2024). Co-Morbidity of Severe Malaria and Generalised Tetanus: A Rare Case Report. Open Access Library Journal, 11, e1831. doi: http://dx.doi.org/10.4236/oalib.1111831.
Dondorp, A.M., Fanello, C.I., Hendriksen, I.C., Gomes, E., Seni, A., Chhaganlal, K.D., et al. (2010) Artesunate versus Quinine in the Treatment of Severe Falciparum Malaria in African Children (AQUAMAT): An Open-Label, Randomised Trial. The Lancet, 376, 1647-1657. https://doi.org/10.1016/s0140-6736(10)61924-1
Marzuillo, P., Pezzella, V., Guarino, S., Di Sessa, A., Baldascino, M., Polito, C., et al. (2021) Acute Kidney Injury in Children Hospitalized for Community Acquired Pneumonia. Pediatric Nephrology, 36, 2883-2890. https://doi.org/10.1007/s00467-021-05022-x
Oshomah-Bello, E.O., Esezobor, C.I., Solarin, A.U. and Njokanma, F.O. (2019) Acute Kidney Injury in Children with Severe Malaria Is Common and Associated with Adverse Hospital Outcomes. Journal of Tropical Pediatrics, 66, 218-225. https://doi.org/10.1093/tropej/fmz057
Sheiban, A.K. (1999) Prognosis of Malaria Associated Severe Acute Renal Failure in Children. Renal Failure, 21, 63-66. https://doi.org/10.3109/08860229909066970
Tetanus. Center for Disease Control and Prevention. https://www.cdc.gov/tetanus/index.html#:~:text=Tetanus%20is%20an%20infection%20caused,open%20the%20mouth%20or%20swallow
Athavale, V.B., Pai, P.N., Fernandez, A., Patnekar, P.N. and Acharya, V.S. (1975) Tetanus Neonatorum. In: Jucker, E., Ed., Progress in Drug Research/Fortschritte der Arzneimittelforschung/Progrès des recherches pharmaceutiques, Birkhäuser Basel, 189-208. https://doi.org/10.1007/978-3-0348-7090-0_23
Smythe, P.M. and Bull, A. (1959) Treatment of Tetanus Neonatorum with Intermittent Positive-Pressure Respiration. BMJ, 2, 107-113. https://doi.org/10.1136/bmj.2.5143.107
Keller, M.A. and Stiehm, E.R. (2000) Passive Immunity in Prevention and Treatment of Infectious Diseases. Clinical Microbiology Reviews, 13, 602-614. https://doi.org/10.1128/cmr.13.4.602
Kwambele, L., Ndeezi, G., Ortiz, Y.A., Twesigemuka, S., Nduwimana, M., Egesa, W.I., et al. (2023) Factors Associated with Acute Kidney Injury among Children with Severe Malaria at Kiryandongo General Hospital, Uganda. International Journal of Pediatrics, 2023, Article 2139016. https://doi.org/10.1155/2023/2139016
de Barros Miranda-Filho, D., de Alencar Ximenes, R.A., Barone, A.A., Vaz, V.L., Vieira, A.G. and Albuquerque, V.M.G. (2004) Randomised Controlled Trial of Tetanus Treatment with Antitetanus Immunoglobulin by the Intrathecal or Intramuscular Route. BMJ, 328, Article 615. https://doi.org/10.1136/bmj.38027.560347.7c
Kabura, L., Ilibagiza, D., Menten, J. and Van den Ende, J. (2006) Intrathecal vs. Intramuscular Administration of Human Antitetanus Immunoglobulin or Equine Tetanus Antitoxin in the Treatment of Tetanus: A Meta‐Analysis. Tropical Medicine & International Health, 11, 1075-1081. https://doi.org/10.1111/j.1365-3156.2006.01659.x
Ganesh Kumar, A.V., Kothari, V.M., Krishnan, A. and Karnad, D.R. (2004) Benzathine Penicillin, Metronidazole and Benzyl Penicillin in the Treatment of Tetanus: A Randomized, Controlled Trial. Annals of Tropical Medicine & Parasitology, 98, 59-63. https://doi.org/10.1179/000349804225003037
Tahery, J., Morris, D.P. and Birzgalis, A.R. (2004) Tetanus: The ‘Forgotten Disease’. A Rare Cause of Dysphagia and Trismus. The Journal of Laryngology & Otology, 118, 974-976. https://doi.org/10.1258/0022215042790529
Paterson, A.W., Ryan, W. and Rao-Mudigonda, V.V. (2006) Trismus: Or Is It Tetanus? A Report of a Case. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 101, 437-441. https://doi.org/10.1016/j.tripleo.2005.04.013
De La Tour, E.H., Tardieu, C., Tabary, J.C. and Tabary, C. (1979) Decrease of Muscle Extensibility and Reduction of Sarcomere Number in Soleus Muscle Following a Local Injection of Tetanus Toxin. Journal of the Neurological Sciences, 40, 123-131. https://doi.org/10.1016/0022-510x(79)90198-9
