- Liberia. A baby 8 days of age has not eaten anything since the morning. His fists are clenched. In the evening the child convulses. Lumbar puncture reveals normal CSF. The following morning an opisthotonus is observed. What do you do?
- Should you vaccinate the mother of the child referred to above against tetanus?
- Four days later the child develops a temperature of 39°C. Breathing is rapid. What complications could have occurred? How could this have been avoided?
- Laos. A man aged 40 has had a temperature of 38.6°
C for 4 days. He can no longer open his mouth. He has pain over the right jaw, which has thickened. What do you think?
- A man has been stabbed in the leg. He has probably already been correctly vaccinated against tetanus. Would it be dangerous or contra-indicated to vaccinate him against tetanus again?
- Mexico. A man aged 26 years is admitted with convulsions. He is given diazepam IV. After 20 minutes he has another convulsion, first only in the left arm but then in the whole of the left hand side of the body and then generalised. A few small subcutaneous nodules can be felt in the arms upon palpation. Should he be given human anti-tetanus serum? Would an X-ray of the skull, shoulders and legs be useful?
- Thailand. A man is bitten by an unknown dog. What do you do?
- In the area where you work there is a high incidence of neonatal tetanus. You are asked whether something can be done.
- Can someone develop tetanus twice?
- A man is admitted with suspected meningitis. A lumbar puncture was traumatic and revealed some bloody fluid. You observe repeated convulsions and muscle stiffness. No wound can be found on the body. Is tetanus still a possibility? Which clinical sign is useful for distinguishing between tetanus and meningo-encephalitis?
- North Thailand. A child of 3 years of age develops fever followed by convulsions and goes into a coma next day. An anti-malarial treatment is given but without success. What do you think?
- The Philippines. A woman aged 19 develops convulsions and stupor. There is no neck stiffness, the CSF is clear, a thick film is negative, glycaemia is 100 mg %, blood pressure is 11/7. There is no heart murmur and the pulse is regular. There is no previous history of convulsions according to her friend. There is no known injury. The X-ray of the skull shows no small calcifications. No subcutaneous nodules can be found on palpation. Why were the above-mentioned investigations carried out? Are other diagnoses possible and what do you do?
