{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:10:34Z","timestamp":1772165434602,"version":"3.50.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Emerg Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Tetanus is a rare disease caused by\n                      <jats:italic>Clostridium tetani<\/jats:italic>\n                      , which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low\u2013middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a case of a 7-year-old girl presented to our institution with a history of falling 10\u2009days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with \u201clockjaw.\u201d Perioperative management of this rare case is reported and discussed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12245-021-00346-9","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T06:09:55Z","timestamp":1619158195000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review"],"prefix":"10.1186","volume":"14","author":[{"given":"Dzulfikar D. 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Tetanus | Clinical Information | Lockjaw | CDC. 2019. Available at http:\/\/www.cdc.gov\/tetanus\/index.html."},{"key":"346_CR2","unstructured":"World Health Organization. WHO vaccine-preventable diseases: monitoring system. 2020 global summary. Available at https:\/\/apps.who.int\/immunization_monitoring\/ globalsummary"},{"issue":"6","key":"346_CR3","first-page":"1","volume":"1","author":"L Ganti","year":"2019","unstructured":"Ganti L, Stead T, Daneshvar Y, et al. GCS 15: when mild TBI isn\u2019t so mild. Neurol Res Pract. 2019;1(6):1\u20138.","journal-title":"Neurol Res Pract."},{"issue":"9","key":"346_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6609a1","volume":"66","author":"CA Taylor","year":"2017","unstructured":"Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013. 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Her family was present at the time.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"We have an attachment from the child\u2019s parents consenting for this case report for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"25"}}