{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T16:55:03Z","timestamp":1743267303498,"version":"3.38.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T00:00:00Z","timestamp":1741392000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T00:00:00Z","timestamp":1741392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["JA Clin Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>We report a case of tetanus developed after inguinal hernia repair without traumatic wounds, which was difficult to be diagnosed under sedation with mechanical ventilation for pneumonia and anaphylactic shock.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>The 67-year-old Japanese male underwent inguinal hernia repair with ileal resection. On postoperative day (POD) 9, he was admitted to the ICU due to dyspnea and worsening oxygenation. Immediately after tazobactam piperacillin was administered as empiric treatment for aspiration pneumonia, anaphylaxis developed, requiring tracheal intubation and continuous intravenous adrenaline. On POD 10, sedative titration increased his extremities\u2019 muscle rigidity; weaning from mechanical ventilation was difficult, while he could communicate. On POD 15, tetanus was diagnosed based on the physical examination findings prior to ICU admission.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Tetanus should be considered when patients show abnormal hypertension and no impaired consciousness during muscle rigidity, even in the absence of obvious trauma.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s40981-025-00779-8","type":"journal-article","created":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T06:04:32Z","timestamp":1741413872000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Difficult diagnosis of tetanus in a sedated patient after ileal resection"],"prefix":"10.1186","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9865-4234","authenticated-orcid":false,"given":"Satoko","family":"Noguchi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiji","family":"Hashiba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,8]]},"reference":[{"key":"779_CR1","doi-asserted-by":"publisher","first-page":"S155","DOI":"10.5005\/jp-journals-10071-23829","volume":"25","author":"DR Karnad","year":"2021","unstructured":"Karnad DR, Gupta V. Intensive care management of severe tetanus. Indian J Crit Care Med. 2021;25:S155\u201360. https:\/\/doi.org\/10.5005\/jp-journals-10071-23829.","journal-title":"Indian J Crit Care Med"},{"key":"779_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.idcr.2020.e01005","volume":"22","author":"G Sivasubramanian","year":"2020","unstructured":"Sivasubramanian G. Generalized tetanus in a landscaper without obvious wounds. IDCases. 2020;22: e01005. https:\/\/doi.org\/10.1016\/j.idcr.2020.e01005.","journal-title":"IDCases"},{"key":"779_CR3","doi-asserted-by":"publisher","first-page":"1848.e3","DOI":"10.1016\/j.ajem.2015.04.069","volume":"33","author":"K Miya","year":"2015","unstructured":"Miya K, Shimojo N, Koyama Y, Enomoto Y, Hagiya K, Yamasaki Y, Nishino T, Kawano S, Mizutani T. Efficacy of concomitant use of dexmedetomidine and propofol in tetanus. Am J Emerg Med. 2015;33:1848.e3-e4. https:\/\/doi.org\/10.1016\/j.ajem.2015.04.069.","journal-title":"Am J Emerg Med"},{"key":"779_CR4","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.71432","volume":"16","author":"K Sivagurunathan","year":"2024","unstructured":"Sivagurunathan K, Kaneshamoorthy P, Mathievaanan A, Jegathesan N, Thampipillai P. Silent entry: the diagnostic challenge of tetanus without an obvious wound. Cureus. 2024;16: e71432. https:\/\/doi.org\/10.7759\/cureus.71432.","journal-title":"Cureus"},{"key":"779_CR5","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/jgf2.153","volume":"19","author":"Y Tomoda","year":"2018","unstructured":"Tomoda Y, Kagawa S, Kurata S, Nakatake N, Tanaka K. Tetanus without apparent history of trauma. J Gen Fam Med. 2018;19:61\u20132. https:\/\/doi.org\/10.1002\/jgf2.153.","journal-title":"J Gen Fam Med"},{"key":"779_CR6","unstructured":"Centers for Disease Control and Prevention (CDC). Tetanus surveillance \u2013 United States, 2001\u20132008. MMWR Morb Mortal Wkly Rep. 2011;60:365\u20139. PMID: 21451446."},{"key":"779_CR7","doi-asserted-by":"publisher","unstructured":"Umemoto D, Shibata Y, Mori H, Shindo K. [Tetanus: the clinical features of 11 cases]. Rinsho Shinkeigaku. 2021;61:537\u201342 (in Japanese) https:\/\/doi.org\/10.5692\/clinicalneurol.cn-001583.","DOI":"10.5692\/clinicalneurol.cn-001583"},{"key":"779_CR8","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1186\/s13613-017-0333-y","volume":"7","author":"R Mahieu","year":"2017","unstructured":"Mahieu R, Reydel T, Maamar A, Tadi\u00e9 JM, Jamet A, Thille AW, et al. Admission of tetanus patients to the ICU: a retrospective multicentre study. Ann Intensive Care. 2017;7:112. https:\/\/doi.org\/10.1186\/s13613-017-0333-y.","journal-title":"Ann Intensive Care"},{"key":"779_CR9","unstructured":"Kato K, Nagasawa Z, Narita T, Funashima Y, Sato K. Rapid identification of Clostridium tetani from drain fluid of a patient with strangulated ileus, using mass spectrophotometry and DNA sequencing. The Journal of the Japanese Society for Clinical Microbiology. 2018:28;213\u20138 (in Japanese). Available at: https:\/\/www.jscm.org\/journal\/full\/02803\/028030213.pdf. Accessed Jan. 14, 2025."},{"key":"779_CR10","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1007\/s00595-011-0023-6","volume":"42","author":"M Mori","year":"2012","unstructured":"Mori M, Iida H, Miki K, Tsugane E, Sasaki M, Nagayama R, et al. Postoperative tetanus after laparoscopic obturator hernia repair for strangulated ileus: report of a case. Surg Today. 2012;42:470\u20134. https:\/\/doi.org\/10.1007\/s00595-011-0023-6.","journal-title":"Surg Today"},{"key":"779_CR11","doi-asserted-by":"publisher","first-page":"20","DOI":"10.15214\/jsodom.33.20","volume":"33","author":"M Imai","year":"2020","unstructured":"Imai M, Udagawa M, Tanaka M, Takaku Y, Yokoo S. A case of tetanus without a history of trauma. Jpn J Oral Diag. 2020;33:20\u20136. https:\/\/doi.org\/10.15214\/jsodom.33.20.","journal-title":"Jpn J Oral Diag"}],"container-title":["JA Clinical Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-025-00779-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40981-025-00779-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-025-00779-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T06:04:35Z","timestamp":1741413875000},"score":1,"resource":{"primary":{"URL":"https:\/\/jaclinicalreports.springeropen.com\/articles\/10.1186\/s40981-025-00779-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,8]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["779"],"URL":"https:\/\/doi.org\/10.1186\/s40981-025-00779-8","relation":{},"ISSN":["2363-9024"],"issn-type":[{"value":"2363-9024","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,8]]},"assertion":[{"value":"7 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 March 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The patient gave his fully informed written consent for the publication of this report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors do not have any conflict of interests regarding the content of this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"16"}}