{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T13:43:33Z","timestamp":1761486213063},"reference-count":15,"publisher":"California Digital Library (CDL)","issue":"4","license":[{"start":{"date-parts":[[2020,10,9]],"date-time":"2020-10-09T00:00:00Z","timestamp":1602201600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Tetanus is an acute onset neurological disease that is often lethal. It has a high disease burden in low and middle-income countries. Tetanus is caused by a toxin made by spores of the bacterium Clostridium tetani, which are found in soil, dust, and animal feces. The toxin impairs the motor neurons leading to muscle stiffness. However, with the development of a toxoid vaccine, the incidence has sharply declined and is now categorized as a vaccine-preventable disease. The treatment of tetanus is primarily supportive and focuses on managing the complications until the effects of toxins resolve.\n\nCase Report: We report the case of a 67-year-old farmer who previously sustained a laceration injury approximately 45 days prior to presenting to the emergency department with abdominal pain and rigidity. After a comprehensive evaluation to rule out other items in the differential diagnoses, he was diagnosed with tetanus based on clinical symptoms and ultimately required mechanical ventilation. The patient was then managed in the intensive care unit and later made an uneventful recovery.\n\nConclusion: This case illustrates an uncommon presentation of tetanus and the latency of the infectious process. Often when patients present with atypical symptoms, it poses a diagnostic dilemma to the clinicians. Thus, it is very important to carefully elicit a history of contaminated injury. This case also highlights the importance of prophylactic vaccine in low and middle-income countries, which can reduce disease-related mortality and morbidity.<\/jats:p>","DOI":"10.5811\/cpcem.2020.8.49073","type":"journal-article","created":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T06:11:29Z","timestamp":1605593489000},"page":"599-602","source":"Crossref","is-referenced-by-count":3,"title":["An Unusual Case of Tetanus Masquerading as an Acute Abdomen: A Case Report"],"prefix":"10.5811","volume":"4","author":[{"given":"Rahul","family":"Thakur","sequence":"first","affiliation":[{"name":"B.P. Koirala Institute of Health Sciences, Department of Emergency Medicine, Dharan, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajshree","family":"Singh","sequence":"additional","affiliation":[{"name":"Nepalese Army Institute of Health Sciences College of Medicine, Department of Emergency Medicine, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabin","family":"Nepal","sequence":"additional","affiliation":[{"name":"Nepalgunj Medical College and Teaching Hospital, Department of Radiology, Bheri, NepalNepalgunj Medical College and Teaching Hospital, Department of Radiology, Bheri, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prasanna","family":"Ghimire","sequence":"additional","affiliation":[{"name":"Nepalgunj Medical College and Teaching Hospital, Department of Radiology, Bheri, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2020,10,9]]},"reference":[{"key":"ref0","unstructured":"European Centre for Disease Prevention and Control. Disease factsheet about tetanus. Available at: https:\/\/www.ecdc.europa.eu\/en\/tetanus\/facts. Accessed June 25, 2020."},{"key":"ref1","unstructured":"(2015). Tetanus. In: Hamborsky J, Kroger A, Wolfe C (Eds.), Epidemiology and Prevention of Vaccine-Preventable Diseases: the Pink Book: Course Textbook. Washington DC: Centers for Disease Control and Prevention."},{"key":"ref2","unstructured":"Government of Nepal. Ministry of Health and Population. Department of Health Service. Annual Report 2017\/2018. Available at: https:\/\/dohs.gov.np\/wp-content\/uploads\/2019\/07\/DoHS-Annual-Report-FY-2074-75-date-22-Ashad-2076-for-web-1.pdf. Accessed August 7, 2020."},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Cook TM, Protheroe RT, Handel JM. Tetanus: a review of the literature. Br J Anaesth. 2001;87(3):477-87.","DOI":"10.1093\/bja\/87.3.477"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Trung TN, Duoc NVT, Nhat LTH, et al. Functional outcome and muscle wasting in adults with tetanus.\u00a0Trans R Soc Trop Med Hyg. 2019;113(11):706-13.","DOI":"10.1093\/trstmh\/trz055"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Filippone A, Cianci R, Delli Pizzi A, et al. CT findings in acute peritonitis: a pattern-based approach.\u00a0Diagn Interv Radiol. 2015;21(6):435-40.","DOI":"10.5152\/dir.2015.15066"},{"key":"ref6","unstructured":"Chan ST and Kang CH. A case of tetanus mimicking acute abdomen. Singapore Med J. 1994;35(6):641-2."},{"key":"ref7","unstructured":"Laha N. A case of tetanus simulating acute abdomen. Ind Med Gaz. 1942;77(11):677-8."},{"key":"ref8","unstructured":"Cattaneo I and Vercillo L. Addome acuto medico da tetano [A case of acute abdomen caused by tetanus].\u00a0Prog Med (Napoli). 1956;12(1):21-5."},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Tihista JA, Guergu\u00e9 JM, Os\u00e9s I, et al. T\u00e9tanos en una unidad de cuidados intensivos que simula un abdomen agudo [Tetanus at an intensive care unit simulating acute abdomen].\u00a0Med Clin (Barc). 2000;114(5):197-8.","DOI":"10.1016\/s0025-7753(00)71240-1"},{"key":"ref10","unstructured":"Sako FB, Sylla AO, Diallo MOS, et al. Tetanus: epidemiology and factors associated with death in the Department of Tropical and Infectious Diseases of Donka National Hospital, Guinea. Med Sante Trop. 2019;29(3):333-6."},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Garcia-Palmieri MR and Ramirez R. Generalized tetanus: analysis of 202 cases. Ann Intern Med. 1957;47(4):721-30.","DOI":"10.7326\/0003-4819-47-4-721"},{"key":"ref12","unstructured":"Ferguson CM. (1990). Inspection, auscultation, palpation, and percussion of the abdomen. In: Walker HK, Hall WD, Hurst JW, eds,\u00a0Clinical Methods: The History, Physical, and Laboratory Examinations 3rd ed. Boston: Butterworths."},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Hammarlund E, Thomas A, Poore EA, et al. Durability of vaccine-induced immunity against tetanus and diphtheria toxins: a cross-sectional analysis [published correction appears in Clin Infect Dis. 2016;63(1):150]. Clin Infect Dis. 2016;62(9):1111-8.","DOI":"10.1093\/cid\/ciw066"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Havers FP, Moro PL, Hunter P, et al. Use of Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2019.\u00a0MMWR Morb Mortal Wkly Rep. 2020;69(3):77-83.","DOI":"10.15585\/mmwr.mm6903a5"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2020,11,19]],"date-time":"2020-11-19T20:20:24Z","timestamp":1605817224000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/0ff2m0wg"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,9]]},"references-count":15,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,11,10]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2020.8.49073","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2020,10,9]]}}}