title: [Tetanus in a young unvaccinated girl after a fall in the street].
abstract: A 4-year-old girl developed tetanus after she had fallen on the street a week before. She had never been vaccinated and despite pressure from the family practitioner, the parents refused to allow her to be given human anti-tetanus immunoglobulin as a matter of principle after the wound had been stitched. Seven days later she was admitted to hospital with trismus and risus sardonicus. Upon initial treatment with human anti-tetanus immunoglobulin and penicillin, and subsequently metronidazole, her clinical condition deteriorated with opisthotonus and life-threatening respiratory insufficiency, upon which she was moved to the intensive-care department where she was intubated and mechanically ventilated for two weeks. Finally she made a complete clinical recovery. Thanks to the extensive national vaccination program, tetanus has become a rare disease in the Netherlands. However, the very serious course and possible fatal outcome warrant a keen attitude and adequate treatment.
authors.affiliation: Afd. Algemene Pediatrie, Universitair Medisch Centrum, locatie Wilhelmina Kinderziekenhuis, Utrecht. k.m.dolman@amc.uva.nl
authors.forename: K M
authors.initials: KM
authors.lastname: Dolman
authors.forename: F B
authors.initials: FB
authors.lastname: Plötz
authors.forename: T F W
authors.initials: TF
authors.lastname: Wolfs
authors.forename: J H J
authors.initials: JH
authors.lastname: Beunders
authors.forename: A J
authors.initials: AJ
authors.lastname: van Vught
mesh_terms: D000058:Accidental Falls; D002675:Child, Preschool; D005260:Female; D006801:Humans; D011379:Prognosis; D012720:Severity of Illness Index; D013742:Tetanus / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D013743:Tetanus Antitoxin / Q000008:administration & dosage / Q000627:therapeutic use*; D013745:Tetanus Toxoid
chemical_list: D013743:Tetanus Antitoxin; D013745:Tetanus Toxoid