Generalized Tetanus Associated With Malaria and Probable Meningitis in a 4-Year-Old Patient: A Case Report in Limbe Regional Hospital, Cameroon

Abstract

Tetanus is a life-threatening disease preventable by immunization through vaccines. In resource-limited settings, its association with other acute infections should be managed cautiously. A 4-year-old unvaccinated male was referred from a nearby hospital for better management of severe malaria and probable enteric fever, after presenting there with febrile seizures, neck stiffness, and vomiting. Shortly after admission, he developed trismus, recurrent generalized paroxysmal muscle spasms, and opisthotonos. Given the clinical features and lack of antitetanic immunization, a diagnosis of tetanus and cerebral malaria was established, with probable bacterial meningitis as a relevant differential. Owing to the caregiver's financial constraints, no specific investigations were carried out. The patient was admitted to the intensive care unit (ICU) and empirically treated for all three likely diagnoses, with anti-tetanus toxoid, antibiotics, and antimalarial. Despite limited supportive care, the patient's condition considerably improved within the first 48 h in the ICU, and he spent 5 additional days in the hospital before being discharged.