In this study, we reported a case report of a 7-year-old girl with inadequate immunization status that had a head injury and initially received suboptimal wound care, which led to tetanus and performed craniotomy debridement. The World Health Organization reported that there were 391 cases of tetanus in children and neonates in Indonesia in 2019. Although prevention has been incorporated in our national immunization program by the Indonesia Health Ministry, tetanus remains one of our major health problems. Nearly all tetanus cases are among people who did not get the recommended tetanus vaccination, which include people who have never received a tetanus vaccine and adults who do not have their 10-year booster shots. This is a preventable disease with available vaccinations. Seizures may occur and the autonomic nervous system may also be affected. Tetanospasmin (metalloprotease) produced by this bacterium travels through axons in a retrograde fashion to CNS leads to unopposed muscle contraction and spasm. Although tetanolysin plays no direct role in the clinical manifestations of tetanus, it is thought to optimize the milieu for bacterial proliferation. Tetanolysin damages surrounding tissue and is also capable of hemolysis. The spores develop to become bacteria when they enter the body usually due to cuts or puncture wounds caused by contaminated objects. Spores of tetanus bacteria are everywhere in the environment and enters the body through damaged skin. It is different from other vaccine-preventable diseases because it does not spread from person to person. Tetanus is an infection that involves the nervous system, caused by a bacterium known as Clostridium tetani ( C. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery. 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. 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 “lockjaw.” Perioperative management of this rare case is reported and discussed. We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. Despite widespread vaccination, especially in low–middle-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 2018, there were only approximately ten tetanus cases reported in Indonesia. Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin.
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