TETANUS FROM WOUND CONTAMINATION BY ELEPHANT DUNG: A CASE REPORT AND REVIEW OF THE RECOGNITION AND EVIDENCE-BASED MANAGEMENT OF ACUTE TETANUS INFECTION

Tetanus, a vaccine-preventable neuroinvasive disease, is caused by Clostridium tetani. Although incidence rates in the western world have decreased drastically when compared with developing nations, these numbers will be on the rise given the increasing immigration rates to developed countries, as seen in recent outbreaks of several other vaccine-preventable diseases in the United States of America. This article highlights a case of a Zimbabwean man with an unexpected method of C. tetani inoculation through application of elephant dung on a malignant foot lesion, and the need for western-world physicians to be aware of this unique presentation. This review emphasizes the utmost importance of early and accurate tetanus diagnosis, and provides a review of the available literature on its coordinated multidisciplinary management approach, most of which is supportive and includes source control, toxin neutralization, airway management, muscle spasm control, hemodynamic support with vasopressors, adequate nutrition, and a discussion on vaccination. Given the bolstering immigration rates, vaccine-preventable diseases, such as tetanus, will become more prevalent in developed nations given that a large proportion of individuals from developing nations are unvaccinated. Physicians in the western world should be aware of these circumstances, and should target these patients in order to stride towards eradication of vaccine-preventable diseases such as tetanus.