Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review
Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission fr...
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| Veröffentlicht in: | BMC infectious diseases 2021-01, Vol.21 (1), p.37-37, Article 37 |
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| creator | Nomura, Kazuhito Sakawaki, Eiji Sakawaki, Sonoko Yamaoka, Ayumu Aisaka, Wakiko Okamoto, Hiroyuki Takeyama, Yoshihiro Uemura, Shuji Narimatsu, Eichi |
| description | Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer.
An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient's symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to.
This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient's active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients. |
| doi_str_mv | 10.1186/s12879-020-05739-4 |
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An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient's symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to.
This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient's active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.</description><identifier>ISSN: 1471-2334</identifier><identifier>EISSN: 1471-2334</identifier><identifier>DOI: 10.1186/s12879-020-05739-4</identifier><identifier>PMID: 33413196</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Acoustic insulation ; Anesthesia ; Bacteria ; Breast cancer ; Breast Neoplasms - complications ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Care and treatment ; Case Report ; Case reports ; Chemotherapy ; Complications and side effects ; Debridement ; Diagnosis ; Female ; Globulins ; Hospitals ; Humans ; Hyperactivity ; Infections ; Insulation ; Literature reviews ; Lymphatic Metastasis - pathology ; Metronidazole ; Middle Aged ; Neoplasm Recurrence, Local - complications ; Ostomy ; Patients ; Remission ; Risk factors ; Shielding ; Skin ; Skin Neoplasms - pathology ; Skin Neoplasms - secondary ; Skin Ulcer - complications ; Skin Ulcer - microbiology ; Surgery ; Tetanus ; Tetanus - etiology ; Tetanus - surgery ; Tetanus - therapy ; Tetanus Toxoid - therapeutic use ; Tetanus, chronic wound, breast cancer, skin ulcer, non-operative strategy ; Thorax ; Toxins ; Ulcers ; Vaccination ; Wound healing</subject><ispartof>BMC infectious diseases, 2021-01, Vol.21 (1), p.37-37, Article 37</ispartof><rights>COPYRIGHT 2021 BioMed Central Ltd.</rights><rights>2021. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c582t-c2cce268049073076cc79af808c92d69b6c4bef662aeb15d0f201e19ed749f7a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792315/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792315/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33413196$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nomura, Kazuhito</creatorcontrib><creatorcontrib>Sakawaki, Eiji</creatorcontrib><creatorcontrib>Sakawaki, Sonoko</creatorcontrib><creatorcontrib>Yamaoka, Ayumu</creatorcontrib><creatorcontrib>Aisaka, Wakiko</creatorcontrib><creatorcontrib>Okamoto, Hiroyuki</creatorcontrib><creatorcontrib>Takeyama, Yoshihiro</creatorcontrib><creatorcontrib>Uemura, Shuji</creatorcontrib><creatorcontrib>Narimatsu, Eichi</creatorcontrib><title>Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review</title><title>BMC infectious diseases</title><addtitle>BMC Infect Dis</addtitle><description>Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer.
An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient's symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to.
This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient's active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.</description><subject>Acoustic insulation</subject><subject>Anesthesia</subject><subject>Bacteria</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - complications</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Care and treatment</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Chemotherapy</subject><subject>Complications and side effects</subject><subject>Debridement</subject><subject>Diagnosis</subject><subject>Female</subject><subject>Globulins</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyperactivity</subject><subject>Infections</subject><subject>Insulation</subject><subject>Literature reviews</subject><subject>Lymphatic Metastasis - pathology</subject><subject>Metronidazole</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - 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complications</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Care and treatment</topic><topic>Case Report</topic><topic>Case reports</topic><topic>Chemotherapy</topic><topic>Complications and side effects</topic><topic>Debridement</topic><topic>Diagnosis</topic><topic>Female</topic><topic>Globulins</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hyperactivity</topic><topic>Infections</topic><topic>Insulation</topic><topic>Literature reviews</topic><topic>Lymphatic Metastasis - pathology</topic><topic>Metronidazole</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - complications</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Remission</topic><topic>Risk factors</topic><topic>Shielding</topic><topic>Skin</topic><topic>Skin Neoplasms - pathology</topic><topic>Skin Neoplasms - secondary</topic><topic>Skin Ulcer - complications</topic><topic>Skin Ulcer - microbiology</topic><topic>Surgery</topic><topic>Tetanus</topic><topic>Tetanus - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMC infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nomura, Kazuhito</au><au>Sakawaki, Eiji</au><au>Sakawaki, Sonoko</au><au>Yamaoka, Ayumu</au><au>Aisaka, Wakiko</au><au>Okamoto, Hiroyuki</au><au>Takeyama, Yoshihiro</au><au>Uemura, Shuji</au><au>Narimatsu, Eichi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review</atitle><jtitle>BMC infectious diseases</jtitle><addtitle>BMC Infect Dis</addtitle><date>2021-01-07</date><risdate>2021</risdate><volume>21</volume><issue>1</issue><spage>37</spage><epage>37</epage><pages>37-37</pages><artnum>37</artnum><issn>1471-2334</issn><eissn>1471-2334</eissn><abstract>Previous studies have reported poor prognosis in cases of tetanus that develops after bacteria enters via breast cancer-related skin ulcers that are not treated with surgical debridement. Herein, we review the literature concerning this presentation and report the first case of complete remission from tetanus without surgical debridement of the skin ulcer.
An Asian woman aged over 60 years had a history of skin ulcer caused by breast cancer. She was diagnosed with tetanus due to trismus and opisthotonus. Based on the suspicion that the skin ulcer was the portal of entry for tetanus bacteria, we considered several debridement and thoracic surgical options for tetanus treatment. However, debridement was not performed as the surgery was considered high risk and the patient did not consent to it. The patient received treatment with anti-tetanus globulin and metronidazole; sound insulation and shielding were also performed in a dark room. Subsequently, the patient's symptoms improved, and sound insulation and deep sedation management were completed on 19th day of hospitalization. With no symptom recurrence, the patient was discharged on Day 54. To date, over 3 years after treatment, no evidence of tetanus recurrence has been observed. The case was characterized by a lack of autonomic hyperactivity. The tetanus severity was likely representative of the low amount of toxin that the patient was exposed to.
This case involved moderate severity tetanus originating from a chronic skin ulcer related to breast cancer. The patient survived without undergoing extensive debridement. No evidence of tetanus relapse was observed during the follow-up period, likely due to vaccination that might have restored the patient's active immunity. Debridement is not always necessary for tetanus complicated by breast cancer skin ulcers. Furthermore, appropriate toxoid vaccination is critical for preventing the onset and recurrence of tetanus in these patients.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>33413196</pmid><doi>10.1186/s12879-020-05739-4</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | SpringerOpen; MEDLINE; PubMed Central; Directory of Open Access Journals; EZB Electronic Journals Library; SpringerLink Journals - AutoHoldings; PubMed Central Open Access |
| subjects | Acoustic insulation Anesthesia Bacteria Breast cancer Breast Neoplasms - complications Breast Neoplasms - pathology Breast Neoplasms - surgery Care and treatment Case Report Case reports Chemotherapy Complications and side effects Debridement Diagnosis Female Globulins Hospitals Humans Hyperactivity Infections Insulation Literature reviews Lymphatic Metastasis - pathology Metronidazole Middle Aged Neoplasm Recurrence, Local - complications Ostomy Patients Remission Risk factors Shielding Skin Skin Neoplasms - pathology Skin Neoplasms - secondary Skin Ulcer - complications Skin Ulcer - microbiology Surgery Tetanus Tetanus - etiology Tetanus - surgery Tetanus - therapy Tetanus Toxoid - therapeutic use Tetanus, chronic wound, breast cancer, skin ulcer, non-operative strategy Thorax Toxins Ulcers Vaccination Wound healing |
| title | Non-surgical treatment of tetanus infection associated with breast cancer skin ulcer: a case report and literature review |
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