Abstract
A 37-year old male farmer was referred with clinical suspicion of meningitis. He was brought to the emergency department with history of fever, jaw and neck pain, and generalized body stiffness. Escorting relatives reported that the symptoms had started approximately 5 days earlier, when he started to develop “low-grade fever.” Fever was associated with progressively worsening body aches, difficulty in opening his mouth, and difficulty in moving his neck. They denied any history of sore throat or toothache or any known preexisting medical conditions. They also reported an alteration in conscious level that had gradually worsened over the last 24 h that alarmed them enough to seek urgent medical assistance. During initial evaluation, the patient was found to be dehydrated and febrile with a temperature of 99 °F, while other vital signs were normal. Physical examination showed restricted movements at the temporomandibular joint and neck, and no enlarged lymph nodes were evident. A 3–4 cm in diameter wound was seen in the right foot, and on inquiry, his relatives reported that he had hurt himself during farming and the wound had been there for the last 10 days. The wound was clean, without any redness (erythema), discharge, or necrosis. In lab data, WBC (white blood count) was 12,000/μL; otherwise all other basic hematological and biochemical results were within normal range. A brain and maxillofacial CT scan was performed which yielded insignificant findings. On grounds of clinical history and available test results, the patient was admitted with a provisional diagnosis of meningitis.
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References
Trujilo MH. Impact of intensive care management on the prognosis of tetanus. Chest. 1987;92:63–5.
World Health Organization. WHO Tetanus Global Report. https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/tetanus/en/
World Health Organization. Tetanus vaccines: WHO position paper—February 2017. Wkly Epidemiol Rec. 2017;6(92):53–76.
Hodowanec A, Bleck TP. Tetanus (Clostridium tetani). In: Mandell, Douglas, Bennett, editors. Principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier; 2015.
Kyu HH, Mumford JE, Stanaway JD, et al. Mortality from tetanus between 1990 and 2015: findings from the global burden of disease study 2015. BMC Public Health. 2017;17:179.
Government of Canada. Tetanus toxoid. In: Canadian immunization guide 2016. https://www.canada.ca/en/publichealth/services/publications/healthy-living/canadianimmunization-guide-part-4-active-vaccines/page-22-tetanus-toxoid.html.
Roper MH, Wassilak SGF, Tiwari TSP, Orenstein WA. Tetanus toxoid. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines. 6th ed. China: Elsevier Saunders Inc.; 2013. p. 746–72.
Tosun S, Batirel A, Oluk AI, et al. Tetanus in adults: results of the multicenter ID-IRI study. Eur J Clin Microbiol Infect Dis. 2017;36:1455.
Centers for Disease Control and Prevention. Neonatal tetanus—Montana, 1998. Morb Mortal Wkly Rep (MMWR). 1998;47(43):928–30.
Yaffee AQ, Day DL, Bastin G, et al. Notes from the field: obstetric tetanus in an unvaccinated woman after a home birth delivery—Kentucky, 2016. Morb Mortal Wkly Rep (MMWR). 2017;66(11):307–8.
Wilkins CA, Richter MB, Hobbs WB. Occurrence of clostridium tetani in soil and horses. S Afr Med J. 1988;73:718–20.
Mellanby J, Green J. How does tetanus toxin work? Neuroscience. 1981;6:281–300.Mellanby J.Green J. How does tetanus toxin work? Neuroscience. 1981;6:281–300
Dance M, Lipman J. Tetanus: an intesivist’s view. Int J Intensive Care. 1994;1:56–60.
Pinder M. Controversies in the management of severe tetanus. Intensive Care Med. 1997;14:129–43.
Kerr J. Current topics in tetanus. Intensive Care Med. 1979;5:105–10.
Curtis DR, De Groat WC. Tetanus toxin and spinal inhibition. Brain Res. 1968;10:208–12.
Carresa R, Lanari A. Chronic effects of tetanus toxin applied locally to the cerebral cortex of the dog. Science. 1962;137:342–3.
Brook I. Current concepts in the management of clostridium tetani infection. Expert Rev Anti Infec Ther. 2008;6:327–36.
Dutta TK. Localised tetanus mimicking incomplete transverse myelitis. Lancet. 1994;343:983–4.
Jagoda A, Riggio. Cephalic tetanus: a case report and review of the literature. Am J Emerg Med. 1988;6:6; 128-30.
Edmondson RS, Flowers MW. Intensive care in tetanus: management, complications and mortality in 100 cases. BMJ. 1979;1:1401–4.
Kokal KC. Disordered pulmonary function in tetanus. J Assoc Physicians India. 1984;32:691–5.
Ablett JJL. Analysis and main experiences in 82 patients treated in the Leeds Tetanus unit. In: Ellis M, editor. Symposium on tetanus in Great Britain. Boston Spa: National Lending Library; 1967. p. 1–10American Academy of Pediatrics. Tetanus (Lockjaw). In: Pickering LK ed. Redbook 2012 Report of the Committee on Infectious Diseases 29th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2012; 707–712.
Centers for Disease Control and Prevention. Chapter 21—Tetanus. Epidemiology and prevention of vaccine-preventable diseases, The pink book: updated 13th edition 2015:341–352.
Engrand N, Guerot E, Rouamba A, Vilain G. The efficacy of intrathecal baclofen in severe tetanus. Anesthesiology. 1999;90:1773.
Thwaites CL, Yen LM, Loan HT, et al. Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet. 2006;368:1436.
Immunization against infectious disease. The stationery Office, London; 1998.
Simonsen O. Vaccination against tetanus and diphtheria: evaluations of immunity in the Danish population, guidelines for vaccination and methods for control of vaccination programmes. Dan Med J. 1989;36:24–47.
Liang JL, Tiwari T, Moro P, et al. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2018;67:1.
Cook TM, Protheroe RT, Handel JM, et al. Tetanus: a review of the literature. Br J Anaesthesia. 2001;87(3):477–87.
Sanford JP. Tetanus – forgotten but not gone. N Engl J Med. 1995;332:812–3.
Lisboa T. Guidelines for the management of accidental tetanus in adult patients. Rev Bras Ter Intensiva. 2011;23(4):394–409.
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Siddiqui, A. (2024). Tetanus. In: Oli, K.K., Shrestha, G.S., Ojha, R., Pal, P.K., Pandey, S., Das, B. (eds) Case-based Approach to Common Neurological Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-99-8676-7_6
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