RUST TO CAUSE

TETANUS
 CASE REPORT:
ETANUS
KNEDRICK KEVIN C. MACALMA
DOCTOR OF MEDICINE II
Severe Generalized Tetanus:
A Case Report and Literature Review
Wadiah A. Alfilfil, Mohammed S. Alshahrani, Mohammed A. Abdulbaser1, Nazeh E.B. El Fakarany2
Department of Emergency Medicine, College of Medicine, University of Dammam, 1,2 Department of Internal Medicine & Critical Care,
King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia

Correspondence: Dr. Wadiah Alawi ALfilfil, College of Medicine, University of Dammam, King Fahd Hospital of the University, P.O. Box
40236, Al-Khobar 31952, Kingdom of Saudi Arabia. E-mail: wfilfil@uod.edu.sa
the
UNKNOWN
truth
PATIENT PROFILE

Patient: X
Age: 45 y/o
Occupation: Driver
Address: Saudi Arabia

complaining of :
progressive dysphagia to fluids and
solids
inability to open his mouth fully
back pain over the past 2 days
TRAVEL HISTORY: 2-month vacation in Indonesia
Healthy
Not known to have any medical illness
Not using any medications
No history of trauma, injury or drug abuse
Vaccination history was not clear.
wha
t ?
?
where
ENT

anxious
sweaty with stable vital signs
extended stiff neck
partially opened mouth (locked jaw)
Blackish discoloration under the right ring finger nail
!
minor trauma to his finger by a
stone
1-week before while he was in
Indonesia
IAGNOSTICS
X-ray: Unremarkable
ECG: normal
Complete Blood Count: within normal limits
Blood culture: Normal
Anti-tetanus antibodies: weakly positive
EDICATIONS
Tetanus toxoid 0.5 ml IM
Metronidazole 500 mg IV
Tetanus immunoglobulin (TIG) 3000 IU IM
Diazepam 10 mg IV every 6 h
After 6 days
Generalized spasticity
Labile blood pressure and heart rate
Difficulty of breathing
Low oxygen saturation
Generalized spasticity
Labile blood pressure and heart rate
Difficulty of breathing
Low oxygen saturation
40
mechanical ventilation was weaned off
sedation stopped
and physiotherapy started

42
tracheotomy was decanulated
sent to the medical ward

44
Discharged
DISCUSSION
MAINSTAY OF DIAGNOSIS:
Clinical manifestations and History

antitetanus antibodies
- done to look for inadequate vaccination which gives low or negative lev
RUST TO
CAUSE
TETANUS
YES
NO
ONCLUSION
Detailed history taking and physical
assessment is needed to be done
REFERENCES
Centre For Disease Control, Atlanta, USA
Management and Prevention of Tetanus, Richard F.
Eldritch, MD PhD, Lisa Hill, Chandra A Mahler, Larry Jude
Cox, MD, Daniel G Becker MD, Jed H Horowitz, MD 4
Larry S Nichter MD MS,4 Marcus L Martin, MD 5
&William C Lineweaver MD6
Current Medical Diagnosis & Treatment, 2011
Harrisons Principles of Medicine, 22nd Edition.
Text of Emergency Medicine, S. David, 1st Edition
Mansons Tropical diseases 21st edition
Txt book of preventive and social medicine 18th edition by
K.PARK
http://www.who.int/immunization_monitoring/diseases/Te
tanus_map_cases.jpg
Tetanus By J J Farrara b, L M Yenc, T Cookd, N
Fairweathere, N Binhc, J Parrya b, C M Parrya b