Tetanus: Case Report, Epidemiology
To describe a rare case with generalized tetanus to reinforce the relevance of early detection and management. Case report: A 38 year old Pakistani man presented with neck stiffness to the emergency room 12 d after he had trivial nail injury to his foot for which he didn’t need to seek any medical advice. Tetanus was diagnosed based on clinical symptoms and history. The management consist of antibiotics therapy with penicillin-metronidazole, tetanus toxoid and tetanus immunoglobulin with other supportive measure in the ICU. The patient had full recovery after 6 way in ICU followed by intensive physiotherapy and rehabilitation. Tetanus is a forgotten disease in the Kingdom of Bahrain and many practicing physicians have not seen a case of the disease in their career.
Tetanus is a potentially lethal disease due to the effect of neuro tropic exotoxin produced Clostridium tetani, which is gram-positive, spore forming non-encapsulated bacillus that is present naturally in the soil and wider environment throughout the world, it can penetrates into the human body through soil contaminated wound or bite, once in a suitable anaerobic environment such as a contaminated wound, the spores are able to germinate and the bacteria multiply at the wound site and release tetanus toxin that diffuses into the body. Due to the continued presence of Clostridium tetani spores in the environment, and given that herd immunity plays no part in tetanus prevention; complete eradication of tetanus is unlikely and cases will continue to occur and the best preventive strategy is through immunization and proper treatment of wounds and traumatic injuries.
Tetanus is classified into four symptomatic types: neonatal, generalized, which represents the most frequent form (more than80%), local and cephalic. The diagnosis is essentially clinical while the treatment needs to be considered a matter of emergency and lifesaving. Although the organism is widely distributed throughout the world, this disease disproportionately affects developing countries due to insufficient immunization coverage.
Journal of Infectious Diseases and Diagnosis