An unexpected tetanus case

Ergönül, Önder; Egeli, Demet; Kahyaoglu, Bulent; Bahar, Mois; Etienne, Mill; Bleck, Thomas P.

doi:10.1016/s1473-3099(16)00075-x

Cited by 38 publications

(49 citation statements)

References 46 publications

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“…Nearly all cases of tetanus in the United States occur in incompletely vaccinated individuals. 16,17 In our cohort, tetanus was the least common VPD among those with at least 1 case and occurred only in unvaccinated children. Compared with other VPDs, tetanus had the highest median age, with the youngest child being 3 years old.…”

Section: Discussionmentioning

confidence: 68%

Vaccine-Preventable Diseases Requiring Hospitalization

et al. 2017

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Section: Discussionmentioning

confidence: 68%

Vaccine-Preventable Diseases Requiring Hospitalization

et al. 2017

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“…The classic presentation of tetanus infectious consists of trismus (Lock Jaw) due to masseter spasm, which is the presenting complaint in 75% of cases 1. This can often extend to facial muscles causing the classic risus sardonicus (sardonic smile) 9. Rigidity spreads down the arms and trunk over 1–2 days and can progress to generalised muscle rigidity, stiffness, spasms, opisthotonous and dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Return of the old guard: a case of tetanus in an unvaccinated patient

Ibe

Rehmani

Jiwa³

et al. 2019

BMJ Case Rep

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A 78-year-old woman with no known medical history presented with severe neck pain that began 4 days prior to admission located in the paraspinal cervical region radiating to the shoulders, legs and back. She had associated stiffness of her neck and progression of pain to her jaw and throat with progression to generalised body spasms with lower extremity stiffness and weakness that limited her ability to walk. She quickly developed dysphagia and odynophagia with subsequent generalised spasms and profound hypoxic respiratory failure requiring nasotracheal intubation. The presumptive diagnosis of tetanus was made and she was given tetanus toxoid immune globulin and Tdap vaccine. She was managed in the intensive care unit and after a week of admission, required a tracheostomy and gastrostomy tube placement. She required a prolonged hospitalisation stay of 21 days before being transferred to a long-term vent facility.

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“…Nevertheless, there was no obvious portal of entry, characteristic generalized muscle spasms and abdominal rigidity were absent, and the patient's C. tetani antibody was above the generally accepted protective concentration of 0.01 IU/mL [9–12]. It should be noted, however, that several clinicians have proposed that the protective antibody titer level be revised, with no current consensus [11, 13]. With a CSF sample that had marked neutrophilic pleocytosis and growing P. aeruginosa , it became evident that meningitis was a likely contributor.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous NosocomialPseudomonas aeruginosaMeningitis Presenting as Trismus

Parr

Wheeler

Sharma

et al. 2017

Case Reports in Infectious Diseases

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We describe the case of a 78-year-old female receiving adjuvant postsurgical chemotherapy for colon adenocarcinoma who spontaneously developed nosocomial Pseudomonas meningitis causing severe trismus. The patient was initially admitted for ileus, developing neck stiffness and trismus on the thirteenth day of admission. Cerebrospinal fluid grew pansensitive Pseudomonas aeruginosa. Magnetic resonance imaging of the brain was consistent with bilateral subacute infarcts secondary to meningitis. The patient responded well to 21 days of broad spectrum antimicrobial therapy modified to ceftazidime alone following speciation and sensitivity. Outpatient follow-up at 46 days revealed normal maximal mouth opening with the ability to chew and tolerate a full diet. Trismus is a motor disturbance of the trigeminal nerve with difficulty in opening the mouth. Infectious etiologies commonly described include tetanus, odontogenic infections, or deep neck space infections. This is the first reported case of simultaneous nosocomial Pseudomonas meningitis and trismus in a patient with no history of neurosurgery or lumbar spinal manipulation.

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An unexpected tetanus case

Cited by 38 publications

References 46 publications

Vaccine-Preventable Diseases Requiring Hospitalization

Vaccine-Preventable Diseases Requiring Hospitalization

Return of the old guard: a case of tetanus in an unvaccinated patient

Spontaneous NosocomialPseudomonas aeruginosaMeningitis Presenting as Trismus

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