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Dysphagia in elderly women: consider tetanus
1Clinic and Policlinic for Infectious Diseases, University Hospital, Inselspital, Bern, Switzerland.
Infection
|February 28, 2006
Summary
Tetanus, a rare but serious disease, can present with dysphagia, particularly in elderly individuals with low tetanus antibody levels. Early recognition and improved tetanus immunization are crucial for preventing severe outcomes.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Tetanus is a rare but serious disease in industrialized nations.
- Dysphagia is an uncommon cause but a frequent symptom of tetanus.
- Recent cases in Switzerland involved elderly women with inadequate tetanus immunity.
Observation:
- Three elderly women presented with dysphagia as their initial symptom.
- Two patients were diagnosed with generalized tetanus; one had cephalic tetanus with secondary generalization.
- All patients had undetectable tetanus antibodies and no documented immunization history.
Findings:
- Clostridium tetani was cultured from wound swabs in all cases.
- Electromyography supported tetanus diagnosis in two patients.
- Treatment included mechanical ventilation, benzodiazepines, metronidazole, and tetanus immunization; outcomes were favorable in two of three cases.
Implications:
- Tetanus remains a significant threat for individuals with insufficient seroprotection.
- Improving tetanus immunization rates, especially in at-risk populations, is essential.
- Dysphagia should be considered in the differential diagnosis of tetanus.