[Tetanus: a case report and literature review]

Area of Science:

• Infectious Diseases
• Neurology
• Critical Care Medicine

Background:

• Tetanus is a serious bacterial infection caused by Clostridium tetani, characterized by muscle stiffness and spasms.
• Immunization is the most effective preventive measure against tetanus, with booster doses recommended throughout life.
• Delayed or incomplete tetanus vaccination increases the risk of developing the disease following an injury.

Observation:

• A 79-year-old farmer presented with trismus (difficulty opening mouth) and stiff masseter muscles, suggestive of tetanus.
• The patient had a recent minor injury (cut finger on barbed wire) and a history of incomplete or lapsed tetanus immunization.
• Progressive respiratory compromise necessitated intubation, followed by autonomic instability and critical illness polyneuropathy.

Findings:

• The patient required prolonged intensive care unit (ICU) stay of 45 days due to severe tetanus complications.
• Treatment included tetanus immunoglobulin and antibiotics, alongside supportive care for respiratory and neurological issues.
• Despite the severity, the patient showed gradual improvement and was discharged after eight months, living unaided.

Implications:

• This case underscores the persistent risk of tetanus in unvaccinated or under-vaccinated elderly individuals, even from seemingly minor wounds.
• Highlights the potential for severe, multi-system complications of tetanus, including respiratory failure and critical illness polyneuropathy.
• Emphasizes the critical importance of maintaining up-to-date tetanus immunization status across all age groups to prevent severe morbidity and mortality.