Tetanus: a case report

Tetanus is a rare disease in the United States, with only 40 to 60 cases reported annually. This potentially lethal disease affects unimmunized or partially immunized persons, with the elderly at greatest risk. Tetanus usually follows an injury such as a puncture wound, abrasion, or laceration. The pathogen is an anaerobic, spore-forming, gram-negative, ubiquitous bacillus known as Clostridium tetani. In the vegetative form, it produces a lethal toxin, tetanospasmin, which enters the central nervous system through retrograde axonal transport, resulting in characteristic muscle spasms and tonic contractions. Severe tetanus can cause autonomic instability, respiratory arrest, and cardiac arrest. Patients with tetanus usually require intensive care with dose monitoring and extensive supportive care. Most patients experience full recovery with no signs of neurological sequelae. This case report and discussion illustrate the severity of the disease and the complexity of managing a patient with tetanus.