Abstrait

A case of tetanus infection following hand injury

Nitsan Z, Kucuk N, Zariki M, Appel S, Tichmanovich N, Gefel D, Kagarel R, Shaviv E, Maayan S, Milo R

Tetanus is a disease caused by a neurotoxin produced by the Gram-positive bacillus (C. tetani), found in the soil and human and animal feces. C. tetani is a mobile, spore-forming obligate anaerobe. Under anaerobic conditions as in necrotic and infected tissue, the tetanus bacillus secretes two toxins: tetanospasmin and tetanolysin. Tetanospasmin leads to the clinical syndrome of tetanus comprised of a triad of rigidity, muscle spasms and, if severe, autonomic dysfunction. We describe a case of a 31-year-old patient who presented with painful stiffness especially of the trunk, intermittent diffuse muscle spasms, difficulty swallowing and opening his mouth. After clinical workup a diagnosis of tetanus was made. The patient was treated with active vaccination by tetanus toxoid (TDaP), and passive vaccination (Tetanus Immune Globulin -TIG), antibiotics, pain relief agents and muscle relaxants and his symptoms resolved gradually. He was discharged from the hospital in a good condition 14 day after his admission.