Chest
Selected ReportsRespiratory Failure in Tetanus: Case Report and Review of a 25-Year Experience
Section snippets
Case Report
A 65-year-old woman presented to the emergency department with hiccups, dyspnea, pleurisy, jaw stiffness, and epigastric pain of 3 days’ duration. She had been seen 1 week earlier for a traumatic knee laceration, which was irrigated and sutured. She was given a tetanus toxoid vaccination as part of her care. Four days after the initial injury, she underwent wound incision and drainage and began therapy with cephalexin.
Evaluation results at the local hospital included a normal ECG and normal
Mayo Clinic Experience
In the past 25 years, nine additional patients have presented to the Mayo Clinic with acute tetanus (Table 1). The majority of the patients were elderly (average age, 68 years) and had received childhood vaccinations only or did not know their vaccination status. Most patients presented with mild early trismus (78%), which led to generalized tetanus. The treatment of these patients is described in Table 2. Respiratory failure requiring intubation developed in seven of these patients (78%). Six
Significant Findings
A novel finding in this case report is the presenting symptom of hiccups. In addition, this report confirms previous reports that elderly patients may not have adequate immunity to prevent the illness. Finally, this case and the Mayo Clinic experience demonstrate the need for prompt diagnosis and treatment because of the risk of respiratory failure.
General Description
Tetanus is caused by a toxin secreted by Clostridium tetani, a Gram-positive, obligate anaerobic bacillus that forms a stable terminal spore. C
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