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40 yo previously healthy male in China who presents with prolonged “seizure” after receiving a cut on his foot while fishing 5 days ago.
Dx: Tetanus
Clinical features:
· Incubation period 4-14 days
· 3 clinical forms:
1. Local spasm
2. Cephalic (rare) - cranial nerve involvement
3. Generalized (most common) - Descending spasm: facial sneer (risus sardonicus), “locked jaw” trismus, neck stiffness, laryngeal spasm, abdominal muscle spasm.
· Spasms continue to 3-4 weeks and can take months to fully recover
Complications: apnea, rhabodymyolysis, fracture/dislocations
Treatment: supportive, benzodiazepines, RSI, Tetanus IG (3000-5000 units IM), wound debridement
University of Maryland Section for Global Emergency Health
Author: Veronica Pei, MD
References
http://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html