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Volume 6
Journal of Infectious Diseases & Therapy
ISSN: 2332-0877
Infection Prevention 2018
December 06-07, 2018
Page 60
conference
series
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December 06-07, 2018 | Valencia, Spain
14
th
World Congress on
Infection Prevention and Control
Roberto P Salvino, J Infect Dis Ther 2018, Volume 6
DOI: 10.4172/2332-0877-C6-052
Cephalic tetanus in a 57-year old female: A case report
T
his is a case of a 57-year old female with no known history of immunizations since childhood especially against tetanus who
presented with jaw spasm without apparent ear infections or visible bodily injuries and trauma. Patient was admitted with
a consideration of pterygomaxillary mass but later to be found out as severe spasm on the left masseter leading to diagnosis of
tetanus infection. She continued to develop bilateral masseter spasms and dysphagia, accompanied by dyspnea that required
tracheostomy. We report a case of cephalic tetanus with dysphagia, which was progressing to generalized tetanus but prompt
intervention prevented disease progression.
INTRODUCTION:
According to the World Health Organization, the incidence of total reported cases of tetanus infection for
2017 is 1,057. Globally, there is a considerable decrease in the incidence andmortality rate of tetanus due to an overall improvement
in the administration of vaccinations, as well as hygiene practices and antitoxin administration. This was significantly lesser than
the total reported cases of tetanus seen in the year 1980 which is 3,080. Tetanus is caused by an exotoxin, tetanospasmin, produced
by Clostridium tetani. Diagnosis of tetanus is clinical and can present as someone with trismus, risus sardonicus, neck stiffness,
dysphagia, muscle rigidity and spasm, or it can also present as a localized form in which the spasms and rigidity are confined to
an anatomic area of the injury. Cephalic tetanus is a very rare type of tetanus which accounts for only 0.9-3% of the total tetanus
cases seen. About two-thirds of cephalic tetanus cases progress to generalized tetanus with bad prognosis. It frequently progresses
to generalized tetanus and is associated with a high mortality. Thus, we report one of the few cases of cephalic tetanus which
presented with left neck stiffness and trismus.
THE CASE:
Presenting the case of a 57-year-old female, gardener, who consulted at the out-patient services due to difficulty
opening hermouth. Condition beganwith left-sided neck stiffness 4 days prior to consult that gradually progressed to development
of dysphagia to solids and liquids with difficulty opening her mouth. Neck stiffness worsened 2 days prior causing her to assume
rightward neck flexion to alleviate pain. Trismus also started to occur at this time that made eating more difficult. Her illness was
not associated with any history of trauma or other symptoms such as pain over gums or throat area, fever, difficulty in speaking
or lateralizing signs. Persistence of symptoms prompted consult.Patient is known to frequently pick her teeth with a reusable
metal pick. She has not sustained bodily injuries for the past several months. Past medical history and family history were
unremarkable. Pertinent physical exam showed she was only able to open her mouth to 2.5cm, temporomandibular joint (TMJ)
non-displaced, spastic masseter tone, no cervical lymphadenopathies, the rest of the physical exam was unremarkable. Her other
cranial nerves were intact, and the rest of the neurological exam was also unremarkable. She was admitted under ENT service as
a case of Pterygomaxillary mass; rule-out Tetanus infection. Diagnostic imaging with contrast MRI of the neck and oropharynx,
revealed diffuse disc bulges at C3-C7 levels with stenosis, cervical disc dessication with slightly reversed cervical lordosis from
spasm. Plain revealed an enlarged left parotid gland which was suspicious for infection. Chest xray was also unremarkable. Blood
tests of CBC (RBC 4.54 WBC 6.2, Hgb 137, Hct 0.41 Platelet 190, Segmenters 64, Lymphocytes 25, Monocytes 10, Eosinphils
1) iCa, Na, K, Bun, Creatinine, aPTT were all normal. Tetanus infection was highly considered during this time patient was
started on an initial antibiotic of clindamycin. She was given treatment of IV Metronidazole instead since treatment wise; It is
the most preferred choice aside from penicillin [15]. She was started and also treated with Tetanus hyperimmune globulin. She
was closely monitored for signs of respiratory distress and placed on standby for intubation or emergency tracheostomy. Spasms
Roberto P Salvino
Asian Hospital and Medical Center, Philippines