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Volume 6 Journal of Infectious Diseases & Therapy
ISSN: 2332-0877 Infection Prevention 2018
December 06-07, 2018
Page 61
conferenceseries.com
December 06-07, 2018 | Valencia, Spain
14th World Congress on
Infection Prevention and Control
of the masseter were treated with antispasmodic medications but worsening was eventually noted during the course, which was
accompanied by dyspnea, oxygen desaturation, and tachycardia. Emergency tracheostomy had to be done to maintain a patent
airway and she was placed on tracheal mask for oxygen support. She was thereafter transferred to the intensive care unit. The
patient gradually improved and vital signs stabilized. Occurrence of mandibular spasm triggered by external stimuli such as lights
or directs stimulation of the patient (such as suctioning) was lessened. There was no recurrence of oxygen desaturation thereafter.
Treatment with metronidazole was completed for 14 days and physical therapy was continued. On the 21st hospital day, the
patient was off O2 support, without any recurrences of the spasm episodes and was discharged without complications. Patient
came back 3 weeks thereafter for tracheostomy removal and tolerated the procedure well. No further complications were noted
and patient resumed usual activities of daily living after the removal of tracheostomy without any difficulties.
DISCUSSION: Cephalic tetanus can progress to a generalized form and can lead to high mortality rate (15-30%), therefore a high
index of suspicion should be made in patients who present with trismus. Tetanus in itself is a clinical diagnosis: acute onset of
hypertonia, especially when the muscles of the jaw and neck are involved, tetanus should be at the top of the differential diagnosis,
even in previously immunized patients without a clear portal of entry. Tetanus results from contamination of a wound by the
bacterium Clostridium Tetani which form spores. It is an acute and often fatal disease is usually accompanied by generalized
rigidity and convulsive spasms of the muscles. The spores are commonly found in the soil and in animal faeces. The spores
would enter the body via wounds in the skin, and, after germination under low-oxygen conditions, they would excrete a potent
toxin, tetanospasmin, which would go further into the blood stream. Although tetanus has become a rare disease in developed
countries, it remains a potential fatal condition without prompt and aggressive management in third world countries. Elderly
people who live in rural settings are especially vulnerable, because of the declining of immunity to tetanus and the high risk of
infected injuries. Tetanus is said to be classified into four types: neonatal, generalized, which represents the most frequent form
(more than 80%), local and cephalic. Cephalic tetanus is a rare type of localized tetanus characterized by the involvement of the
cranial nerves in the facial area. Either local or cephalic tetanus may progress to the generalized form. [6] Based on the initial
manifestations of the patient, tetanus was already considered early on in the disease course of the patient due to presence of neck
spasm and trismus. Index of suspicion increased further knowing that she has not received any form of prior immunization due
to the fact that the patient was born in 1961. Expanded programs on immunization was later established in the Philippines in
the year 1976 according to the Philippine’s Department of Health. Diagnostic tests done revealed negative results for any mass
lesions or malignancies and it was later found out that the mass was actually the severe spasm of the left masseter muscle. Despite
of the primary consideration, the patient was still treated for tetanus in the first hospital day due to the high consideration of this
diagnosis given her background and clinical presentation since tetanus is a clinical diagnosis and is not a laboratory diagnosis.
The patient was aggressively managed with starting tetanus antitoxin, Human Tetanus Hyperimmune Globulin administration,
and eventual tracheostomy placement since dyspnea developed during her course in the hospital. The aggressive management of
this patient was done since cases of cephalic tetanus are known to progress to the generalized type, and mortality with the cephalic
type is reported to be high. Antispasmodics were also helpful in this case to control the episodes of spasms together with putting
emphasis on decreasing external stimuli that can trigger the patient’s spasm episodes. We therefore conclude that tetanus should
be a high suspicion in cases which would present with trismus especially for those without a known history of immunization and
in those who don’t present with an apparent source of injury or portal of entry for developing tetanus infection.
Biography
Roberto P Salvino completed his Internal Medicine residency In Akron City Hospital, Akron, Ohio and subsequently went to Cleveland Clinic for 1 year for Infectious
Diseases Fellowship. He held multiple positions in the past such as Board of Council of International Society for Infectious Diseases, Director of Medical Education and
subsequently Chief of Clinics at the University of Perpetual Help DALTA Medical Center, President of Las Pinas Medical Society, Secretary of the Philippine College of
Pharmaceutical Medicine. He also served as Country Medical Director of Johnson and Johnson Philippines. Currently, he is the Medical and Regulatory Affairs Director
of iNova Pharmaceuticals.