Akademik Veri Yönetim Sistemi
World Academic Congress of Emergency Medicine , Antalya, Türkiye, 28 - 31 Ekim 2023, ss.166-167, (Tam Metin Bildiri)
Introduction and Purpose: Tetanus is caused by Clostridium tetani. It is a vaccine-preventable disease that can develop especially after injuries contaminated with soil. Tetanospasmin toxin secreted by C. tetani can cause uncontrollable, painful spasms and death due to respiratory muscle involvement. In this case report, we present a case of generalized tetanus in a patient who was not vaccinated after tetanogenic injury.
Materials and Methods: An 85-year-old woman was admitted to the emergency department with complaints of a wound on the right forearm, convulsions radiating from the right arm to the jaw and shortness of breath. 10 days before admission she fell to the ground and a broke flower pot injured her forearm. Dressing was applied at home without hospitalization. 1 week later, she applied to the emergency department 3 times due to the onset of contractions in her right hand, wound care was performed and she was discharged with analgesic treatment. On physical examination; Consciousness was clear, oriented, coherent, GCS: 15, temperature 37.5 °C, pulse 110/min, BP: 164/85 mmHg, respiratory rate 35/min, there was a 5x4 cm necrotic wound on the right forearm with redness around it and increased temperature. Nuchal rigidity was present. There was contraction in the jaw in the form of Risus Sardonicus and spastic contraction in the right wrist. Analyzes showed that; Creatinine 1.13 mg/dL, AST 71 U/L, ALT was 31 U/L, LDH 359 U/L, WBC 17 10*3/uL, NEU 15 10*3/uL, CRP: 51 mg/L, CK 4568 U/L. Tetanus vaccination and tetanus immunoglobulin were recommended and Metronidazole 3x500 mg iv treatment was started.She was transferred to the intensive care unit due to opistotonic contractions in the whole body and development of oxygen demand. Midazolam infusion was started in intensive care unit and she was intubated due to respiratory distress.A planned tracheostomy was opened on the second day. Since the contractions continued on the fifth day Rokuronium infusion was started. The patient is still being followed up in the intensive care unit.
Results and Conclusion: Tetanus is a disease that is seen with tetanogenic injury and is 100%
preventable with vaccination. Tetanus vaccine and immunoglobulin must be administered in
injuries for which there is an indication.