Unique Hospital ICU

14 year child , Male , came with history of fall down in farm while playing , injured in right feet with danger stick through and through cut in lateral aspect of feet.

Patient went to primary care hospital after 7-8 days for complain of tightness of abdomen , inability of open the mouth , severe muscle ache and inability to lie down in supine position

Pt was admitted in periphery for same complain and then next day shifted to unique hospital

Came in Emmergency abdominal muscle spasm , trismus and opisthotonos,
Tachycardia 125/min, SpO2 with room air was 92%, BP 106/65, RS clear and he was irritable.

Pt was admitted in ICU in isolation, Suspecting tetanus clinically and confirmed clinically by Intensivist neurophysician and ID specialist,
Started with midazolam infusion , antibiotic like metrogyl and piptaz, IVF, magnesium sulfate infusion , beclofen and other supportive treatment with continues watch on airway.

Urgent surgical opinion taken with primary debridement of wound was done

Tetanus immune globulin was given 5000unit Intramuscularly

On 8 th day He was improved with abdominal muscle spasm and trismus , conscious and mobilised and shifted out of the ICU.

Duration of illness — Tetanus toxin-induced effects are long lasting because recovery requires the growth of new axonal nerve terminals. The usual duration of clinical tetanus is four to six weeks.

The diagnosis of tetanus is usually obvious and can generally be made based upon typical clinical findings outlined above. Tetanus should especially be suspected when there is a history of an antecedent tetanus-prone injury and a history of inadequate immunization for tetanus. However, tetanus can sometimes be confused with other processes

Case-fatality rates for non-neonatal tetanus in resource-limited countries range from 8 to 50 percent, whereas the majority of patients with tetanus recover when supportive care is available.

Case courtesy to dr Parthiv Desai