Page 24 - Delaware Medical Journal - April 2018
P. 24
Management of Autonomic Instability
in Clostridium Tetani Infection
Fazal Ali, DO; Sanjana Bhatia-Patel, DO; Kathleen Eldridge, MD
KEY WORDS: Clostridium tetani, arrhythmia, autonomic instability, tetanus, tetnoid toxin
BACKGROUND
Tetanus has been known since the time
of Hippocrates, who described sailors suffering minor wounds and then developing worsening muscle spasms eventually leading to death. Despite better understanding of
the pathogenesis of Clostridium tetani and its toxin, its effects on the cardiovascular system are not fully understood. Although around 60,000 deaths annually worldwide,
with fewer than 50 cases reported in the U.S. Here we discuss an interesting case of tetanus and its natural progression along with its unfortunate consequences.
CASE PRESENTATION
A 70-year-old Amish man presented with complaints of worsening foot pain and He had no prior medical or surgical history and didn’t take any medications. The patient belonged to an Amish community and had no records of childhood
vaccinations. He reported cleansing
the wound thoroughly and applying herbal remedies. Over the course of the next few days, he began experiencing worsening pain, swelling, fevers and swallowing due to inability to chew.
In the emergency department he received empiric antibiotics and intravenous human tetanus immunoglobulin and vaccine for suspected tetanus. Due to personal beliefs, he declined any surgical intervention of the foot to obtain source control. He also declined other supportive and resuscitative measures, such as mechanical ventilation
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Del Med J | April 2018 | Vol. 90 | No. 4
