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Cephalic Tetanus from Penetrating Orbital Wound
Elo se Guyennet,Jean-Laurent Guyomard,Emilie Barnay,Franck Jegoux,Jean-Fran ois Charlin
Case Reports in Medicine , 2009, DOI: 10.1155/2009/548343
Abstract: Tetanus is a neurologic disorder caused by tetanospasmin, a protein toxin elaborated by Clostridium tetani. Cephalic tetanus is a localized form of the disease causing trismus and dysfunction of cranial nerves. We report the case of a man who presented with facial trauma, complete ophthalmoplegia, exophthalmos, areactive mydriasis, and periorbital hematoma. An orbital CT revealed air bubbles in the right orbital apex. The patient was given a tetanus toxoid booster and antibiotherapy. After extraction of a wooden foreign body, the patient developed right facial nerve palsy, disorders of swallowing, contralateral III cranial nerve palsy, and trismus. Only one case of cephalic tetanus from penetrating orbital wound has been reported in literature 20 years ago. When a patient presents with an orbital wound with ophthalmoplegia and signs of anaerobic infection, cephalic tetanus should be ruled out.
A Rare Case of Cephalic Tetanus with Infranuclear Facial Palsy Following Foot Injury  [PDF]
Srikanth paleti, Srinivasa Rao B, Umakanth Venkat Kodali, Ranjith Kumar N, Suresh Babu P
Asian Journal of Medical Sciences , 2011, DOI: 10.3126/ajms.v2i2.4409
Abstract: We present here a rare case of cephalic tetanus with infranuclear facial nerve palsy following injury to the left foot with progression to generalized form, recovered completely in 6 weeks. There were few reports that cranial nerve palsies may occur in tetanus when the site of injury is other than in the head and neck, and indeed when there is no apparent site of entry of infection. In cephalic tetanus the prognosis is generally worse but here patient recovered completely without any residual paresis Key Words: Cephalic tetanus; Facial palsy; Foot injury DOI: http://dx.doi.org/10.3126/ajms.v2i2.4409 Asian Journal of Medical Sciences 2 (2011) 131-133
Tetanus following replantation of an amputated finger: a case report  [cached]
Hayashida Kenji,Murakami Chikako,Fujioka Masaki
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-343
Abstract: Introduction Tetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani and induces severe neurological manifestations. We treated a patient who developed tetanus during hospitalization for replantation of an amputated finger. To the best of our knowledge, this is the first published case report of such an entity. Case presentation A 49-year-old Japanese man had an amputation of his right middle finger at the distal interphalangeal joint region in an accident at work. His middle finger was successfully replanted, but his fingertip was partially necrotized because of crushing and so additional reconstruction with a reverse digital arterial flap was performed 15 days after the injury. Tetanus developed 21 days after replantation of the middle finger, but symptoms remitted via rapid diagnosis and treatment. Conclusions In replantation after finger trauma with exposure of nerve and blood vessel bundles, concern over injuring nerves and blood vessels may prevent irrigation and debridement from being performed sufficiently; these treatments may have been insufficiently performed in this patient. It is likely that the replanted middle finger partially adhered, and Clostridium tetani colonized the partially necrotized region. Even when there is only limited soil contamination, administration of tetanus toxoid and anti-tetanus immunoglobulin is necessary when the fingers are injured outdoors and the finger nerves and blood vessels are exposed. The drugs should be administered just after replantation if the finger has been amputated. However, if clinicians pay attention to the possibility of tetanus development, treatment can be rapidly initiated.
Intraoperative Diagnosis and Use of Glidescopetm Video Laryngoscope for Cephalic Tetanus  [PDF]
Steven Shulman, Yana Yasyulyanets, Patricia Kloser
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.31008

This case report describes the clinical characteristics and management of a 38-year-old man with cephalic tetanus. He presented with a massive facial infection after a dental procedure. After induction of anesthesia, cephalic tetanus was clinically diagnosed during induction based on the presence of a new facial nerve palsy and nuchal rigidity even after the administration of succinylcholine. The first attempt at intubation was unsuccessful with a Macintosh laryngoscope due to persistent nuchal rigidity and lockjaw despite the use of succinylcholine. Consistent with other reports, intubation was remarkably uncomplicated when the video laryngoscope was used. Postoperatively, the Clostridium tetani infection progressed to generalized tetanus and responded to supportive care. This case highlights the difficulties of diagnosis, and supports the utility of the Glidescopetm video laryngoscope in this unusual pathological condition.

Tetanus in the dog: review and a case-report of concurrent tetanus with hiatal hernia
Els Acke, Boyd R Jones, Rory Breathnach, Hester McAllister, Carmel T Mooney
Irish Veterinary Journal , 2004, DOI: 10.1186/2046-0481-57-10-593
Abstract: Tetanus is a relatively uncommon disease in dogs and cats because of their natural resistance to the toxin; nonetheless, the prognosis has to be very guarded, especially if there are concurrent problems such as hiatal hernia or aspiration pneumonia. Oesophageal hiatal hernia is an uncommon complication of tetanus. The prognosis in these cases appears to be extremely poor although only a few cases have been reported [14,5,15]. In this communication we present a brief review of tetanus in the dog and report on the full recovery of a dog from tetanus and concurrent hiatal hernia.Animals affected with generalised tetanus have rigidity of the limb, neck and tail muscles and characteristic facial muscle abnormalities (risus sardonicus, trismus, prolapsed third eyelids). Intracranial signs, gastrointestinal signs, respiratory signs and arrhythmias have also been reported. The signs of tetanus are caused by a neurotoxin produced by the vegetative form of Clostridium tetani, an obligate anaerobic, sporeforming Gram-positive bacillus. Resistant spores, commonly found in the environment, will vegetate in response to anaerobic conditions such as in a deep penetrating wound or in teething animals. Three toxins are produced: tetanospasmin, tetanolysin and nonspasmogenic toxin. Tetanospasmin is the most important toxin and is responsible for the principal clinical signs. This toxin inhibits neurotransmitter release at inhibitory interneurons of the spinal cord and brain resulting in muscle hyperextension. Tetanolysin causes haemolysis and enhances the multiplication of anaerobic bacteria by increasing tissue necrosis. The role of nonspasmogenic toxin is poorly understood; it is thought to cause paralysis of the peripheral nervous system [2,8,11].Following germination of the spores in an anaerobic environment, the toxins are released and tetanospasmin can gain access to the central nervous system by uptake into axonal terminals and retrograde intra-axonal transport. The toxin is al
Tetanus in a post operative patient—A case report  [PDF]
Paul Dienye, Andrew Bock-Oruma, Damien Uyagu
Case Reports in Clinical Medicine (CRCM) , 2013, DOI: 10.4236/crcm.2013.21009

Tetanus is a preventable disease which commonly occurs with puncture or penetrating wounds, or contamination of cutaneous wounds. It may be secondary to surgical procedures such as gastrointestinal surgery on rare occasions. This article reports a fatal case of tetanus in a post operative patient in which the source of infection could not be ascertained. Active immunization of all persons against tetanus, adequate sterilization of surgical equipment and consumables as well as the operating rooms is advocated.

Prolonged trismus post tetanus in a Nigerian boy: The role of oral baclofen- A case report and literature review
DD Umoru, O Oyetundun, S Anikoh, K Osisami, H Mohammed, F Abdulrahaman
Nigerian Journal of Paediatrics , 2012,
Abstract: Background: Tetanus is characterized by increased muscle tone and spasms caused by the neurotoxin, tetanospasmin. Management principles include wound debridement, antibiotic therapy, neutralize circulating toxins, spasm control, supportive care and initiation of active immunization. Aim: To highlight the use of oral baclofen in tetanus treatment. Method: The management of a peculiar case of tetanus was highlighted. Medscape and Pubmed were also searched for some related literatures. Case Presentation: A nine year old boy with antecedent history of dirty wound presented with trismus and generalized spasms of one week duration. Though fully conscious, he could neither talk nor eat. He was from a poor socio-economic background. He had wound debridement, I.V metronidazole for seven days, a cocktail of diazepam infusion 5mg/kg/day, I.V chlorpromazine 25mg 12hourly and I.M phenobarbitone for 14 days. Five days into treatment the spasms stopped but trismus persisted up to the third week.By this time the maximal interincisors distance was 0.5cm. Baclofen syrup was commenced at 10mg daily. Five days later the maximal inter-incisors’ distance was 1.0cm, and a week later it was 2.5cm. By the second week of oral baclofen there was complete resolution of trismus and recovery of speech. Conclusion: This report suggests the need for further studies on the use of enteral baclofen during tetanus. Although intratheccal baclofen is in use, during recovery from tetanus, treatment with oral baclofen may reduce morbidity.
Botulinum toxin A for trismus in cephalic tetanus
Andrade, Luiz Augusto F.;Brucki, Sonia Maria D.;
Arquivos de Neuro-Psiquiatria , 1994, DOI: 10.1590/S0004-282X1994000300021
Abstract: cephalic tetanus is a localized form of tetanus. as in generalized forms , trismus is a prominent feature of the disease, leading to considerable difficulty in feeding, swallowing of the saliva and mouth hygiene. these difficulties often precede respiratory problems and aspiration bronchopneumonia is a frequent life-threatening complication. muscle relaxants other than curare drugs may show a limited benefit for relieving trismus. tetanospasmin, the tetanic neurotoxin, and botulinum toxin share many similarities, having a closely related chemical structure, an origin from related microorganisms (clostridium tetani and clostridium botulinum, respectively), and presumably, the same mechanisms of action in the neuron. the difference between the two lies in their peculiar neurospecificity, acting in different neurons. injection of minute doses of botulinum toxin in the muscles involved in focal dystonias or other localized spastic disorders have proved to be very effective in these conditions. we describe the use of botulinum toxin a in the successful treatment of trismus in a patient suffering from cephalic tetanus. we believe that this form of treatment may be of value in lowering the risk of pulmonary complications in tetanic patients.
Tetanus  [PDF]
P Poudel,S Budhathoki,S Manandhar
Kathmandu University Medical Journal , 2009, DOI: 10.3126/kumj.v7i3.2744
Abstract: Tetanus is now a rare disease in developed world. However it remains an important cause of death worldwide and is associated with a high case fatality, particularly in the developing world. Tetanus is caused by contamination of wound by spores of Clostridium tetani. Neonatal tetanus results from contamination of the umbilical stump at or following delivery of a child born to a mother who did not possess sufficient circulatory antitoxin to protect the infant passively by transplacental transfer. It produces its clinical effects via a powerful exotoxin, tetanospasmin, which leads to uncontrolled disinhibited efferent discharges from motor neurons in the spinal cord and brainstem, causing intense muscular rigidity and spasm. Shorter incubation and onset times are associated with more severe disease and poorer prognosis. Four clinical forms of tetanus are recognised. They are generalised, localised, cephalic and neonatal tetanus. Tetanus is associated with several complications like respiratory failure, cardiovascular instability, renal failure and autonomic dysfunctions. Recovery from tetanus takes a long time. Diagnosis is established clinically. Symptomatic management, early recognition of complications, careful monitoring for dysautonomia and respiratory assistance are the anchors for successful outcome of patients. Tetanus is preventable through vaccination. Vaccination is highly safe and efficacious. Active immunisation should be instituted in all partially immunised, unimmunised persons and those recovering from tetanus. Passive immunisation is given as treatment of a case as well as prevention following high risk injury. Nepal has achieved neonatal tetanus elimination status on 2005 and is running different programs to sustain the status.
Dysphagia and trismus: an unusual case of tetanus
"Antonio Villa","Marianna Gregorio","Francesca Bassi","Alessandra Perego", "Maria Francesca Donato","Vilma Galimberti", "Maria Grazia Bellotti","Antonella Cheldi"
Journal of Health and Social Sciences , 3, DOI: 10.19204/2016/dysp9
Abstract: Tetanus is a life-threatening infection that is rare in the developed world; it is more frequent in the elderly people and immunocompromised patients. We report a case of a 53-year-old woman who presented with dysphagia, mouth pain and trismus. She did not report any injuries. The suspected diagnosis of tetanus was made. The blood examination showed severe lymphocytopenia and a positive result for the antinuclear antibody (ANA) test, with a suspected diagnosis of Sjogren’s syndrome. It is possible that her immunocompromised conditions could have led to the onset of tetanus, even after casual and minimal contact with Clostridium spores.
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