Tetanus: Simple Cut Leading to Neurological Problems

It is important that I mention that the medical cases I write is for educational purposes and to shed light on common medical misconceptions that some of us have while doing what we love the most. In that light, is important that we recommend seeing your doctor if you have any health concern.

That said, have you been invited to the beech so as to have fun and catch up with friends, and while you were playing, you cut your leg from a soda can but when you looked at the wound, it isn't something big so you decided to wash it off in the beech and continue the fun. Or you were playing the game of soccer when a nail pricked your legs and you decided to just use your hand to apply pressure and then continue playing since the cut wasn't big. What could possibly go wrong with such minor cuts. You conclude and say nothing but what if that isn't true?

Let me discuss the case of a 78 year old patient who presented to an emergency department with jaw pain, difficulty opening his mouth, spasm affecting speech (dysphonia), he had a rigid and mildly distended stomach but it wasn't tender, and on inspection of his right forearm, there a healing laceration that was approximately 5 × 2 centimeters wide.

According to the patient, this happened about two weeks before his appearance at the hospital when he fell from a tractor into a muddy water. Upon medical examinations, the patient explained that he hasn't received any immunization in recent times, neither did he remember taking any immunization as a child while growing up. He claimed that a local medical practitioner applied a topical oitment on the injury when he had it.

While he was being observed and treated at the hospital, and spending 4 days at the hospital, he began to experience severe apnea that closed his airways and he had a cardiac arrest shortly after. In other for him to breath, a tracheotomy was done and he was treated with multiple antibiotics after which he was fine. But before he was treated, he was diagnosed with Tetanus since the patient’s blood tests and computed tomography of his head and neck were within normal limits.^{Case reference}

Another case is that of a 77 year old woman that was brought into the emergency room presenting with tightness of the jaw, and lesions in her mouth. Upon further examination, she suffered oral candidiasis which is the overgrowth of fungi on the tongue. Laboratory data revealed mild leukocytosis and moderate hyponatremia, and she was treated with diazepam, cyclobenzaprine, nystatin, and chlorhexidine mouthwash and was given nutritional supplementation and was released to go home but came back two days after with complains of seizures.

The woman claimed that she didn't have any injuries in recent times, and has her vaccines complete as a child. She was a lifetime nonsmoker and denied alcohol use. She was treated for depression and somatization but after 2 weeks in the hospital, it became clear that she was suffering from tetanus but within those two weeks, she had developed three brief episodes of tonic-clonic seizures, brain damage, pns eumonia, cardiac arrests, liquid in her lungs, and sepsis. She died as it was late to treat her properly in accordance to the diagnosis.^{case reference}

Both of the cases in this post have injuries at different parts of their body, and were both diagnosed with tetanus. While one survived, the other didn't survive but to understand what happened, let's explain tetanus. Tetanus also known as lockjaw is a bacterial infection caused by the bacteria Clostridium tetani and the infection presents in patients with muscle spasms, difficulty swallowing and speaking, convulsion triggered by minor activities like talking, breathing, or bright light.

Muscle spasms from tetanus can lead to airway blockages which can lead to cardiac arrest. Clostridium tetani is usually found in soil, dust, and animal feces but it isn't dangerous in these locations because it isn't oxygen deprived but it is very dangerous in healing wounds because it grows in oxygen deprived regions and healing wounds are deprived of oxygen.

This bacteria inhibits the release of GABA and Glycine which controls muscle inhibition and this leads to the uncontrollable spasms that the patients but you might wonder why it looks like the bacteria acts quickly, this is because the bacteria's incubation period is within 1 to 60 days and symptoms can begin to appear in about 7 to 10 days. the tetanospasmin toxin in the brainstem causes autonomic dysfuction which leads to the brain's inability to control lots of activities including the heart, pupils, bladder, intestine and so on but the severity is dependent on the location of the infection in relation to the central nervous system.

People who are vaccinated still have a 10% chance of the toxin reaching the brain and causing symptoms but for unvaccinated people, it is about 40% and the CDC refers to tetanus as a medical emergency. To treat tetanus, administering human tetanus immune globulin (TIG) is advised and this attacks the bacteria before it releases its neurotoxin.

That said, the believe thyat tetanus only happens when a rusty nail pricks a person is completely wrong. This is because it makes it look like it is the rust that causes the tetanus but that is not true. Any injury can lead to tetanus infection and while one can certainly get tetanus from rusty nails, rust isn't the culprit for the infection.

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^{https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625
https://www.ncbi.nlm.nih.gov/books/NBK459217/
https://www.cdc.gov/tetanus/about/diagnosis-treatment.html
https://www.healthlinkbc.ca/healthlinkbc-files/tetanus-immune-globulin
https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/public/index.html}

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Image Reference

Image 1 || Getarchive|| Opisthotonus in a patient suffering from tetanus
Image 2 || Needpix || Vaccination Doctor Syringe