Röttgering J G, Herderscheê D, Lionarons D A, de Vries P J
Tergooi, afd. Neurologie, Blaricum.
Contact: J.G. Röttgering (
Ned Tijdschr Geneeskd. 2020 Jan 9;164:D3932.
Clostridium tetani is a gram-positive spore-forming bacterium that produces toxins and grows under anaerobic conditions. Infections with this bacterium can lead to local or generalised forms of tetanus.
An 83-year-old man presented to the acute cardiac care unit with a painful left arm and jaw. Because the patient had a hypertonic left arm and was unable to open his mouth fully, the neurologist was consulted. The patient had been to the emergency department 9 days earlier for an infected wound after falling in the garden. He had not been actively or passively immunised against tetanus at that time. On inquiry, it appeared that the patient had also not been vaccinated as a child. We made a clinical diagnosis of tetanus. The patient was admitted and treated with tetanus immunoglobulin, metronidazole, diazepam and painkillers. He was also administered tetanus toxoid and the wound was cleaned. After 1 month and 7 months, the patient was again administered tetanus toxoid.
Patients with a wound that may have come into contact with road grime, dirt or manure, should always be asked for their vaccination status, especially people from high-risk groups, such as the elderly.
破伤风梭菌是一种革兰氏阳性产芽孢细菌，可产生毒素并在厌氧条件下生长。感染这种细菌可导致局部或全身性破伤风。
一名83岁男性因左臂和下颌疼痛就诊于急性心脏护理病房。由于患者左臂肌张力亢进且无法完全张开嘴巴，遂咨询神经科医生。该患者9天前因在花园摔倒后伤口感染前往急诊科就诊。当时他未接受过破伤风主动或被动免疫。经询问，发现该患者小时候也未接种过疫苗。我们做出了破伤风的临床诊断。患者入院后接受了破伤风免疫球蛋白、甲硝唑、地西泮和止痛药治疗。还给他接种了破伤风类毒素并对伤口进行了清理。1个月和7个月后，再次给患者接种了破伤风类毒素。
对于伤口可能接触过道路污垢、泥土或粪便的患者，应始终询问其疫苗接种情况，尤其是来自高危人群（如老年人）的患者。
