Karna Priya, Thakur Amit Kumar
Manipal College of Medical Sciences, Manipal, Nepal.
Ann Med Surg (Lond). 2025 May 20;87(7):4567-4569. doi: 10.1097/MS9.0000000000003407. eCollection 2025 Jul.
Tetanus, caused by 's toxin, remains a deadly disease, particularly in tropical regions. Generalized tetanus, the most severe form, leads to painful muscle spasms due to tetanospasmin binding to motor neurons. Early diagnosis and treatment are crucial, especially in developing countries with limited vaccination access, highlighting the importance of routine immunization and addressing healthcare challenges in low-resource settings.
A 55-year-old male with a history of alcohol abuse presented with classic tetanus symptoms, including muscle rigidity, trismus, and opisthotonus. Despite intravenous medications and antibiotics, his condition worsened, requiring intubation, mechanical ventilation, and resuscitation for cardiac complications. Unfortunately, due to financial constraints, he left the ICU against medical advice and died shortly after discharge.
The incidence of tetanus has significantly decreased in affluent nations since the 1940s due to widespread vaccination. From 2009 to 2017, 264 cases were reported in the U.S. Despite global efforts, tetanus remains a public health concern, with the World Health Organization reporting 21,897 cases globally in 2023, reflecting ongoing gaps in prevention, vaccination coverage, and healthcare access. Generalized tetanus, characterized by painful muscle spasms and autonomic dysfunction, is more common than localized or cephalic tetanus. Diagnosis is clinical, and treatment involves wound care, managing spasms, administering anti-tetanus immunoglobulin, and an accelerated immunization regimen for long-term protection.
This case highlights the critical need for vigilance and vaccination programs in areas with limited healthcare resources. Tetanus continues to be a major public health concern, and timely interventions, such as intravenous immunoglobulin, can be lifesaving. In developing countries, prioritizing routine vaccination and booster shots is essential to reduce the devastating impact of this preventable disease.
由破伤风杆菌毒素引起的破伤风仍然是一种致命疾病，在热带地区尤为如此。最严重的全身型破伤风会因破伤风痉挛毒素与运动神经元结合而导致肌肉剧烈痉挛。早期诊断和治疗至关重要，特别是在疫苗接种机会有限的发展中国家，这凸显了常规免疫以及应对资源匮乏地区医疗保健挑战的重要性。
一名有酗酒史的55岁男性出现了典型的破伤风症状，包括肌肉僵硬、牙关紧闭和角弓反张。尽管接受了静脉用药和抗生素治疗，他的病情仍恶化，需要插管、机械通气，并因心脏并发症进行复苏。不幸的是，由于经济限制，他违背医嘱离开了重症监护病房，出院后不久便去世。
自20世纪40年代以来，由于广泛接种疫苗，破伤风在富裕国家的发病率已显著下降。2009年至2017年期间，美国报告了264例病例。尽管全球都在努力，但破伤风仍然是一个公共卫生问题，世界卫生组织报告称2023年全球有21897例病例，这反映出在预防、疫苗接种覆盖率和医疗保健可及性方面仍存在持续差距。全身型破伤风以肌肉剧烈痉挛和自主神经功能障碍为特征，比局部型或头面部破伤风更为常见。诊断依靠临床症状，治疗包括伤口护理、控制痉挛、注射破伤风抗毒素免疫球蛋白以及采用加速免疫方案以提供长期保护。
本病例凸显了在医疗资源有限地区保持警惕并开展疫苗接种计划的迫切需求。破伤风仍然是一个重大的公共卫生问题，及时的干预措施，如静脉注射免疫球蛋白，可能挽救生命。在发展中国家，优先进行常规疫苗接种和加强注射对于减少这种可预防疾病的毁灭性影响至关重要。
