An 88-Year-Old Man with Dysarthria: A Rare Presentation of Tetanus

Tetanus is a lethal disease caused by Gram-positive Clostridium tetani bacteria toxin. The annual incidence of this disease in the world is one million people per year [1]. Typical symptoms include trismus, risus sardonicus, and opisthotonos. The main cause of death in the primary phase is laryngeal muscle spasm and in the late phase is dysrhythmia [1].
Case Report: An 88-year-old man referred to the emergency department with the chief complaint of dysarthria, neck pain, and limitation of opening the mouth. Considering the history of wound, no previous tetanus vaccination, clinical signs and symptoms, and the results of the studies, the tetanus disease was established for the patient. After taking the tetabulin and tetanus vaccine for the patient and administering metronidazole, the patient was admitted to the intensive care unit (ICU). The patient was under supportive care for 13 days in the ICU, and eventually died of septic shock and multiple organ failure.

Tetanus is a rare dangerous disease, that after implementation of the vaccination program for children and pregnant women, adult tetanus incidence has dramatically reduced in the country. Unfortunately, when clinical manifestation precipitates, even in the case of medical interventions, 13.2% of cases lead to death [6]. The Ministry of Health and Medical Education has drafted a comprehensive national immunization program, including immunization of tetanus from the early years of sixty decade and impart it to universities to run in hospitals, clinics, and health centers [7]. Despite the dramatic decrease in adult tetanus and the elimination of neonatal tetanus, a number of adult's tetanus, including the current case in this article, are still recorded annually.

Tetanus is a rare but serious disease. Comprehensive prevention programs in the country have led to reduction of tetanus incidence in the country. To control and eradicate this disease, it is necessary to identify the gaps in Tetanus Prevention Programs and consider the necessary measures to correct them.