Five adult patients with severe tetanus: cases report and literature review / 中华全科医师杂志

ABSTRACT

The clinical date of 5 adult patients with severe tetanus admitted in the ICU of Jiangsu Provincial Subei People′s Hospital between October 2019 and January 2021 were analyzed retrospectively. There were 2 males and 3 females, aged 19-65 years. Patients had a history of trauma 5 to 30 days before the onset of the disease, and were admitted 1 to 11 days after the onset of the disease. The main manifestations were neck pain with limited movement, difficulty in opening the mouth, paroxysomal convulsions of the neck and both upper limbs, generalized paroxysomal convulsions or abdominal muscle tension, and abdominal pain. At the time of admission, the wounds of 2 patients had healed. After admission, all patients were treated with local debridement, metronidazole combined with penicillin/cephalosporin for anti-infection, and human tetanus immunoglobulin (HTIG) 3 000 U was injected into the gluteus and deltoid muscles to neutralize the free toxin in the body. Midazolam combined with magnesium sulfate was intravenously infused to control and relieve skeletal muscle spasm.Among them, 3 patients received tracheotomy and ventilation due to respiratory failure. One patient underwent bedside continuous renal replacement therapy (CRRT) for severe skeletal muscle spasm resulting in rhabdomyolysis syndrome and acute kidney injury. All five patients with severe tetanus were cured and discharged.