Tetanus in the Era of Vaccination: A Case Report

Tetanus is a rare disease in the present era of widespread vaccination. We report a case of a 18 year old male patient with history of nail prick who presented with generalised tetanus with trismus, dysphagia and opisthotonos, though being vaccinated with Tetanus toxoid on day 3 after injury. Patient was intubated and mechanically ventilated on admission, andsubsequently developed autonomic dysfunction with severe bradycardia, which was managed with TPI.  Medical management aimed at removal of source of infection, neutralization of unbound toxin, control of rigidity, spasms and autonomic dysfunction along with supportive care. Spasms were treated with lorazepam, magnesium sulphate and baclofen. Patient was managed in isolation in a dark room with adequate analgesia, muscle relaxation and enteral nutrition. The patient was tracheostomised on day 10 and was slowly weaned off ventilator. Spasms reduced and patients showed improvement in neurological status and hemodynamic stability. Prompt diagnosis and appropriate management is important in the treatment and prevention of early life-threatening complications of tetanus.