A Family Doctor's Tale - TETANUS

DOC I HAVE TETANUS

Tetanus is a very potentially dangerous disease. I have one patient (my one and only ) who is alive today although she had a almost fatal episode of tetanus infection and was rescusitated after her heart and lung stopped muscle movement.

The danger of tetanus was  that the muscles of the body go into spasm(locked) and the heart stopped and the breathing also stopped because the muscles goes into spasm.

After getting a history of being treated with with rusty dental instruments and the resulting stiffness of one side of her jaw, I sent her immediately to hospital where her heart stopped and was rescusitated back to life. She was very lucky to be alive. I was very angry at the unhygienic dentist.


Tetanus is an acute infectious disease caused by the bacteria Clostridium tetani which lives in the soil.

Tetanus is transmitted by bacterial spores of the tetanus bacteria entering a wound in the skin of a person such as wounds caused by rusty nails.

When the spore developed into the tetanus bacteria, it can produce a powerful toxin which can cause the muscles to go into spasm.

In the jaw the muscle may go into spasm causing a condition called lockjaw.

In more severe cases the respiratory muscles can go into spasm resulting in stoppage of  breathing and therefore loss of oxygen to the brain and heart.

This usually results in death unless treated.

The infections occur in persons of all ages.

There is usually a history of a wound, laceration or operation with contamination of soil or rust in nails or surgical instruments.

Symptoms start off with:

1. irritability

2. fever

3. muscle cramps

4. lockjaw

5. difficulty in breathing or swallowing

Complications of tetanus occur when the muscle spasm affect the respiratory muscles resulting in inability to breathe.

The loss of oxygen to the heart can cause the heart to stop.

The loss of oxygen to the brain can cause the brain to stop functioning resulting in death.

Diagnosis of Tetanus :


The detection of tetanus bacterium in the wound can confirm tetanus infection.

Treatment of Tetanus is by:


Isolation in hospital is necessary.

1.Antibiotics (metronidazole) are used in the treatment of Tetanus.

2.Antitoxin can be given by intramuscular injection

3.Intravenous fluids given for dehydration

4.Respirator is used if breathing stops from spasm of respiratory muscles or vocal muscles

5.Proper wound cleansing is important to remove the infectious spores


6.Cardiac failure should be treated

Vaccination against Tetanus is the best prevention .

Since vaccination began, the worldwide incidence of Tetanus has declined.

Vaccination against Tetanus, pertussis (whooping cough), tetanus (DPT) is usually given to

1.a baby at 3 months of age and repeated at 4 and 5 months of age.

2.a booster vaccination at 18 months.

In adults tetanus vaccines are given in all cases of wounds:

first dose followed by a

second dose 6 weeks later and

third dose  6 months later and

fourth dose 18 months later

Besides the vaccinations there should be proper washing of wounds and avoidance of use of rusty instruments.

Prognosis in Tetanus is still not very good because by the time diagnosis is made complications may have set in.


Death occurs in 30% of cases.

Mortality is highest in very young children and adults over 50.

Death is usually due to respiratory failure or heart failure.

A Family Doctor's Tale - PIN IN THE FOOT

DOC I HAVE A PIN IN THE FOOT

This memorable case was a 8 year boy who was brought by the mother to see me because of pain and swelling in his right foot for 2 weeks.
The mother gave a history of the boy jumping on his bed which had small head pins left by his younger sister. 
The boy claimed one of the pin entered his right foot and caused pain in his foot. 
So the mother brought him to a nearby clinic where the young doctor examined his foot and told the mother there may be just a slight infection of his foot. 
He was given some antibiotic and painkiller and an antibiotic cream to apply to the sole of his foot. 

After 5 days the foot became more swollen and painful and the boy was brought to the same doctor again . He was given an injection and an another antibiotic.

After 2 weeks when the swelling of the foot did go down and remains red and painful she was recommended by a friend to bring the child to consult me.

The first thing after I heard the history of a possible pin entering his right foot was to examine the foot carefully. There was indeed a red painful swelling of  the dorsum or the top surface of his foot. 
The second thing that I did was to send him for an X-ray of his right foot.
As suspected the urgent x-ray showed the presence of a pin stuck in his foot in the flesh between the 3rd and 4th toes.

I had to do an urgent surgery to remove the pin. 
Luckily the boy was quite brave and although he cries a bit he knew it was for his own good. 
In an operation that lasted almost 1 hour I had to search for the pin guided by the x-ray and finally retrieved a small rusty pin which was surrounded by fibrous tissues from his foot.
The mother was so relieved to see the pin.
She said she was praying so hard for me to find the pin. 

As the mother did not know whether the boy was given a tetanus toxoid injection to prevent lockjaw in his 2nd visit to the doctor, I had to call the doctor to ask whether he had given the tetanus injection. 
He was shocked to hear that the boy had a rusty pin in his foot for 2 weeks. He said that he gave the boy only an antibiotic injection and not the tetanus toxoid injection which was to prevent lockjaw. 

Lockjaw( A Simple Guide to Tetanus) was a dangerous condition where a rusty nail or metal can cause the tetanus bacteria to grow in the foot resulting in the contraction of muscles including the the heart muscle and then death.

I gave the boy the tetanus toxoid injection and hoped that he will not get tetanus. 

Only once in my work as a family doctor, I have seen a lockjaw patient who had to be sent to hospital where her breathing stopped and had to be resuscitated back to life.

After another x-ray showed the pin was no longer in the foot, I gave him some antibiotics, painkiller and reviewed him the next day.

Happily he was well and he was given an antibiotic cream to apply to his surgery wound. 
After the stitches were removed and the pain and swelling was gone, I was satisfied that the boy was going to be all right.

Any body who has a possibility of a metal foreign body in his flesh should be sent for an x-ray. 
The x-ray can detect any metal in the body easily and knowledge of this can prevent any tragic consequences to the patient.

It was a lesson to all new young general practitioners.