Generalized Tetanus in a Geriatric Age Group Patient

Tetanus is a vaccine preventable infectious disease which presents itself in four clinical types as generalized, localized, cephalic and neonatal tetanus. Generalized tetanus generally occurs in elderly patients, in whom the level of serum antitoxin is inadequate, with high mortality rates. As muscle spasms and autonomic dysfunction are the major findings, patients should be followed in intensive care units. This necessity may cause healthcare associated infections and complications. In this case presentation, a 68-year-old male patient who had developed generalized tetanus was reported. The patient admitted to the emergency service two days after a nail wound on his left foot sole and received only tetanus vaccine for prophylaxis. Symptoms started six days after injury. The patient could only be diagnosed with tetanus five days after the first clinical findings. The patient was intubated and followed in the intensive care unit. 3000 IU human tetanus immunoglobulin and 14-day course of metronidazole therapy was administered. Muscle spasms were managed via rocuronium and midasolame. The patient died on the 35th day of follow-up due to ventilator associated Acinetobacter baumannii complex pneumonia and nephrotoxicity related to colistin therapy.