Document Detail

Respiratory failure in tetanus: case report and review of a 25-year experience.
MedLine Citation:
PMID:  12377887     Owner:  NLM     Status:  MEDLINE    
The objectives of the study were to describe a novel presentation of tetanus and to review the course of the respiratory component and the treatment and management of the disease. A case report is presented with a review of a 25-year experience at Mayo Clinic. We describe the case of a 65-year-old woman who presented with persistent hiccups, dyspnea, and pleurisy of 3 days duration that was caused by tetanus from inadequate secondary immunity. She required intubation for progressive trismus and laryngospasm-associated respiratory failure. Infusion of lorazepam did not control her spasms. Refractory spasms and hiccups resolved with fentanyl and cisatracurium therapy. After 3 weeks, the patient was weaned from the ventilator with complete recovery. In the past 25 years, nine additional patients have presented to Mayo Clinic with acute tetanus. Respiratory failure requiring intubation developed in seven patients, and six of the seven intubated patients survived with minimal deficits. The prognosis of tetanus is favorable if it is diagnosed promptly and if treatment and supportive measures are begun. To our knowledge, this is the first report of a patient with acute tetanus presenting with hiccups. This report also confirms the results of previous studies that suggested a need for improved immunity in the elderly population.
T Jared Bunch; Muna K Thalji; Patricia A Pellikka; Timothy R Aksamit
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Chest     Volume:  122     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-14     Completed Date:  2002-11-22     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1488-92     Citation Subset:  AIM; IM    
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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MeSH Terms
Acute Disease
Combined Modality Therapy
Follow-Up Studies
Respiration, Artificial
Respiratory Insufficiency / etiology*,  therapy*
Risk Assessment
Severity of Illness Index
Tetanus / complications*,  diagnosis*,  therapy

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