顔面麻痺を伴った破傷風例

Abstract

Tetanus is a well acknowledged infectious disease designated in the law on infectious disease. Due to a progress of protective inoculation and public health, the incidence of this disease has been decreasing recently. In Japan, we seldom encounter patients with tetanus at present; however, it is important to consider this disease, because of its extremely poor prognosis. If early diagnosis and suitable treatment are not perfomed, prognoses of tetanus is frequently miserable. A sixty-four-year old woman consulted our hospital complaining of trismus and severe dysphagia, with facial nerve palsy 10 days after a head injury. Physical examination showed trismus, and a 5cm wound was seen on her left forehead. Blood examinations showed an increased level of C-reactive protein. The patient was suspected of having tetanus based on the clinical symptoms and was admitted to our hospital immediately. She received 3000 units of antitetanus human immunogloblin on the first day, and daily intravenous infusion of Benzylpenicillin was administered for 10 days. After the treatment was initiated, trismus showed daily improvement, and she recovered without developing any complications such as airway obstruction or circulatory disturbance. Despite progress in protective inoculation and public health, tetanus has not been eradicated, since bacillus tetani widely exists in the soil and intestines.Altough tetanus is rare in Japan, it is important to consider this disease as part of the the differential diagnosis when we encounter patients with Stage 1 or Stage 2 symptoms of tetanus such as dysphonia, dysphagia, and trismus after an injury.