破傷風の１例

Abstract

Although treatment progress has substantially decreased incidence of tetanus, once aperson develops this disease, fatality is very frequent owing to diagnostic difficulty. Reported herein is a case of tetanus with the chief complaint of trismus that our department encountered.Patient was a 43-year-old male. On December 30, 1989 in Ichihara City, Chiba Prefecture he had a severe fall. He was brought to the surgical department of a hospital because of left ear contusion and received emergency treatment. Speech disturbance appeared around January 9, 1990 and tnismus the next day. Patient recognized general malaise around January 16. He went to the neurosurgery and internal medicine departments of near by hospitals during this period, but case etiology remained unknowl. On January 17, he came to the department of neurosurgery of this university. Hey diagnosed facial palsy and sent him to our department for examinaton. Clinical manifestations on the first physical examination were definite trismus, cervical and back pains, left auricle contusion, and tetanica face (i.e., risus sardonicus). According to his history of trauma and clinical progression, we diagnosed tetanus. We ran a germiculture examination with the effusion obtained from the contused part of his left ear and applied a topical treatment.(Clostridium butyricum was later detected). After his admission to this department, we began treating him with tetanus immune human globulin, antibiotics, anticonvulsants, relaxants, neuroleptics and the like. Because of the possibility of respiratory muscle palsy, on the third clay after hospitalization, he was transferred to anesthesiology's department intensive care unit (ICU) and the department of neurology and was successfully treated.Tetanus is a disease with a high fatality rate. Thus, correct diagnosis and treatment in the early stage is necessary. Tetanus patients show trismus symptoms in the course of disease progress and sometimes seek treatment at dentistry and oral surgery departments. Therefore familiarity with the clinical symptoms of these cases and cooperative treatment with related departments are essential to effective treatment.