Abstract
The widespread use of the tetanus toxoid vaccine has been very effective in the prevention of tetanus. However, older patients who may have failed to receive or complete immunization schedules for this vaccine are prone to the significant risks of this life-threatening illness. We present two cases stemming from diabetic foot ulcers to remind clinicians of the presentation and treatment of this now rare disease and to also draw attention to the need to emphasize immunisation as a prevention strategy.
Highlights
A 70-year-old Trinidadian male of African descent with a 10-year history of diabetes on metformin and gliclazide presented with a one-day history of trismus and progressive left foot third digit gangrene for the past two months along with subjective fevers and progressive dysphagia for the last two days
The patient was admitted to the High Dependency Unit (HDU) and a diagnosis of tetanus was made secondary to left diabetic foot gangrene
An emergency tracheostomy was performed under general anaesthesia and the patient was placed on the ventilator and transferred to the Intensive Care Unit (ICU)
Summary
A 70-year-old Trinidadian male of African descent with a 10-year history of diabetes on metformin and gliclazide presented with a one-day history of trismus and progressive left foot third digit gangrene for the past two months along with subjective fevers and progressive dysphagia for the last two days. The head and neck showed risus sardonicus (Figure 1) His left foot third digit was gangrenous with a foul-smelling discharge. 6000 units of tetanus immune globulin was administered intramuscularly He underwent a femoralfemoral bypass and extensive debridement of the left foot wound under general anaesthesia. Within 48 hours of admission, the patient developed facial spasms and worsening respiratory distress He was intubated and started on midazolam and cisatracurium infusion along with further debridement and amputation of the first two metatarsals of the left foot.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
