Tetanus Complicated by Dysautonomia: A Case Report and Review of Management

Sharma, Nishant; Li, Si; Sravanthi, Metlapalli Venkata; Kazmierski, Dan; Wang, Yichen; Sharma, Amit; Dhaubhadel, Pragya

doi:10.1155/2021/8842522

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…In contrast to this finding, primarily hypotension is described in previous case reports (9,16). In human patients, clinical signs of autonomic dysfunction range from profound hypertension and tachycardia to bradycardia, arrhythmia, and hypotension (35). Elevated serum levels of norepinephrine, with spikes of epinephrine levels, cause a hyperdynamic circulatory state.…”

Section: Discussionmentioning

confidence: 99%

“…Excess acetylcholine may contribute to this autonomic dysfunction (37). Possible mechanisms of bradycardia are sudden withdrawal of catecholamines or increased vagal tone (35). In human patients, autonomic storms are often followed by severe resistant hypotension, bradycardia, and asystole and result in massive fluctuations in systemic vascular resistance index, with little change in cardiac index (37).…”

Section: Discussionmentioning

confidence: 99%

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Retrospective study of tetanus in 18 dogs—Causes, management, complications, and immunological status

Dörfelt,

Mayer,

Wolf

et al. 2023

Front. Vet. Sci.

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ObjectiveTetanus is a severe neurologic disease caused by Clostridium tetani, resulting in spastic paralysis. Canine tetanus is associated with serious complications such as aspiration and a high mortality rate of up to 50%.Materials and methodsMedical records of all dogs diagnosed with tetanus over 8 years (2014–2022) were analyzed for severity grade, treatment protocols, nutritional management, and complications, as well as outcome, vaccination, and antibody production in some dogs. No medical records were excluded. Normality was analyzed by the D'Agostino–Pearson test. Parametric, normally distributed data were presented as mean ± standard deviation. Non-parametric, non-normally distributed data were presented as median (m) and range (minimum–maximum). The association between tetanus grade, progression of diseases, and duration of hospitalization was analyzed using the t-test, Mann–Whitney U test, and Kruskal–Wallis test. A P ≤ 0.05 was considered significant.ResultsEighteen dogs were identified. Most affected dogs were classified into severity grade II (66.7%, 12 of 18). Clinical signs deteriorated in 55.6% of dogs (10 of 18). A source was identified in 88.9% of dogs (16 of 18). Nine dogs required surgical wound revision. A percutaneous endoscopic gastropexy tube was placed in 83.3% of dogs (15 of 18) for nutritional support. Medical treatment included metronidazole, methocarbamol, and combinations of different sedatives adapted to the patient's requirements. Tetanus antitoxin was used in 72.2% of dogs (13 of 18) without reported adverse events. The survival rate was 88.9% (16 of 18). Complications, such as hypertension, aspiration pneumonia, and laryngeal spasm occurred in 12 of 18 dogs. Median hospitalization time (8 days; range 0–16 days) was associated with the maximum tetanus severity grade (p = 0.022). Rapid eye movement behavior disorder was observed in 72.2% of dogs (13 of 18). In 5 dogs, antibodies were measured after recovery, and in 4 of 5 dogs, no antibodies were detectable despite generalized tetanus disease. Vaccination with tetanus toxoid was performed in five dogs following the disease.ConclusionIn the present study, the mortality rate was lower than previously reported. Tetanus is still a life-threatening disease, but the prognosis may be good if adequate management and monitoring can be ensured.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrospective study of tetanus in 18 dogs—Causes, management, complications, and immunological status

Dörfelt,

Mayer,

Wolf

et al. 2023

Front. Vet. Sci.

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“…Most of the studies in the review showed that magnesium sulfate was effective in controlling dysautonomia, especially cardiac arrhythmia or heart block, compared with the non-magnesium group. There are recently reported cases where magnesium sulfate was used successfully alongside other supportive medications to treat dysautonomia in tetanus patients [24,25]. Although the exact mechanism is unclear, magnesium sulfate perhaps helps in controlling dysautonomia by decreasing calcium availability at presynaptic terminals, thereby preventing the release of catecholamines.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of Magnesium Sulfate in the management of Tetanus: A systematic review

Nepal

Coghlan

Yadav

et al. 2021

Tropical Med Int Health

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Tetanus is a rare life-threatening condition often complicated by repetitive spasms, dysautonomia and neuromuscular respiratory failure contributing to high fatality rates in its severe form. Benzodiazepines used to treat muscle spasms pose a high risk of respiratory failure requiring mechanical ventilation, which is unaffordable and inaccessible for many. Magnesium sulfate, a cheap and widely available medication in all urban and rural health centres of LMICs for the treatment of eclampsia, can be used to control muscle spasms and dysautonomia. We thus conducted a systematic review of evidence to assess the safety and efficacy of magnesium sulfate in the treatment of tetanus. Any study published before April 15, 2021, discussing the efficacy and/or safety of MgSO4 infusion in the treatment of tetanus was systemically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our systematic review included data from 13 studies, three were randomised, double-blind and controlled trials.The remaining ten studies were observational; six prospective and four retrospective studies. Our review showed no mortality benefit associated with the use of magnesium sulfate. However, magnesium sulfate was found to be effective in reducing spasms along with diazepam, leading to better control of dysautonomia, reduced need for mechanical ventilation and shorter hospital stay by 3-7 days. The incidence of magnesium toxicity was very low in the studies included.

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Generalised tetanus in a cat successfully treated with magnesium sulphate and dexmedetomidine

Moretti,

Botto,

Calabria

et al. 2024

Vet Record Case Reports

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A 4‐year‐old, neutered male domestic short‐haired cat was presented with an abdominal injury, severe extensor rigidity of all limbs and sardonic facial expression. The cat was diagnosed with tetanus and antibiotics, and antiemetics and analgesics were administered. In order to provide myorelaxation, in addition to midazolam, a supraphysiologic dose of magnesium sulphate was infused intravenously at a constant rate of 10 mg/kg/h, after a loading dose of 70 mg/kg; serum magnesium and ionic calcium were measured daily. During hospitalisation, the cat showed hypersensitivity to stimuli, tetanic seizures, hyperthermia and autonomic dysfunction, presenting as severe hypertension, sinus and ventricular tachycardia. An intravenous infusion of dexmedetomidine (1 ± 0.5 µg/kg/h) improved haemodynamic parameters and attenuated muscle spasms, and its administration was continued for 96 h without adverse reactions. The magnesium infusion was maintained for 11 days without toxicity, except for a mild hypocalcaemia. The cat's clinical signs gradually improved and the patient was discharged on day 28.

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Tetanus Complicated by Dysautonomia: A Case Report and Review of Management

Cited by 5 publications

References 14 publications

Retrospective study of tetanus in 18 dogs—Causes, management, complications, and immunological status

Retrospective study of tetanus in 18 dogs—Causes, management, complications, and immunological status

Safety and efficacy of Magnesium Sulfate in the management of Tetanus: A systematic review

Generalised tetanus in a cat successfully treated with magnesium sulphate and dexmedetomidine

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