Treatment of Adult Severe Generalized Tetanus with Magnesium: A Case Report

Tetanus is a disease caused by tetanospasmin produced by Clostridium tetani, a noninvasive grampositive anaerobic bacillus. Tetanospasmin is taken up by the neuronal end plates and irreversibly inhibits release of the neurotransmitter, gamma-aminon-butyric acid (GABA), at the synaptic junction, leading to muscle spasms. Different forms of tetanus exist: generalized, cephalic, localized, and neonatal forms. The severest one is the generalized form, involving the bulbar and paraspinal muscles; i t s man i f e s t a t i ons i nc lude lock jaw, r i sus sardonicus, difficulty swallowing, muscle rigidity and spasms, and opisthotonos. Death, if left untreated, is caused by respiratory compromise or fracture of the spine. There was a decreased prevalence in tetanus during the 20th century in the wake of widespread immunization programs. There is an average of 15 suspected cases of tetanus reported annually in Taiwan but only 1 case was confirmed in Yunlin, southwestern Taiwan, in 2001. Mainstay management is supportive care. Even with the introduction of heavy sedation, muscle relaxation, and intensive care support, the fatality rate is still unacceptably high due to complications of the therapy itself. We report a case of severe generalized tetanus in a 40-year-old man who received magnesium sulfate via an intravenous infusion. Successful control of the muscle spasms and clinical improvement without sedation-associated complications were achieved. Treatment of Adult Severe Generalized Tetanus with Magnesium: A Case Report