Tetanus

A 37-year old male farmer was referred with clinical suspicion of meningitis. He was brought to the emergency department with history of fever, jaw and neck pain, and generalized body stiffness. Escorting relatives reported that the symptoms had started approximately 5 days earlier, when he started to develop “low-grade fever.” Fever was associated with progressively worsening body aches, difficulty in opening his mouth, and difficulty in moving his neck. They denied any history of sore throat or toothache or any known preexisting medical conditions. They also reported an alteration in conscious level that had gradually worsened over the last 24 h that alarmed them enough to seek urgent medical assistance. During initial evaluation, the patient was found to be dehydrated and febrile with a temperature of 99 °F, while other vital signs were normal. Physical examination showed restricted movements at the temporomandibular joint and neck, and no enlarged lymph nodes were evident. A 3–4 cm in diameter wound was seen in the right foot, and on inquiry, his relatives reported that he had hurt himself during farming and the wound had been there for the last 10 days. The wound was clean, without any redness (erythema), discharge, or necrosis. In lab data, WBC (white blood count) was 12,000/μL; otherwise all other basic hematological and biochemical results were within normal range. A brain and maxillofacial CT scan was performed which yielded insignificant findings. On grounds of clinical history and available test results, the patient was admitted with a provisional diagnosis of meningitis.