A case of severe tetanus definitely diagnosed through a gene analysis and treated with high-dosage magnesium therapy

DOI 1 Citations 29 References
  • Iwamura Takashi
    Emergency Care Center, Faculty of Medicine, Saga University
  • Ijuin Masahito
    Department of Emergency Medicine, Karatsu Red Cross Hospital
  • Hirahara Kenji
    Department of Emergency Medicine, Karatsu Red Cross Hospital
  • Inoue Shinsuke
    Department of Clinical Laboratory, Karatsu Red Cross Hospital
  • Kawachi Yasuhiko
    Department of Clinical Laboratory, Karatsu Red Cross Hospital
  • Sano Naoto
    Division of Microbiology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University
  • Miyamoto Hiroshi
    Division of Microbiology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University

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  • 遺伝子解析により確定診断し大量マグネシウム投与を行った重症破傷風の１例

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An 80-year-old male presented with an infection due to nail avulsion and was hospitalized 7 days after the injury. Due to systemic muscle spasms and seizure, ventilatory support was started, but it was difficult to suppress the above symptoms with midazolam and diazepam. On day 6 of hospitalization, findings of sympathetic overactivity became prominent, and fluctuations in daily systolic blood pressure reached 170 mmHg. Combination therapy with propofol and magnesium was started, and this was effective for suppressing those symptoms. Considering the risk of side effects caused by hypermagnesemia, it was determined that the concomitant use of both agents should be the first choice of treatment. In the results of anaerobic culturing from the wound, Clostridium-like bacilli with spores and a club-like configuration were identified. A 16S ribosomal RNA analysis of the bacteria was conducted to genetically reach a definite diagnosis of Clostridium tetani. Because high-dosage magnesium therapy involves the risk of side effects, it is important to take sufficient care regarding the blood magnesium level and make a definite diagnosis of tetanus. Clostridium tetani is generally considered difficult to identify, but new advancements in genetic testing for making a definite diagnosis are eagerly awaited.

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