Tetanus attacks an old person with inadequate vaccination showing 'Risus Sardonicus' face.
Tetanus attacks an old person with inadequate vaccination showing 'Risus Sardonicus' face.
复制标题
破伤风袭击了一个老人，疫苗接种不足，表现出“ risus sardonicus”的脸。
DOI：
10.1016/j.idcr.2017.08.009
复制
发表时间：
2017
期刊：
影响因子：
1.5
通讯作者：
Iwasaki H
中科院分区：
文献类型：
--
作者：
Kobayashi A;Iwasaki H
一位有酗酒史的79岁男性，因严重的上腹痛就诊。诊断为急性胰腺炎。患者接受支持性治疗，包括补液、止痛药和肠道休息。入院后3天症状好转。第四天，他出现颈部僵硬;吞咽困难;牙关紧闭，由于咬肌僵硬而无法完全张开嘴;咀嚼肌和颈部肌肉组织的肌肉痉挛（图1）;以及特征性的“Risus Sardonicus”脸，面部肌肉的疼痛性肌肉痉挛类似于微笑（图2）。虽然没有外伤史，身体上也没有伤口，但他的病情被临床诊断为破伤风，并给予破伤风类毒素（TT; 0.5 mL，IM）、人破伤风免疫球蛋白（TIG; 4500 IU，div）和青霉素G（4000万IU/天，div）。初五，发生抽搐，没有缓解。由于呼吸困难，进行气管插管，患者接受人工呼吸管理。同时给予抗惊厥和镇静药物，但惊厥很容易由轻微刺激诱发，如简单的医疗和护理程序。插管后5天开始出现自主神经紊乱，伴持续不稳定高血压、心动过速和出汗。惊厥发作的频率和强度在发作后约15天开始轻微降低，开始逐渐减少静脉抗惊厥药注射。他在发病后20天脱离呼吸机。入院后第35天，他出院，症状已完全恢复。图3、图4显示了他出院后的面部和正常的张口度。虽然破伤风现在在发达国家是一种罕见的疾病，但据报告，在日本每年仍有约100例破伤风病例。破伤风可以通过接种疫苗来预防。破伤风类毒素于1952年作为自愿接种疫苗上市，并于1968年作为常规接种疫苗上市[1]。然而，尽管建议每10年接种一次加强疫苗[2]，但大多数日本成年人由于身体受伤或出国旅行而没有接种疫苗。因此，许多没有接种疫苗的成年人感染破伤风的风险更高。
A 79-year-old man with history of alcohol abuse presented with severe epigastric pain. Acute pancreatitis was diagnosed. The patient received supportive care with fluid hydration, pain medication, and bowel rest. And his symptoms had improved 3 days after hospital admission. On the fourth day, he developed nuchal rigidity; dysphagia; trismus, the inability to open the mouth fully owing to rigidity of the masseters; muscle spasms in the masticatory and neck musculature (Fig. 1); and a characteristic ‘Risus Sardonicus’ face, a painful muscle spasm of the facial muscles resembling a smile (Fig. 2). Although there was no history of trauma and no wound was seen on his body, his condition was clinically diagnosed as tetanus, and tetanus toxoid (TT; 0.5 mL, IM), human tetanus immunoglobulin (TIG; 4500 IU, div) and penicillin G (40 million IU/day, div) were administered. On the fifth day, convulsions occurred and did not remit. Because of respiratory difficulties, tracheal intubation was performed and the patient underwent artificial respiratory management. Anticonvulsant and sedative medications were concomitantly administered, but convulsions were readily induced by minor stimuli such as simple medical and nursing procedures. Autonomic disturbance with sustained labile hypertension, tachycardia, and sweating started 5 days after intubation. The frequency and intensity of the convulsive seizures started to decrease slightly approximately 15 days after onset, and a tapering of the intravenous anticonvulsant injections was initiated. He was waned from the ventilator 20 days after onset. On the 35th day after admission, he was discharged and his symptoms had recovered completely. Fig. 3, Fig. 4 show his face and normal mouth opening after he was discharged. Although tetanus is now a rare disease in developed countries, it is still encountered with a reported occurrence rate of approximately 100 cases/year in Japan. Tetanus can be prevented by vaccination. Tetanus toxoid became commercially available as a voluntary inoculation in 1952 and as a routine vaccination in 1968 [1]. However, despite recommended booster vaccinations every 10 years [2], most Japanese adults do not receive it because of a physical injury or when they travel overseas. Therefore, many adults with an inadequate vaccination history are at a higher risk of contracting tetanus.