Tetanus is an acute disease caused by the tetanospasmin toxin produced by Clostridium tetani , with a high mortality particularly in developing countries. Although preventable through primary immunization and booster vaccination, cases in adults with uncertain immunization status remain common. Intraoral wounds are uncommonly reported as portals of entry. A 54-year-old male developed generalized tetanus after manipulating a tooth with a toothpick, causing bleeding. Initial dental pain and oral numbness progressed to trismus, opisthotonus, and risus sardonicus. He was admitted to the intensive care unit (ICU) of a tertiary referral hospital in Indonesia for 19 days and received spasm control (diazepam, midazolam, rocuronium, magnesium sulfate), bacterial eradication (metronidazole, procaine penicillin), stepwise mechanical ventilation, and both enteral and parenteral nutritional support. Complications included ventilator-associated pneumonia, candiduria, hypokalemia, hypocalcemia, and hypoalbuminemia, all managed through a multidisciplinary approach. At the end of treatment, the patient demonstrated a favorable clinical outcome despite a complex disease course accompanied by multiple complications. Despite a prolonged and complex clinical course, the patient favorable outcome. This case highlights that intraoral wounds, though uncommon, may serve as clinically relevant source of tetanus infection due to the anaerobic and necrotic environment that facilitates Clostridium tetani spore germination.
Edward et al. (Sun,) studied this question.