Generalized tetanus in a ship captain following a puncture wound that occurred at work

A 57-year-old man from the Philippines working as a ship captain was brought to the emergency department. He had a 2-cm ulcerative wound on his left elbow resulting from puncture with an iron bar 10 days earlier. To his knowledge, he had not received a tetanus vaccine. Physical examination was notable for masseter muscle stiffness and difficulty swallowing. Doctors diagnosed him with tetanus.

Tetanus is caused by tetanospasmin, a neurotoxin secreted by the anaerobe Clostridium tetani, which is found in soil and enters the human body via contaminated wounds, especially puncture wounds or burns.

Full practice article published in the Canadian Medical Association Journal: www.cmaj.ca/lookup/doi/10.1503/cmaj.190161

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