Abstract

Tetanus remains a significant public health concern in low- and middle-income countries (LMICs), particularly among adults with incomplete immunization. This case report describes a 40-year-old male farmer from rural India who developed generalized tetanus following a puncture wound to the foot. Classical clinical features including trismus, generalized muscle spasms, and signs of autonomic dysfunction were present. The patient was managed in the intensive care unit with continuous intravenous magnesium sulphate (MgSO4) infusion at 1g/ hour, alongside supportive care and antibiotics. Notably, mechanical ventilation and sedative agents were not required throughout the hospital stay. Progressive improvement in muscle rigidity and spasms was observed by day two of treatment, and the patient was discharged after three weeks without complications. This case highlights the efficacy of magnesium sulphate as a neuromuscular depressant and autonomic stabilizer in moderate to severe tetanus. It underscores its potential to reduce the need for invasive ventilation, especially in resource-limited settings, and supports its use as a safe and cost-effective adjunct in tetanus management.

• 1.   Ali A, Ahmed K, Farooq M, Mahmood S. Comparative study of magnesium sulfate versus diazepam in the management of tetanus. Pak Armed Forces Med J. 2011;61(3):372–376.
• 2.   Attygalle D, Rodrigo N. Magnesium as first line therapy in the management of tetanus: a prospective study of 40 patients. Anaesthesia. 2002;57(8):811–817.
• 3.   Boer M, de Voogd M, Niemeijer ND, van Hoeven L. Tetanus – a case report highlighting the challenges in diagnosis and treatment. Trop Dis Travel Med Vaccines. 2024;10(1):10.
• 4.   Larrubia AL, Zafalon B, Bressan EM, Dos Santos HG, Cândido KV, Blaszak PR, Junior FD. Tétano acidental: uma revisão dos aspectos clínicos, epidemiológicos e neuroquímicos/ Accidental tetanus: a review of clinical, epidemiological and neurochemical aspects. Braz J Health Rev. 2021;4(3):12392–12401.
• 5.   Mathew PJ, Samra T, Wig J. Magnesium sulphate for treatment of tetanus in adults. Anaesth Intensive Care. 2010;38(1):185–189.
• 6.   Nepal G, Coghlan MA, Yadav JK, Kharel S, Ka Shing Y, Ojha R, Xing HS, Bo Y, Zhi Lan T. review. Trop Med Int Health. 2021;26(10):1200–1209.
• 7.   Osalusi BS, Ogun SA, Ogunniyi A, Kolapo KO. Comparison of the efficacy of magnesium sulphate and diazepam in the control of tetanus spasms. Sci Res Essays. 2008;3(12):571–576.
• 8.   Sikendar RI, Samad B, Ali A, Memon MI. Post traumatic tetanus and role of magnesium sulphate. J Ayub Med Coll Abbottabad. 2009;21(2):132–135.
• 9.   Susanto TD. Magnesium sulphate for tetanus: review of two cases. Medicinus. 2020;8(2): 112–116.
• 10.   Thwaites CL, Yen LM, Loan HT, Thuy TT, Thwaites GE, Stepniewska K, Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet. 2006;368(9545):1436–1443.

Data Sharing Statement

Funding