Successful Therapeutic Plasma Exchange Therapy In Severe Tetanus

Abstract

Introduction: Tetanus is an acute toxemia condition caused by neurotoxin produced by Clostridium tetani manifested as periodic muscular spasm. Manifestation could range from localized tetanus into generalized tetanus and cephalic tetanus. Severe forms of tetanus complicating management and mostly resulted in death because of asphyxia and hyperactivity of sympathetic system. Therapeutic plasma exchange (TPE), in which plasma separated from whole blood and replaced with normal saline, albumin, or fresh frozen plasma, could improve survival in toxemia condition although studies about the use of TPE in the treatment of tetanus still lacking.

Case Illustration: A man in his 60s presented to the ER with complaint of generalized stiffness on belly, legs, arms and jaw in which the patient hardly open his mouth. Patient was diagnosed with tetanus due to history of unhealed wound on patient’s left pinky toe two weeks prior. Patient condition worsened through period of admission that requiring intensive care and mechanical ventillation on fifth day after admission. Two TPE therapy on fifth and eighth day of admission was given with improvement of patient’s clinical condition after two days of second TPE therapy.

Discussion: Indication of TPE has expanded, and severe tetanus could be indicated as one of TPE indications inline with principle of management of tetanus to prevent the spread and toxicity of neurotoxins. The general principle of TPE is to remove a circulating molecule from the blood in the hope of improving the clinical condition of the patient.

Conclusion: Tetanus is pretty common case in developing countries related to high mortality rate. Management of severe tetanus could be tricky in several case. Therapeutic plasma eschange (TPE) may be a better therapeutic alternatives with some successful use reported in treatment of neurological cases.