The most interesting part of the case is that the type of circumstances that would lead the doctor to make the right call at the end of the day. There was a lot of trial and error here. Especially since the doctor was going based of same symptoms from a different type of case. However, that being said I also find it amazing that prior experience no matter in what sense can still save a life. Making this whole case into something like a type of medical drama and almost thrilling to try to guess the disease, cure and outcome.
The bacterial species that causes tetanus is called Clostridium tetani. This type of organism is mainly found in soil especially in heavily manured soils and in the traces of various animals’ feces. Though carrier rates are extremely rare the organism is thought to be a transient member of the flora whose presence depends on ingestion of any means. The organism produces terminal spores that sort of appear in the form of a drumstick. Though the bacteria has a typical gram positive cell wall it may stain gram negative or gram variable especially if the cells are a bit older than others. That being said C. tetani causes tetanus to be split into 4 clinical types generalized being the basic version, localized stating a particular place or nerves get attacked, cephalic is the same as localized however it affects cranial nerves, and finally neonatal this mainly affects new born infants when the umbilical cord is cut.
The clostridial neurotoxins responsible for tetanus are proteins consisting of three domains endowed with different functions: neurospecific binding, membrane translocation and proteolysis for specific components of the neuroexocytosis apparatus. Tetanus neurotoxin (TeNT) binds to the presynaptic membrane of the neuromuscular junction, is internalized and transported retroaxonally to the spinal cord. Tetanospasmin binds to peripheral nerve terminals. It is then transported with the axon and synaptic junctions until it reaches the nervous system. By this point it reaches the nerve endings and basically results in the “lockjaw” state that the infection is know for as well. Your body will not be able to control its self from doing this making your body still and stiff especially int eh spinal and neck area
The first course of action was to check Eduardo’s electrolyte count when that checked out to be normal the low calcium was ruled out at the outcome of his spastic muscles. The backup plan of this was the fact that he may suffers from dystonia in other words the spastic muscles. They gave him Benadryl which should help with the spastic muscles but only in the sense that it helps moderate them not so much stop them all together. However, this also did not work. While in the ICU the chief of said ICU gave Eduardo Valium I’m assuming as a stand by while they figured out what kind of antibiotics to give him. Valium being used to help with the seizures by helping calm down the brain and its nerves. At the end of the day though the doctor went with Penicillin as a way to clear up all the toxin producing bacteria from his blood.
Eduardo could have gotten the C. tetani. Form countless different types of places. I would assume that maybe since he does play soccer a mosquito bite could have been left untreated and while rolling around in the dirt it could have gotten infected. Another possible way could be depending on the type of work Eduardo does and the type of car he was found in we could assume that he could have gotten a laceration and again that could also lead to an infected leg that would also result in the bacteria getting in.
The antibodies especially the penicillin works as cleanser to clear out all the toxins that were produced by the C. tetani. Especially since this type of bacteria attacks the nervous systems and the only actual way to cure this is to get rid of all the bad bacteria. 7. It’s able to survive in the such environments because like many types of bacteria its able to go in a catatonic state which is of course is the endospore. A type of protective shell that keep the bacteria in hibernation until the right type of circumstances are met for the bacteria to move and spread.
Todar, K P.H.D. (2008-2012). Pathogenic Clostridia, including Botulism and Tetanus (page 3). Madison, Wisconsin. http://www.textbookofbacteriology.net/clostridia_3.html
Mayo Foundation for Medical Education and Research (MFMER). (1998-2019). Tetanus https://www.mayoclinic.org/diseases-conditions/tetanus/symptoms-causes/syc-20351625
Nordqvist, C (Wed 13 December 2017) Everything you need to know about tetanus. Brighton, UK. https://www.medicalnewstoday.com/articles/163063.php
R Pellizzari, O Rossetto, G Schiavo, and C Montecucco (1999 Feb 28). Tetanus and botulinum neurotoxins: mechanism of action and therapeutic uses. Bethesda, Maryland. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1692495/
https://www.webmd.com/drugs/2/drug-5680/benadryl-oral/details 7. https://www.webmd.com/drugs/2/drug-11116/valium-oral/details