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Therapeutic management of tetanus in a dog.

Introduction

Tetanus is of worldwide significance in humans, being more common in warm tropical climate. Its incidence and severity is relatively low in dogs and cats. The present report describes a clinical case of generalized tetanus in a non-descript male dog with its successful treatment.

History

A three year old male non-descript dog, was presented with history of missing for last 48 hours and on return had stiff muscles, recumbancy, wound and showed strong reaction to mild stimulation.

Clinical Observations

Clinical examination revealed wound next to medial canthus of left eye marked weakness, lethargy, dullness, vomiting, recumbancy, pyrexia (104.6[degrees] F), dyspnoea, bradycardia (HR-58 bpm), muscle rigidity, difficulty in standing and lying down, out stretched tail (Fig.1), stiff motor response, accentuated myotactic reflex, protusion of third eyelid, enophthalmos, erect ears, drawn back lips, tragic face, trismus, increased salivation, dysphagia, strong reaction to tactile and auditory stimulation of even mild nature, opisthotonus posture, muscle contraction, inability in prehension and swallowing and distended abdomen at various stages under treatment.

Haematological Observations

Haemogram revealed normal haemoglobin (14.8 g/dl), total erythrocyte count (5.55 millions/[mm.sup.3]), packed cell volume (45.5%), mean corpuscular volume (53.1 fl), mean corpuscular haemoglobin (21.5 pg), mean corpuscular haemoglobin concentration (24.8 g/dl) and RDW (16.8%); leukocytosis (23700/[mm.sup.3]) with neutrophilia (70%) and shift to left; high platelet count (1400000/); normal serum creatinine (1.08 mg/ dl) and ALT (89.09 IU/l.).

Diagnosis

Detection of recent wound and clinical symptoms were the primary means of making diagnosis of tetanus in this case as isolation of Clostridium tetani from the wound was difficult and many times unrewarding.

Treatment

The dog was treated with fluids (Dextrose 10% @ 80 ml/kg b.wt. intravenously followed by Dextrose 5% for 4 days), human anti-tetanus immunoglobulins (Tetiga) @ 250 IU IM and 250 IU intrathecally (before injecting Tetig IM a test dose was given intradermally and waited for an hour for any reaction if any); Procaine penicillin (40000 unit/kg im 6 hrly for 7days), Diazepam (10 mg intravenously bid for controlling convulsions), Chlorpromazine (2.0 mg/ kg im b.i.d. for controlling Hyperexcitable state) and Vitamin-B complex (2 ml iv with fluid daily). Doxapram @ 0.5 mg/kg IV within 30 seconds (repeated after 45 minutes) was given when the dog developed respiratory arrest during the course of therapy.

Results and Discussion

Though dogs and cats are relatively resistant to tetanus as compare to other domestic animals, the disease when it occurs is fatal. The present case describes a clear cut case of generalized tetanus. Clinical signs were observed within 72 hours. In India tetanus in dogs, caused by Clostridium tetani, is a well established clinical entity but rational treatment has not been attempted owing to high cost. Wound next to medial canthus, muscle rigidity, difficulty in standing and lying down, out stretched tail, stiff motor response, accentuated myotactic reflex, protusion of third eyelid, erect ears, drawn back lips, tragic face, strong reaction to tactile and auditory stimulation of even mild nature were suggestive of tetanus as described for by other authors (Greene, 1984; Malik et al., 1989; Nelson and Couto, 1998; Ettinger and Feldman, 2000). Haemoglobin total erythrocyte count, packed cell volume, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and RDW, serum creatinine and ALT were within normal range and uncommittal. However, leukocytosis (23700/[mm.sup.3]) with neutrophilia (70%) and shift to left appeared to be due to wound and infection (Greene, 1984).

Intensive and critical care with fluids, human anti-tetanus immunoglobulins, procaine penicillin, diazepam, chlorpromazine, Vitamin-B complex, and doxapram yielded highly satisfactory and favourable results. Since there was no clear cut dose schedule for human antitetanus immunoglobulins for dogs, the schedule prescribed for humans (250 IU single intramuscular injection with similar dose intrathecally and some amount locally at the site of the wound) was followed. Human anti-tetanus immunoglobulins was used to neutralize tetanus toxin as tetanus antitoxin of equine origin, generally recommended for treatment, was not available in the market. Penicillin is the drug of first choice and was used locally and parenterally for a week to kill any vegetative C. tetani organism present in the wound. Chlorpromazine and diazepam were used to control reflex spasms and convulsions. During the course of treatment the dog once started showing signs of respiratory failure on the 3rd day. This is usually a very serious complication as it progress to death (Nelson and Couto, 1998). Fortunately respiratory failure was successfully averted with an immediate treatment with doxapram. Intravenous fluids with vitamins were the part of nutritional supportive till the dog assumed oral feeding. Hand feeding was adopted as soon as the dog was able to prehend and swallow. In most of the cases of clinical tetanus in dogs, prognosis is poor owing to fatal outcome. In the present case recovery was spectacular with the intensive care and therapy (Fig.2).

Acknowledgements

The authors are thankful to the Chairman, Managing trustees and Board of trustees for providing necessary facilities at the hospital.

References

Ettinger, S. J. and Feldman, E.C. (2000). Textbook of Veterinary Internal Medicine. Diseases of the Dog and Cat. 5th Edn. Vol.1, W.B Saunders Company, Philadelphia. p. 398.

Greene, C.E. (1984). Tetanus In: Clinical Microbiology and Infectious Diseases of the Dog and Cat. W.B. Saunders Company, Philadelphia. pp. 608-16.

Malik, R., Church, D.B. and Maddison, J.E. (1989). Three cases of localized tetanus. J. Small. Anim. Pract. 30: 469.

Nelson, R.W. and Couto, C.G. (1998). Small Animal Internal Medicine. 2nd Edn. C.G. Mosby, St. Louis. pp. 977-78.

J.P. Varshney (1), V.V. Deshmukh (2) and P.S. Chaudhary (3)

Shri Surat Panjarapole

Nandini Veterinary Hospital

Ghod-Dod Road

Surat--395 007 (Gujarat)

(1) Medicine Consultant and Corresponding Author

E-mail: dr_jpvarshney@rediffmail.com

(2) Veterinary Pathologist

(3) Veterinary Surgeon

(a) - Brand of Synergy Diagnostics Pvt. Ltd., Mumbai
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Title Annotation:Short Communication
Author:Varshney, J.P.; Deshmukh, V.V.; Chaudhary, P.S.
Publication:Intas Polivet
Article Type:Report
Geographic Code:9INDI
Date:Jan 1, 2013
Words:989
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