Can the nail damage be fatal? A case report of the tetanus in German Boxer

Abstract

Tetanus is a neurologic disease caused by the action of tetanus toxin (TeNT) produced by the Gram-positive, ubiquitous, sporulating, anaerobic bacterium Clostridium tetani. It is a rare disease in dogs due to their resistance to the toxin. A 1-year-old, male German Boxer presented with a three-day history of lethargy, facial abnormalities, dyspnea, ptyalism, dysuria and constipation. The owners also reported that the dog’s nail had broken two weeks ago. Clinical examination revealed ptyalism, hyperthermia, abnormal facial expressions (wrinkled forehead, risus sardonicus) and eyes’ position (ventrolateral strabismus), trismus, dysuria, and muscle rigidity, which progressed to seizures and generalized spastic tetraplegia. Complete blood count showed increased reticulocyte count, low reticulocyte hemoglobin content, and eosinopenia. The biochemistry profile revealed decreased amylase values, hypochloremia, and creatine kinase was significantly elevated. A presumptive diagnosis of generalized tetanus was based on the history, wound presence, and characteristic clinical signs. The initial treatment was based on previously published recommendations, and it included: IV fluids, sedation and muscle relaxation, antibiotic (metronidazole), tetanus antitoxin, and supportive care. Unfortunately, during an episode of spastic muscle rigidity, apnea occured, leading to the dog’s death.