title: Dysphagia in elderly women: consider tetanus.
abstract: BACKGROUND
  Dysphagia is seldom caused by tetanus; however, it is a common symptom of tetanus. Treating patients with tetanus is a rare event in industrialized countries and awareness is needed to recognize early signs of this serious disease. In Switzerland, the most recently reported tetanus cases occurred in elderly women with insufficient seroprotection.
  
  
  METHODS
  We report on three elderly women presenting with dysphagia as an initial symptom of tetanus.
  
  
  RESULTS
  Generalized tetanus was diagnosed in two patients upon admission, the third presented with cephalic tetanus with secondary generalization. All three patients had undetectable levels of tetanus antibodies and had no documented prior tetanus immunizations. Cultures of wound swabs grew Clostridium tetani in all cases. Electromyography was highly suggestive for tetanus in two patients. Treatment involved mechanical ventilation, intravenous benzodiazepine and metronidazole therapy, and active and passive tetanus immunization. The disease had a favorable outcome in two cases and was fatal in one.
  
  
  CONCLUSIONS
  Tetanus remains a threat in patients with insufficient seroprotection and efforts are needed to improve tetanus immunization in these individuals. Tetanus should be considered in the differential diagnosis of dysphagia.
authors.affiliation: Clinic and Policlinic for Infectious Diseases, University Hospital, Inselspital, Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Rauch
authors.forename: S
authors.initials: S
authors.lastname: Droz
authors.forename: S
authors.initials: S
authors.lastname: Zimmerli
authors.forename: S L
authors.initials: SL
authors.lastname: Leib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003017:Clostridium tetani / Q000302:isolation & purification; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007114:Immunization; D007717:Knee / Q000473:pathology; D013742:Tetanus / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D013745:Tetanus Toxoid / Q000008:administration & dosage; D016896:Treatment Outcome; D014313:Trismus / Q000473:pathology; D014946:Wound Infection / Q000150:complications / Q000175:diagnosis / Q000382:microbiology
chemical_list: D013745:Tetanus Toxoid