title: Tetanus--a case report with severe autonomic instability and: a review of the literature.
abstract: BACKGROUND
  Tetanus is an infection that can be associated with a high mortality especially in developing countries. Critical care which may include artificial control of respiration is crucial in survival, but cardiovascular complications from autonomic instability remains an important cause of death. The objective of this report is to highlight this important cause of mortality despite artificial control of ventilation to prevent respiratory arrest.
  
  
  METHODS
  The medical record of the patient and relevant literature were reviewed.
  
  
  RESULTS
  A 29-year old male following a wound on the lower limb presented with clinical features suggestive of tetanus. Incubation period was short and immunization history was uncertain. Basic treatment directed at removing source of infection and neutralisation of unbound toxin was however commenced. Following signs of imminent respiratory failure due to severe uncontrollable spasms, controlled mechanical ventilation was instituted in the critical care unit (CCU). However, the patient succumbed to cardiac arrest as a result of severe autonomic instability, despite aggressive cardiopulmonary resuscitation.
  
  
  CONCLUSIONS
  Cardiovascular arrest from severe autonomic instability remains an important cause of mortality in tetanus despite artificial ventilation. Early management with appropriate therapy is advisable to prevent its occurrence.
authors.affiliation: Department of Anaesthesia and Intensive Care, Lagos State University Teaching Hospital, Ikeja, Lagos. busolabriggs@yahoo.co.uk
authors.forename: O T
authors.initials: OT
authors.lastname: Alagbe-Briggs
authors.forename: S A
authors.initials: SA
authors.lastname: Tinubu
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000382:microbiology / Q000503:physiopathology*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000382:microbiology / Q000628:therapy*; D013742:Tetanus / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*