Quinn and Dr Gabe Young from CareVets Napier

Quinn was a 4 month old Border collie crossbreed male that presented to the Napier vet clinic in late June for his vaccination boosters.  Upon questioning by the vet, Quinn’s owners stated that he did not seem right for several days. He had been at a family friend’s house over the previous weekend, and when the owners collected him a couple days before coming to the vet clinic, he seemed lethargic. He had bumped into the wall a few times earlier that day, but was eating and drinking normally.

When Quinn was examined, he was bright and alert with a normal temperature but had protruding 3rd eyelids and crimpled up erect ears, with contracted muscles on his forehead.  Quinn also had a couple of broken baby teeth, but otherwise was normal. A clinical diagnosis of tetanus was established, and a guarded prognosis given to the owner, with further deterioration likely.  Quinn was started on a 3 week course of antibiotics, and discharged home with the owner since he was still relatively normal.  The owner was instructed to keep him in a quiet environment and to avoid sensatory stimulation when around him, and to monitor his eating and drinking ability.  The owner was warned that worsening clinical signs were likely to occur.  Equine Tetanus Antitoxin was ordered, and scheduled to be administered the following day.

Quinn came in the next day for his antitoxin injection.  The owner was not sure if he was eating OK, but noticed he seemed a bit stiff in his front limbs. Physical exam was identical to the previous day, but Quinn was starting to show signs of stiffness in his front limbs.  He was walking, eating, and drinking well in the clinic.  The equine tetanus antitoxin was given to him, and he was sent home again with similar instructions as the previous day.

Quinn presented to the clinic the next day ‘stiff as a board’; he was extremely rigid from nose to tail with extended limbs, and an extended stiff neck and tail. He was able to open his mouth approximately 3 centimeters, and could apprehend food with his tongue.  A grave prognosis was given to the owner, but she elected to continue with treatment in the hospital. Referral to Massey University was declined.

Quinn was admitted for intensive care in the hospital.  Intravenous fluid therapy was established to maintain hydration status, antibiotic treatment was continued, and his ability to eat closely monitored.  He was also given injectable sedatives to counter the muscle contractions that were constantly occurring, and placed in an isolated quiet part of the clinic.  The nurses had their hands full, as Quinn needed lots of supportive care and attention.

For the 1st week, Quinn seemed to improve little. He maintained his ability to eat on his own, but needed to be hand fed slowly several times a day.  He was recumbent and unable to move at all for 1 week.  On day 8 or 9, he took a turn for the better; he was less stiff and able to turn himself over in his cage. By day 12, he was able to sit up, but was still tripping over his rigid front limbs. He was discharged on day 13, and revisited a week later to see how he was doing.  At the 1 week revisit, he was near normal, with erect ears being the only remnant clinical sign. Otherwise, he is a happy and healthy puppy.

Tetanus is a disease caused by the bacteria Clostridium tetani, which is found throughout the environment in soil.  The bacteria enters the body through wounds (in Quinn’s case, the wounds were from his broken baby teeth), and releases a neurotoxin known as tetanospasmin as it grows.  The neurotoxin targets nerve cell bodies, and causes sustained muscle contractions.  Clinical signs usually develop within 5-10 days of the organism entering the body.  The disease is diagnosed based on its clinical signs, with the history of a recent wound.  Once clinical signs develop, animals remain affected for days to weeks before a gradual resolution of the disease starts to occur. Animals with the disorder often die due to inhalation pneumonia as the muscles of the swallow reflex start to be compromised, or due to respiratory paralysis if the diaphragm becomes involved. Many are euthanased prior to reaching this point. Unlike people, dogs and cats are not routinely vaccinated for Tetanus as it is considered rare in these species.

Dr. Gabe Young, BVSc Veterinarian, CareVets Napier

 

Acknowledgements:

I would like to thank Dr. Doug Gempton for helping me with this case.

I would also like to thank our wonderful team of vet nurses, Tracy, Katie, and Lisa for all of their dedication and persistence in caring for Quinn; everyone went above and beyond the call of duty and it was an enriching experience for all involved.

Thank you to Quinn’s family for allowing us to treat him as well!