This first post about a case is going to be kind of “exciting” as tetanus in pets is very, very rare.  Tetanus in Horses is very common, mainly due to the fact they sustain injuries so readily and also live in the environment where the bacteria (Clostridium tetani) grows (soil mainly).  Its extremely rare for dogs and even rarer for cats to get tetanus as they appear to have a high resistance to the tetanus toxin and can take 3-4 weeks sometimes to begin showing clinical signs.  It is more common in horses to get generalised tetanus – ie the whole body is involved, whereas in cats/dogs, they can get localised tetanus, usually around where the contaminated wound is.  Cats and dogs can still, however, get generalised tetanus, but this is rarer still

This case was a 2 1/2 month old American Bull Dog.  The family who owned it were lovely and did everything by the book (kept at home, only allowed into well enclosed back garden until both vaccines given etc).  I saw the dog on a Friday afternoon.  All he presented with was raised 3rd eyelids and slightly off colour.  Nothing found on clinical exam, everything completely normal apart from a slightly high temperature.  He was given some antibiotics in case a brewing infection of some origin (suspected gastroenteritis as he was eating things in the garden).  Saturday the dog was apparently fine, back to normal, running around with the kids, then, Sunday morning, the dog was flat out and unable to stand.  Our practice was on call that weekend so my boss saw the client in question.  The dog presented stiff, mentally aware, could move legs and head and tail but just couldn’t move to stand up.  Boss man suggested likely differential diagnosis such as ingestion of neurotoxin, genetic defect, meningitis or tetanus and gave him sedatives and muscle relaxants.  I then took over on call and the case in question.

Typical "concerned" facial expression due to contracted facial muscles

At the time he was mentally very aware, would wah his tail when you spoke to him but any loud noises/touching him would send him into increased muscle spasms.  His body was shaped like a typical tetanic “rocking horse”, a shape known as opisthotonus.  He was, at this stage, able to lift up his head and lap from a bowl so we could feed him liquid food and water.  Repeat sedative and muscle relaxants like Diazepam were given intravenously but Diazepam has a very short duration in dogs and we didn’t have the Midazolam that we needed to put him on a constant rate infusion to stop the muscle spasms.

Opisthotonus

Monday morning he had deteriorated and the opisthotonus had increased, he was now unable to lift or move his head at all and was very distressed.  Diazepam only worked for a short while and then the spasming would start up again.  Money was an issue for the family and this was a total unexpected shock for them.  If the animal deteriorated any further (as can happen with tetanus as the respiratory muscle spasm.seize up and they can go into respiratory arrest) referral would be on the cards to a Veterinary School/hospital with the necessary drugs and equipment to put him on a ventilator.  The thing is, with Tetanus, if you have enough time and money, some cases can pull through as the nerve endings unbind eventually from the tetanus toxin and normal muscle movement is regained.  The owners decided, partially for monetary reasons and the fact they couldn’t bear to see him so distressed, to put him to sleep   A sad ending to a very rare and unfortunate case