Case Conference - Dr. Reyner

Tetanus

• Tetanus is caused by anaerobic spore forming GPR and is transmitted via contaminated wounds and tissue injury.
• Consider the diagnosis in patients presenting with trismus, which is the cardinal feature. 
• There are very few disorders of generalized stiffness in patients with preserved consciousness: stiff personsyndrome, tetanus, drug induced dystonia, hysteria, and strychnine poisoning (rat poison)
• Verify tetanus immunization history in all trauma patients and IV drug users.

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Leishmeniasis

• Leishmeniasis is a vector born disease transmitted by the sandfly.
• 2nd largest parasitic killer in the world!
• Incubation period: weeks to months
• Classic presentation:  Pink-colored papule -> enlarges into a nodule or plaque-like lesion (often with central softening) -> painless ulceration with an indurated border

Guillan Barre Syndrome

• Guillan Barre Syndrome is the most common acute paralytic disease in the west.
• Diagnosis requires clinical suspicion, LP, and EMG studies.
• LP classically shows albumino-cytologic dissociation (elevated protein); however, normal protein level does NOT rule-out the condition.
• Patients in the early stage of their illness may not have reflex changes.
• Criteria for intubation:  1 major or  2 minor criteria:
– MAJOR: Hypercarbia, arterial CO2 > 48 mm Hg, Hypoxemia, paO2 < 56 mmg Hg, FVC < 15 cc/kg or NIF < -25 cm H20
– MINOR: Inefficient cough, Impaired swallowing, and Atelectasis