Case Study #7: A 58-year old lawyer presents in the emergency room with headache,irritability, generalized muscle pain and uncontrollable back spasms. He has becomevery restless and worried because he has had the back spasms all through his courtcase that afternoon and they became extremely painful. In his history, the lawyer statesthat he has a very busy practice. He is on medication for high blood pressure (betablocker) and has mild asthma. He injured himself about 10 days earlier, puncturing hisleft arm with a nail from an old barn he is tearing down. The wound has producedmoderate quantities of pus, but he has been keeping it clean. When asked, he did notremember having a tetanus shot since he was a kid. The wound was sampled formicroscopic examination and culture. The back appears to have very tight contractionsand spasms. The patient is in obvious agonizing pain.1. What is your presumptive diagnosis?2. What bacterium is most likely causing the problem?3. Which factors were key in leading you to your diagnosis?4. What is the proper treatment for this condition?

The symptoms that should be looked for in this patient for diagnosing the disease is headache, muscular spasm and irritability. 1. he is probably suffering from tetanus. Any damage to the skin, even burns and blisters, allows tetanus-causing bacteria to enter the body. 2. Tetanus is an infection caused by a bacterium called Clostridium tetani. 3.Warning signs of tetanus may include headache, increased blood pressure, stiff jaw, difficulty swallowing, and body spasms. Now comparing these warning signs to the patient's symptoms we find- Painful muscle stiffness all over the body, muscle spasm which is present in the patient's back, head ache and irritability thus confirming the diagnosis. 4.Antibiotics, given either orally or by injection, may help fight tetanus bacteria. Benzodiazepines such as diazepam is the most effective primary agents for muscle spasm prevention and work by enhancing gamma-aminobutyric acid (GABA) inhibition.