A 74-year-old female wound is red and swollen with neck stiffness and difficulty swallowing. Which condition should you suspect?

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Multiple Choice

A 74-year-old female wound is red and swollen with neck stiffness and difficulty swallowing. Which condition should you suspect?

A wound with neck stiffness and trouble swallowing points to tetanus. The wound provides an entry point for Clostridium tetani, which releases tetanospasmin. This toxin blocks inhibitory neurotransmitters in the central nervous system, leading to unchecked excitatory activity of motor neurons. The result is muscle rigidity and spasms, often starting with the jaw and neck—hence neck stiffness and dysphagia. While meningitis can cause neck stiffness, it typically comes with fever and altered mental status, and septic shock involves systemic instability rather than focal neuromuscular symptoms. Malnourishment wouldn’t produce this acute neuromuscular picture. This combination is characteristic of tetanus.

A wound with neck stiffness and trouble swallowing points to tetanus. The wound provides an entry point for Clostridium tetani, which releases tetanospasmin. This toxin blocks inhibitory neurotransmitters in the central nervous system, leading to unchecked excitatory activity of motor neurons. The result is muscle rigidity and spasms, often starting with the jaw and neck—hence neck stiffness and dysphagia. While meningitis can cause neck stiffness, it typically comes with fever and altered mental status, and septic shock involves systemic instability rather than focal neuromuscular symptoms. Malnourishment wouldn’t produce this acute neuromuscular picture. This combination is characteristic of tetanus.

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