一例重度全身性犬破伤风的整合诊断方法：系列神经学、临床病理学与肌电图评估及成功的临床管理。

文献信息

中文摘要

背景： 破伤风在犬中不常见，犬被认为对破伤风痉挛毒素相对耐受，而重度全身性病例诊断评估的详细描述仍然有限。方法：一只5.5月龄未去势雄性迷你雪纳瑞犬在右后肢被刺伤四天后就诊。入院时该犬警觉但不能行走，伴有全身性肌肉强直、震颤、明显的颈部过度伸展、脊髓反射亢进、面部肌肉痉挛和吞咽困难。结合创伤史和快速进展，这些发现支持全身性破伤风的推定诊断，临床分级为III级。在给予破伤风抗毒素前采集的血清中未检测到针对破伤风梭菌神经毒素的抗体。治疗包括马源破伤风抗毒素、抗菌药物、多模式镇静和肌肉松弛、肠内营养、强化护理和物理治疗。结果：第10天的针极肌电图显示插入活动增加、正锐波和纤颤电位，以及持续的自发性运动单位活动。尽管患者年幼且疾病进展迅速，从第10天起临床改善明显，该犬于第16天出院，能够行走并自主进食。结论：本病例强调，重度全身性犬破伤风主要仍是一种临床诊断，而系列神经学检查、临床病理学监测和肌电图可增强诊断信心、描述疾病进展并支持临床管理。

英文摘要

Tetanus is uncommon in dogs, which are considered relatively resistant to tetanospasmin, and detailed descriptions of the diagnostic evaluation of severe generalized cases remain limited. A 5.5-month-old intact male Miniature Schnauzer was presented four days after a puncture wound to the right pelvic limb. On admission the dog was alert but non-ambulatory, with generalized muscle rigidity, tremors, marked cervical hyperextension, hyperactive spinal reflexes, facial muscle spasms and dysphagia. Together with the wound history and rapid progression, these findings supported a presumptive diagnosis of generalized tetanus, clinically classified as Grade III. Serum collected before tetanus antitoxin administration contained no detectable antibodies against Clostridium tetani neurotoxin. Treatment comprised equine tetanus antitoxin, antimicrobials, multimodal sedation and muscle relaxation, enteral nutrition, intensive nursing and physiotherapy. Needle electromyography on day 10 showed increased insertional activity, positive sharp waves and fibrillation potentials, and continuous spontaneous motor unit activity. Despite patient young age and rapid disease progression, clinical improvement was evident from day 10, and the dog was discharged on day 16, ambulatory and eating voluntarily. This case highlights that severe generalized canine tetanus remains principally a clinical diagnosis, while serial neurological examination, clinicopathological monitoring and electromyography can strengthen diagnostic confidence, characterize disease progression and support clinical management.