PEER REVIEWED

Tetanus in Cattle: Review and Case Description of

Clinical Tetanus in a Holstein Heifer
Jonathan R. 0. Garber, VMD; Billy I. Smith, DVM, MS, DABVP
University of Pennsylvania, School of Veterinary Medicine, New Bolton Center, Kennett Square, PA 19348
Corresponding author: Dr. Jonathan R. 0. Garber; Tel.: 610-925-6310; fax: 610-925-6803;
Email address: [email protected]

Abstract ci-haut devraient considerer le tetanos en premier lieu

pour le diagnostic differentiel et amorcer un traitement
Tetanus (Clostridium tetani infection) is a poten- medical approprie des plus energiques.
tially life-threatening neurologic disease affecting cattle.
Clinical signs of tetanus are frequently unrecognized Introduction
until advanced stages of the disease, when treatment
and management of affected animals are difficult and Within the bovine veterinary community, bacterial
prognosis is relatively poor. This case report demon- pathogens are dealt with routinely; therefore, it is easy
strates the successful early diagnosis and subsequent to be complacent regarding infections that appear to be
management of wound tetanus in a 13-month-old Hol- under control or are relative clinical rarities. Infection
stein heifer. Primary clinical signs that led to an accurate with Clostridium tetani, resulting in tetanus, has largely
diagnosis and early treatment included stiff gait, erect been controlled by adoption of husbandry practices
tail, and prolapsed nictitans. Intensive medical manage- that reduce risk of infection. Since C. tetani spores are
ment yielded a relatively rapid improvement in clinical prevalent in the environment, the potential for wound
signs. The heifer calved and entered the lactating herd. contamination will always be present, and astute recog-
Practitioners that observe the previously mentioned nition of tetanus clinical signs is important. Diagnosis
clinical signs in cattle should consider tetanus as a of tetanus in early stages by the practitioner is based
primary differential diagnosis and initiate aggressive entirely on detecting relatively subtle clinical signs. This
medical management. case report provides a review of tetanus diagnosis and
treatment, then describes the diagnosis and subsequent
Keywords: clostridium, tetanus, wound, bovine, diag- case management of a 13-month-old Holstein dairy
nosis, treatment heifer with wound-induced tetanus .

Resume Review of Clostridium tetani Infection

Le tetanos (infection au Clostridium tetani) est une Etiology and Pathogenesis

maladie neurologique potentiellemenet mortelle qui af- The neuroparalytic syndrome of tetanus is caused
fecte les bovins. Les signes cliniques du tetanos passent by exotoxins produced by the gram-positive bacillus,
souvent inaper~us avant que la maladie n'atteigne un Clostridium tetani. 2 •17 It is a motile, spore-forming ob-
stade avance. Or, a ce moment, le traitement et la ges- ligate anaerobe. 2 •16 C. tetani is ubiquitous in soil world-
tion des animaux affectes sont difficiles et le pronostic wide, but may also be isolated from the feces of domestic
defavorable. Le cas presente ici fait etat d'un diagnostic animals. 2•16 Under aerobic conditions, C. tetani produces
effectue suffisamment tot et du traitement reussi d'une hardy spores that may survive in soil for years. 3 These
blessure infectee au tetanos sur une genisse Holstein de spores are resistant to many standard disinfection pro-
13 mois. Les premiers signes cliniques qui ont permis un cedures, including steam heat at 212°F (100°C) for 20
diagnostic exact et un traitement rapide etaient : une minutes. 10 Germination of C. tetani spores in anaerobic
demarche raide, une queue dressee et le prolapsus de la environments, such as devitalized tissue, results in
membrane nictitante. Le traitement medical intensif qui rapid growth during the vegetative stage. During rapid
fut applique a permis !'amelioration rapide des signes growth, the bacteria produce several exotoxins, including
cliniques. La genisse a vele et fut integree aux autres tetanospasmin, the tetanus neurotoxin (TeNT) respon-
vaches en lactation du troupeau. Les veterinaires qui sible for causing clinical disease. 2· 10 TeNT is a 150-kd
observent sur des bovins les signes cliniques mentionnes protein with three active domains that each contribute to

110 THE BOVINE PRACTITIONER-VOL. 45 , NO. 2

the overall effect on the patient. 16 C. tetani also produces of the patient only occurs with the growth of new nerve
tetanolysin, an exotoxin that has a necrotizing effect on terminals. 17 This process may take days to weeks, and
tissues, and may serve to further decrease tissue oxy- explains the variable duration of clinical signs in af-
genation to allow further proliferation of the bacteria. 16 fected animals. 16
The most common infection sites in cattle for C.
tetani include deep, necrotic wounds, either traumatic Clinical Presentation
or surgical, necrotic lesions of the vulva or vagina Clinical signs of tetanus in cattle are varied and
following dystocia, and severe postpartum metritis. 3 range from mild to severe on presentation. 3 The first
Surgical wounds that may predispose to germination detectable clinical signs of tetanus in cattle are usu-
of C. tetani spores include those following dehorning, ally generalized stiffness and reluctance to move. 1 As
castration, nose ring placement, tail docking, and ear the disease progresses, a change in gait is detected; a
tag placement. 3 •18·20 The site of infection may never be stiff, stilted walk is classic for tetanus in cattle. 3 •16 A
identified in some cases .3 The incubation period, or time "sawhorse" stance is typical in affected cattle due to
from injury to first clinical signs, averages seven to 10 extensor muscle rigidity. 3 On further physical examina-
days but may be as long as 60 days. 2 tion, the practitioner will frequently note while taking
Tetanus is usually a disease affecting individual a rectal temperature that the animal's tail is stiff and
animals, 18 but two older case reports describe out- raised away from the perineum. 3 This "pump-handle"
break situations involving C. tetani. 6 •15 The first report tail is frequently seen in cattle due to involvement of
describes an outbreak affecting an entire group of 48 the coccygeal muscles. 16 Affected cattle may display an
yearling Angus-Jersey cross heifers and steers grazing anxious expression with head extended, nostrils flared,
on a pasture of lush clover and dry millet stalks. The erect ears pulled toward the poll, and eyelids held widely
second case report describes two separate instances of open. 3 •16 Prolapse of the nictitans, due to spasm of the
Shorthorn heifers grazing sorghum stubble pastures retractor oculi muscles pulling the globe into the bony
and subsequently demonstrating classic clinical signs orbit and allowing passive prolapse of the nictitans, is
of tetanus. Both case reports demonstrate the potential frequently noted.3 The muscles of mastication may be
for gastrointestinal absorption of TeNT following over- involved so that attempts to open the mouth are met
growth of C. tetani in the stomachs of affected cattle. The with extreme rigidity of the jaws. 3 Affected cattle usu-
most recent published case describes tetanus in a group ally lose the ability to eat and may also lose the ability
offeeder calves following dehorning or band castration. 9 to drink, resulting in progressive dehydration. 3 Rumen
A group of 140 calves were processed, and three weeks contractions are usually weak or absent as the disease
later 11 of the calves exhibited tetanus signs ranging progresses. Cattle frequently will bloat due to failure
from prolapse of the nictitans to stiff gait and erect tail. 9 of eructation. 3
The target of TeNT is inhibition of neurotrans- Subtle muscle tremors may be detected early, but
mission , which is the same target of toxins produced these become more pronounced in later stages of teta-
by Clostridium botulinum. 17 · 19 From the site of produc- nus.1 Tetanic convulsions may be triggered by external
tion or absorption , TeNT diffuses in body fluids until it stimuli, such as loud noises or handling of the animal,
reaches the presynaptic membrane of cholinergic nerve but in advanced cases these convulsions may occur
terminals, where it binds irreversibly. 17 Then, TeNT is spontaneously. 1 As the disease progresses, animals may
internalized and transported retroaxonally to spinal become recumbent and unable to rise due to extension
cord inhibitory interneurons. 17 Transport to interneu- of their rear legs and the inability to pull their legs
ron s occurs first in motor neurons and later in sensory underneath them to rise. 16 If left untreated, animals
and autonomic nerves. 2 Inhibition of neurotransmitter may become severely dehydrated and fall into a self-
release, or neuroexocytosis, in these interneurons is destructive cycle oflateral recumbency, extensor rigidity,
caused by specific cleavage of a group of proteins called pain, panic, and exertion. 3 Death in cattle with tetanus
SNARE proteins (soluble n-ethylmaleimide sensitive may result from exertion and respiratory failure or from
factor attachment protein receptor), which are integral bloat-induced aspiration pneumonia. Furthermore,
to the exocytosis process. 19 Within spinal inhibitory musculoskeletal injuries, such as long bone fracture or
interneurons, cleavage of these SNARE proteins by hip luxation, may necessitate euthanasia. 3
TeNT blocks the release of vesicular contents to the ex-
tracellular environment, 19 thus preventing the release Diagnosis
of neurotransmitters. 16 The resulting spastic paralysis, The distinctive clinical signs of tetanus detected
demonstrated by stiff gait, prolapsed nictitans, and during thorough physical examination of cattle are
other clinical signs, is due to a loss of spinal inhibitory usually sufficient to make a diagnosis. 3•16 There are no
control of motor neuron activity. 17 The binding of TeNT reliable clinicopathologic tests to confirm a diagnosis
to nerve tissue is considered irreversible, and recovery of tetanus, 18 and no significant effort has been made to

SUMMER 2011 111

develop an immunodiagnostic test. 1,16 An ELISA test a widely reported range from 1,500-100,000 U per ani-
was developed to detect TeNT at a level ofl.2 ng/ml, but mal per day. 16 As a standard treatment for adult cattle,
TeNT is so powerful that detection at the picogram level one text recommends 15,000 U once or twice as initial
would be necessary to be clinically useful. 16 Differential therapy. 3 If the site of the infection has been identified,
diagnoses include hypomagnesemia, polioencephaloma- then local injection of the antitoxin may be ofvalue. 1 It
lacia (PEM), bacterial meningitis, nervous coccidiosis, is recommended that antitoxin be administered locally
and lead encephalopathy. Clinical hypomagnesemia and prior to debridement and irrigation of the wound to avoid
PEM in cattle may result in tetany and convulsions, facilitating further absorption and binding of TeNT. 10
but prolapse of the nictitans or rumen tympany do not The concentration ofTeNT required to cause neurologic
occur. 1 Bacterial meningitis in cattle usually manifests signs may or may not stimulate an active immunologic
clinically by fever, cutaneous hyperesthesia, and rigid- response. 3 Affected animals should be immunized with
ity of the muscles. This disease is more common in tetanus toxoid at the time of initial treatment and one
neonatal calves, but primary meningitis is extremely to two months later. 18 Simultaneous injections of tetanus
rare in mature cattle except in cases associated with toxoid and antitoxin should be made at different sites,
Listeria monocytogenes or Histophilus somni. 13 While and must not be mixed prior to administration. 18
the nervous form of coccidiosis may cause muscular The infection site that resulted in vegetative
tremors, hyperesthesia, and convulsions, a fecal ex- growth of C. tetani must be addressed. If the wound
amination for detection of oocysts may be diagnostic. 12 or site of infection is readily identified, then it must be
Lead encephalopathy in ruminants leads to staggering, cleaned and debrided to remove necrotic tissue. 3 Opening
head pressing, muscle tremors, champing of the jaws, the site to oxygen or irrigating the wound with hydrogen
and convulsions, but elevated lead levels in blood, urine, peroxide will reduce toxin production by eliminating
or milk are diagnostic. On physical examination, lead bacteria in the stage of vegetative growth. 10· 16 Systemic
encephalopathy patients are frequently blind and are antibiotics that have a gram-positive spectrum should
unlikely to display prolapsed nictitans, stiff gait, or be administered at high doses. 16 Primarily, penicillin
trismus that are characteristic of tetanus. 11 (10,000-20,000 IU/lb or 22,000-44,000 IU/kg IM q 12
h ) is used for treatment of bovine tetanus patients and
Treatments should be administered for at least seven days. 1·8·18
Favorable outcomes in tetanus cases depend on Good nursing care is very important during medi-
early detection of the classic clinical signs and institu- cal management of tetanus patients. The animal must
tion of treatment. 16 Cattle appear to respond better to be placed in a stall with deep bedding and good footing
aggressive treatment than horses and sheep. 1Advanced to prevent decubital sores and difficulty rising. 18 The
cases are unlikely to respond to therapy and euthana- animal's hydration status should be monitored closely,
sia should be considered. 1,3 Basic principles for medical and animals may require intravenous fluid support.
management of tetanus cases in cattle are: provide Recumbent cattle should be maintained in a sternal
muscular relaxation, neutralize the unbound TeNT position to prevent rumen tympany. 16 If the patient
toxin, establish active antitoxic immunity, eliminate the develops free gas bloat requiring stomach tubing, then
C. tetani infection, maintain hydration and nutritional a rumen fistula should be placed to relieve rumen gas
status, and provide good footing with deep bedding. 16 ,18 until the patient regains the ability to eructate. 3 A fistula
Excitement, tetanic episodes, and the associated can also provide a portal for the delivery of water and
pain must be minimized in the tetanus patient. 3 The feed to the rumen. 3
animal should be placed in a dark, quiet stall, and The mortality rate may reach 50% in cattle, but
interaction with the patient should be kept to a mini- animals that survive longer than seven days have a
mum.16 Tranquilization is very helpful in managing fair-to-good chance of complete recovery. 18 Mild cases
tetanus patients during administration of treatments. 3 usually respond to treatment within one week, but it is
Acepromazine (0.023 to 0.045 mg/lb or 0.05 to 0.1 mg/kg important to realize that many patients may stabilize
IV/IM q 4-12 h) is useful for this purpose. 3, 16·18 Diazepam and subsequently develop unforeseen complications that
(0.0045 to 0.18 mg/lb or 0.01 to 0.4 mg/kg IV q 3-12 h) result in death or necessitate euthanasia. 3 Regaining
may effectively reduce muscle spasms, but prolonged the ability to drink is one of the most encouraging signs
administration to cattle is expensive. 18 Guaifenesin (5% ofrecovery. 3 Cattle that degenerate to a state of lateral
solution) may lessen muscular spasm by blocking nerve recumbency usually require euthanasia. 3
transmission at the level of the spinal cord interneurons,
and should be administered intravenously to effect. 16 Prevention and Control
Tetanus antitoxin cannot counteract the effects of While cattle are reported to be less susceptible
toxin bound to receptors, but may bind any circulating to tetanus than other farm animals, it is important to
or unbound toxin. 3 The dose for tetanus antitoxin has reduce the risk of cattle developing wounds or necrotic

112 THE BOVINE PRACTITIONER-VOL. 45, NO. 2

sites where C. tetani spores may germinate. Elective packed a significant amount of cud material in its mouth
procedures that could lead to open wounds include due to limited ability to masticate and swallow.
dehorning, band castration, nose ring placement, tail The initial problem list included an old, contami-
docking, and ear tag placement. 3 · 18 •20 It is important nated wound over the distal left MT III and clinical
that surgeons maintain clean surgical conditions and signs of C. tetani infection, including distinctive signs of
use sterile instruments for each procedure. Cattle are muscle spasms and hyperesthesia. Patient signalment,
not routinely vaccinated against tetanus, 18 and most physical examination findings consistent with C. tetani
multi-clostridial vaccines for cattle do not contain infection, and the presence of a contaminated wound left
specific protection against C. tetani. 9 On farms or in a short differential diagnosis list: tetanus, hypomagne-
geographical areas where tetanus is a problem, cattle semic tetany, bacterial meningitis, nervous coccidiosis,
can be vaccinated easily and inexpensively with tetanus and unusual presentation of PEM or lead toxicity. While
toxoid. 3 Protective antibody levels usually occur about hypomagnesemic tetany is a common occurrence in
two weeks following the booster injection of the primary ruminants, 14 the heifer was kept in closed housing and
series. 7 Tetanus antitoxin is recommended for immedi- fed a balanced total mixed ration (TMR), thus making
ate, emergency, passive treatment of exposed animals hypomagnesemia doubtful. Since bacterial meningitis
when clinical tetanus is expected. 7 is extremely rare in mature cattle, except in cases as-
sociated with Listeria monocytogenes or Histophilus
Case Report somni, 13 this disease was ruled out. The nervous form of
coccidiosis was unlikely because the heifer's TMR diet
History included an ionophore coccidiostat. While PEM and lead
A 13-month-old Holstein dairy heifer was originally encephalopathy may cause muscle tremors, trismus, and
examined on February 25 , 2009, after the farm manager stiff gait, the heifer's consistent TMR diet and housing
noticed that the heifer had been behaving abnormally precluded these differentials from the list.
and appeared lame. Signs were of two days' duration. Infection with C. tetani was the most likely cause of
At the time of initial evaluation, the heifer was nearing the following clinical signs: stiff gait, tucked-up abdomen,
breeding age and was due for enrollment in a prosta- prolapsed nictitans, erect tail, and moderate trismus. Ag-
glandin reproductive synchronization program in early gressive medical management, evaluation of blood chem-
March. The farm's records revealed that the heifer had istry and hematology values, and radiographic evaluation
received routine vaccinations for bovine respiratory dis- of the left hind fetlock were recommended to the farm
ease, leptospirosis, and clostridial pathogens about six manager; at that time it was not possible to provide an ac-
months prior to this initia l evaluation. No treatments curate prognosis, even with an aggressive diagnostic and
had yet been administered by the farm staff. treatment plan. Due to the uncertainty of the situation,
the farm manager consented to medical management for
Clinical Findings tetanus, but elected not to pursue radiographs or diag-
While moving the heifer into a chute for restraint, nostic blood work until the heifer showed improvement.
it was apparent that the tail was rigidly extended and
the heifer's gait was markedly stiff, especially in the Therapeutic Management
hind limbs where the stride was visibly shortened. No An aggressive medical management treatment
lameness was apparent. Also, the heifer's abdomen plan was initiated on February 25, 2009. First, the
was contracted, causing a tucked appearance. Using a heifer was tranquilized with 7 mg acepromazine intra-
Holstein-specific weight tape, the heifer's weight was muscularly to provide muscle relaxation and to control
estimated at 770 lb (350 kg). Physical examination hyperesthesia. This treatment reduced the heifer's
revea led a quiet, alert heifer with a relatively low body response to external stimuli and made treatments less
condition score (2. 75/5). Vital signs were within normal traumatic. Next, 15,000 U of tetanus antitoxin was ad-
limits, and the heifer was mildly dehydrated. Its abdo- ministered. Half the dose was administered by single
men was not distended, and one moderate rumen con- subcutaneous injection in the left neck and the other
traction per minute was auscultated. There was a deep, half was administered subcutaneously in the tissues
3.2 inch (7 cm) laceration over the medial aspect of the proximal to the medial laceration of distal left MT III.
distal left metatarsus (MT III) with associated soft tissue It was considered important to administer the antitoxin
swelling extending distally. The wound appeared old, prior to cleaning and flushing the wound. To initiate
and a moderate amount of malodorous, grey purulent active anti toxic immunity, a dose of tetanus toxoid was
material discharged from the wound after the scab was administered intramuscularly.
peeled back. Examination of the heifer's head revealed The distal MT III wound was clipped and flushed
an anxious expression, erect ears, bilateral prolapse of using dilute povidone iodine solution. A teat cannula
the nictitans, and moderate trismus. The heifer had flushing system allowed exploration of the extent of the

SUMMER 2011 113

wound; it was found to be at least 1.4 inches (3 cm) deep for such complications as rumen bloat, aspiration pneu-
and down to bone. In order to oxygenate the deeper tis- monia, or musculoskeletal injury. Table 1 summarizes
sues in the wound, it was irrigated with 3% hydrogen the physical examination findings and progression of the
peroxide. The wound was left with no bandage or cover heifer's clinical signs during the first week of treatment.
to allow further oxygenation and drainage. To provide The most notable changes in the heifer's status were a
broad-spectrum antimicrobial coverage, the heifer was reduction in the rigidity of the jaws and subsequent lack
treated with systemic procaine penicillin (15,900 IU/lb of cud material packed into its mouth. At the same time,
or 35,000 IU/kg IM q 24 h) for seven days and a single the heifer was showing increased interest in TMR and
injection of long-acting ceftiofura (3 mg/lb or 6.6 mg/kg hay. Improvement in the nictitans, less elevation and
SQ). Flunixin meglumine (0.68 mg/lb or 1.5 mg/kg IV q stiffness of the tail, and an improvement in gait were also
24 h) was administered for three days to provide pain noted. At the end of the first week, the heifer had a mild
relief. The packed cud material was flushed from the fever (102.7°F; 39.3°C), likely related to the leg wound.
heifer's mouth. During this procedure, the heifer was As a result of the improvements, the farm manager
observed to willingly and successfully swallow a good consented to radiographs of the left hind fetlock and
portion of the flush water during each flushing event. limited blood work. On March 4, the heifer's serum fi-
Lastly, the heifer was returned to a box stall deeply bed- brinogen was moderately elevated (1,060 mg/dl; Table 2),
ded with chopped straw. The farm staff were instructed but consistent with the deep , penetrating fetlock wound.
to consult the veterinarian if the heifer's clinical signs Digital radiographs of the fetlock were taken on
deteriorated or if other problems arose, such as bloat or the same date and demonstrated a focal osteomyelitis
inability to rise and ambulate. of the medial aspect of distal MT III with associated
The next day, the farm staff tranquilized the heifer soft tissue swelling, dystrophic mineralization in the
with 7 mg acepromazine intramuscularly to make follow- overlying soft tissue, and a soft-tissue defect consistent
up treatment easier. Following sedation, second doses with the history of focal trauma. The radiographs pro-
of tetanus antitoxin (15,000 U ), systemic procaine peni- vided no evidence of osseous sequestration, foreign body,
cillin, and flunixin meglumine were administered. The fractures, or other problems.
heifer's mouth was flushed with water and a significant Next, the wound was scrubbed and flushed with
amount of cud material was removed. The heifer again dilute povidone iodine solution. At this time , the wound
drank a good portion of flush water during each flushing did not appear as deep and granulation tissu e was pres-
event. It had no interest in TMR or hay at this time and ent; therefore , it was no longer possible to penetrate
was returned to a deeply bedded box stall. to bone with the teat cannula flu shin g system . The
While the farm staff continued systemic procaine wound was again irrigated with hydrogen peroxide
penicillin treatments, periodic re-examinations were and left uncovered for drainage. In order to maintain
performed to monitor the heifer's progress and observe broad-spectrum antimicrobial coverage, a second dose

Table 1. Progression of heifer's clinical signs at each re-examination in the fir st week fo ll owing diagnosi s of tetanus.
An increased number of check marks ( ✓ ) indicate a higher degree or more severe m a nifestation of t h e clinical sign.

Day0 Day2 Day3 Day 5

Clinical signs
(2/25/09) (2/27/09) (2/28/09) (3/2/09 )
✓
Fever
(102.5°F)
Respiratory rate
28 32 30 30
(breaths/min)
1/min 1/min 1/m in 1/min
Rumen contraction
Moderate Weak Weak Moderate
Rigidity of the jaws ✓✓✓ ✓✓ ✓ ✓

Cud material packed in mouth ✓✓ ✓ Resolved Resolved

Eating TMR ✓ ✓

Stiff gait ✓✓ ✓✓ ✓✓ ✓

Prolapsed nictitans ✓✓ ✓✓ ✓✓ ✓

Elevated tail head ✓✓ ✓✓ ✓ ✓

114 THE BOVINE PRACTITIONER-VOL. 45, NO. 2

Table 2. Progression of heifer's clinical signs at each re-examination in the weeks following diagnosis of tetanus,
including day 0. An increased number of check marks ( ✓) indicate a higher degree or more severe manifestation of
the clinical sign. (Q)
n
0
Day0 Day7 Day9 Day 13 Day20 "'O
Clinical signs '-<
(2/25/09) (3/4/09) (3/6/09) (3/10/09) (3/17/09) ......
'"i
(JQ
✓
Fever g
(102.7°F)
Respiratory rate
>
8
28 32 28 30 30 (D
(breaths/min) ......
'"i
(")
1/min 2/min 2/min 2/min 2/min §
Rumen contraction
Moderate Moderate Moderate Moderate Strong
✓✓✓ ✓ ✓
>
00
Rigidity of the jaws Resolved Resolved 00
0
Cud material packed in mouth ✓✓ Resolved Resolved Resolved Resolved ......
(")

Eating TMR ✓✓ ✓✓ ✓✓ ✓✓✓

a
......
0
~
Stiff gait ✓✓ ✓ ✓ Resolved Resolved 0
1-i;
Prolapsed nictitans ✓✓ ✓ ✓ Resolved Resolved to
✓✓ ✓ ✓ 0
Elevated tail head Resolved Resolved <
Serum fibrinogen (mg/dl) 1,060 802 5·
(D

~
~
(")
......
,-+-

......
,-+-

0
oflong-acting ceftiofur (3.0 mg/lb or 6.6 mg/kg SQ q 7 d) future antimicrobial treatments. The heifer had mild ~
(D
'"i
was administered, and staff were instructed to continue hyperfibrinogenemia (802 mg/dl), which was consider- 00

systemic procaine penicillin treatments for seven more ably improved from the previous evaluation (Table 2).
days. Because of the heifer's low-grade fever and the Radiographs of the heifer's left hind fetlock dem-
wound management procedures performed, another dose onstrated progressive healing of the focal osteomyelitis.
of flunixin meglumine was administered (0.68 mg/lb or Based on its clinical signs, progressive wound healing,
1.5 mg/kg) IV. When released from restraint, the heifer decreased serum fibrinogen, and improved radiographic
ate TMR for 10 to 15 minutes. findings, systemic antimicrobial treatments were dis-
While the farm staff continued penicillin treat- continued.
ments, periodic re-examinations were performed to The heifer was moved out of a box stall and re-
monitor the heifer's progress and assess for complica- turned to the breeding group. A booster dose of tetanus
tions. Table 2 shows the progression of clinical signs at toxoid was administered five weeks after the initial dose.
each re-examination in the weeks following diagnosis, No further clinical signs of tetanus were observed in
including day 0. The most notable changes in the heifer's this animal, and it entered the farm's routine breeding
status included improved appetite and resolution of management program. The heifer subsequently carried
jaw rigidity, gait stiffness, prolapse of the nictitans, a calf to term and entered the lactating herd.
and elevation and stiffness of the tail. By the end of the
second week of treatments, the heifer had resolved all Discussion
clinical signs of tetanus and penicillin treatments were
discontinued. However, the leg wound continued to drain This case represents the typical early clinical
purulent material and was only marginally contracted, presentation of tetanus in cattle. Clinical diagnosis of
compared to the prior week. Therefore, a week-long Clostridium tetani infection was made early, and the
course of systemic florfenicol was initiated (9.1 mg/lb heifer was able to return to normal function following
or 20 mg/kg IM q 48 h). medical management. A case report by McGuirk provides
By March 17, three weeks after initial presenta- a similar history, and is another good example of the
tion, no clinical signs of tetanus were observed. The importance of early diagnosis oftetanus. 8 A two-year-old
heifer's rectal temperature was normal, and appetite Holstein heifer in that report was sent to a referral hos-
was excellent. The wound appeared to be healing well, pital following a week-long treatment of rumen tympany.
with significant contraction of the wound margins and Two treatments of oral poloxalene were unsuccessful at
no further discharge noted. Further radiographic and relieving the bloat, and the heifer was reported to walk
serum fibrinogen evaluations were conducted to plan stiffly to the trailer for transport to the hospital. On ar-

SUMMER 2011 115

rival the heifer was recumbent, and examination of the Following radiographic evaluation of the leg
limbs revealed a healing laceration of the right forelimb wound, a diagnosis of focal osteomyelitis of the medial
with persistent swelling around the wound. Despite aspect of distal MT III was made. Following two weeks
aggressive medical management, the heifer died due to of systemic penicillin and ceftiofur treatment, the
respiratory failure within 24 hours of arrival at the hos- wound was still draining purulent material; therefore,
pital. It is possible that earlier identification of the wound treatment was changed to systemic florfenicol, which
or more thorough examination of this animal in the field represents an extra-label drug use. Currently there is
to identify additional signs of tetanus beyond ruminal no labeled antimicrobial for treatment of osteomyelitis
tympany may have yielded a more positive outcome. lesions in cattle. Florfenicol has been reported as a
One text reports it is not uncommon for tetanus suitable antimicrobial for treatment of vertebral os-
cases to be misdiagnosed by veterinarians. 3 As with teomyelitis in cattle, 4 and a recent study demonstrated
McGuirk's case report, a common feature of misdiagnosis the pharmacokinetics of florfenicol in synovial fluid
is rumen tympany. To avoid overlooking tetanus in the after regional intravenous perfusion of the hind limb
early stages, close observation of the animal's gait and of adult cows. 5 The authors suggested that florfenicol
head is recommended. 3 Early cases of tetanus in cattle delivered by regional intravenous perfusion may be a
frequently demonstrate a stiff gait or sawhorse stance. suitable treatment for deep digital sepsis and similar
It is important to release confined cattle to make this lesions in cattle. 5 Following florfenicol treatment in
evaluation. Examination of the head may reveal pas- this case, the limb wound contracted and purulent
sive prolapse of the nictitans and trismus. In the case discharge ceased.
reported here, these signs were all present and led to When procaine penicillin is used at an extra-label
rapid diagnosis and initiation of medical management. dose for an extended period, such as in this case, it is im-
Early detection and aggressive treatment of this tetanus perative that the veterinarian recommend an extended
case, where there was diminished swallowing and rumen pre-harvest withdrawal time before the animal can be
motility, contributed to the favorable outcome. harvested. The withdrawal time was not an issue in
Identifying the source of C. tetani infection in this case because the heifer regained full function and
animals with clinical signs of tetanus is important so later entered the milking herd.
that wounds can be cleaned and debrided. While the
site of infection may never be identified in a significant Conclusions
proportion of cases, the most common infection sites in
cattle are generally deep, penetrating wounds, either The Holstein heifer in this case report demon-
iatrogenic or traumatic. 3 Necrotic lesions of the vulva strated typical early signs of tetanus in cattle and
or vagina and severe metritis in the postpartum period subsequently responded to aggressive medical manage-
are common infection sites in cattle. 3 The distal MT III ment. While cattle are relatively resistant to tetanus,
wound in this case was the obvious source of C. tetani it is important that veterinarians perform a complete
infection, and the wound was subsequently debrided physical examination of cattle presenting with relatively
and irrigated to kill C. tetani in the vegetative growth nonspecific signs, such as stiff gait or rumen tympany,
stage. Identifying the wound site allowed for enhanced to avoid misdiagnosing tetanus in the early stages. If
use of tetanus antitoxin proximal to the wound prior bovine tetanus cases are diagnosed early and an ag-
to debridement and irrigation. The heifer returned to gressive treatment plan is initiated, cattle may make a
normal function, as noted in Table 2. full recovery. The heifer in this case had an uneventful
Medical management of this case followed accepted pregnancy, transition period, and early lactation, peak-
medical principles. Tetanus antitoxin was administered ing at 85 lb/day (38.6 kg/day) on a three-times-a-day
subcutaneously and at the site of the wound prior to milking schedule.
debridement, and the animal was treated with procaine
penicillin. Because the heifer never bloated or became Endnote
recumbent, the decision was made to manage the case on
site. This heifer never lost the ability to drink and was aExcede, Pfizer Animal Health, New York, NY
able to maintain hydration during the recovery period.
If the heifer had become bloated or severely dehydrated, Acknowledgment
the farm manager indicated she would consent to place-
ment of a rumen fistula. Clinical signs of tetanus began No external funding was used for preparation
to resolve within one week of treatment initiation, and of this review and case report. The authors wish to
clinical signs were fully resolved with two weeks of treat- thank the staff of Walmoore Dairy, especially Charlene
ment. This represents typical case progression in cattle M. Dickens (Chatam, PA, USA), for all their help and
diagnosed early and treated aggressively. enthusiasm during the management of this case.

116 THE BOVINE PRACTITIONER-VOL. 45, NO. 2

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