title: An immunohistochemical study on a tetanus fatal case using toxin fragment C (TTC). Should it be a useful diagnostic tool?
abstract: A 65-year-old man fell in his garden and sustained a right pre-radial cutaneous laceration associated with a Colles' fracture. His status for tetanus immunization was uncertain; so a course of antitetanus treatment was immediately started. Two days after admission the man suddenly developed severe nucal pain, rigidity and dysphagia. A brain CT scan was negative. His condition progressively worsened and then he developed trismus. Cultures from the wound were negative for Clostridium tetani; the CSF analysis was negative. On the 9th day after admission, the man died. A presumptive clinical diagnosis of tetanus was made. Autopsy was performed 24 h after death. An immunohistochemical study was conducted with an antibody directed against tetanus toxin fragment C (TTC). By immunohistochemical evaluation, large motor neurons in the ventral horn were immunopositive for TTC. High power magnification of the ventral horn of spinal cord gray matter samples showed TTC immunoreactivity in motor neuron axons and cell bodies, using a confocal laser scanning microscope. The correct diagnosis could be established on the basis of pathological examination with TTC immunostaining.
authors.affiliation: Department of Forensic Pathology, University of Foggia, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Turillazzi
authors.forename: Margherita
authors.initials: M
authors.lastname: Neri
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Pomara
authors.forename: Irene
authors.initials: I
authors.lastname: Riezzo
authors.forename: Vittorio
authors.initials: V
authors.lastname: Fineschi
mesh_terms: D000368:Aged; D000870:Anterior Horn Cells / Q000737:chemistry / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018613:Microscopy, Confocal; D009046:Motor Neurons / Q000737:chemistry / Q000473:pathology; D054792:Muscle, Striated / Q000473:pathology; D010446:Peptide Fragments / Q000032:analysis* / Q000276:immunology; D013116:Spinal Cord / Q000737:chemistry / Q000473:pathology; D013742:Tetanus / Q000175:diagnosis* / Q000473:pathology*; D013744:Tetanus Toxin / Q000032:analysis* / Q000276:immunology
chemical_list: D010446:Peptide Fragments; D013744:Tetanus Toxin; C040635:tetanus toxin fragment C