An unexpected tetanus case.
1 million cases of tetanus are estimated to occur worldwide each year, with more than 200 000 deaths. Tetanus is a life-threatening but preventable disease caused by a toxin produced by Clostridium tetani-a Gram-positive bacillus found in high concentrations in soil and animal excrement. Tetanus is almost completely preventable by active immunisation, but very rarely unexpected cases can occur in individuals who have been previously vaccinated. We report a case of generalised tetanus in a 22-year-old woman that arose despite the protective antitoxin antibody in her serum. The patient received all her vaccinations in the USA; her last vaccination was 6 years ago. The case was unusual because the patient had received all standard vaccinations, had no defined port of entry at disease onset, and had symptoms lasting for 6 months. Tetanus can present with unusual clinical forms; therefore, the diagnosis and management of this rare but difficult disease should be updated. In this Grand Round, we review the clinical features, epidemiology, treatment, and prognosis of C tetani infections.
Infectious Diseases Department, School of Medicine, Koc University, Istanbul, Turkey. Electronic address: oergonul@ku.edu.tr.
Onder
O
Ergonul
Intensive Care Unit, American Hospital, Istanbul, Turkey.
Demet
D
Egeli
Neurology Department, American Hospital, Istanbul, Turkey.
Bulent
B
Kahyaoglu
Intensive Care Unit, American Hospital, Istanbul, Turkey.
Mois
M
Bahar
New York Medical College, Valhalla, New York, NY, USA.
Mill
M
Etienne
Rush Medical College, Chicago, IL, USA.
Thomas
T
Bleck
D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D013742:Tetanus / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D013745:Tetanus Toxoid / Q000276:immunology; D014611:Vaccination; D055815:Young Adult
D013745:Tetanus Toxoid