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Dtsch Med Wochenschr. 2006 Apr 28;131(17):979-81.

[Tetanus following an abrasion injury].

[Article in German]

Author information

1
Abteilung f├╝r Medizinische Mikrobiologie u. Hygiene, Universit├Ątsklinikum Freiburg.

Abstract

HISTORY AND CLINICAL FINDINGS:

A 80 year-old woman contracted an abrasion of her right forearm while gardening. 5 days later, dysphagia, trismus and a cramp of the right hand developed. On admission (8 days after the injury) cramps of the platysma and pharyngeal muscles were observed. A tetanus vaccination had not been carried out for years.

INVESTIGATIONS:

Electrophysiologically a pathological masseter inhibitory reflex with a missing "silent period" was observed. The level of serum anti-tetanus-toxoid IgG antibodies was 0.03 IU/ml (definitively protective above 0.1 IU/ml). Free tetanus toxin was not detectable in the serum upon mouse challenge. The diagnosis of tetanus was made based on the typical symptoms and the serological susceptibility.

TREATMENT AND COURSE:

On admission the wound was antiseptically cleaned and a bandage was applied. On the next day a debridement was performed. After taking a serum sample the patient was immunized against tetanus (active and passive). On the following two days the patient received a further dose of tetanus-antitoxin. The patient was treated with metronidazole for 8 and with penicillin G for 10 days. Within the first days after hospital admission laryngospasms, tachycardia and tachypnoe occurred. From the 7 (th) day in hospital the trismus and the cramp of the hand improved. 4 weeks after admission the patient was discharged; the trismus had completely disappeared, but a slight cramp of the hand was still present.

CONCLUSION:

Minor superficial injuries can lead to acute tetanus, if the level of anti-tetanus toxin-antibodies is non-protective and a disinfective wound cleaning and a postexpositional vaccination are not performed.

PMID:
16673220
DOI:
10.1055/s-2006-939880
[Indexed for MEDLINE]
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