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Unprotected People Reports: Tetanus

Death from Tetanus after a Pretibial Laceration 

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The Immunization Action Coalition (IAC) publishes articles about people who have suffered or died from vaccine-preventable diseases and periodically devotes an “IAC Express” issue to such an article. This is the 60th in our series.
It was published in the “British Medical Journal” June 15, 2002. The introduction and case report are reprinted below.
By Oliver C S Casssell, consultant
Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford
Clinicians should be familiar with Department of Health guidelines for immunoprophylaxis when wounds through which tetanus can be acquired occur. I report on a patient in whom tetanus immunoprophylaxis did not follow the guidelines.

Case report
A 76 year old woman fell in her garden and sustained a pretibial laceration. Her wound was cleaned and approximated with Steri-strips (3M; Loughborough) at an emergency department. Her status for tetanus immunisation at the time was recorded as "no previous tetanus injection," and a course of antitetanus treatment was started. However, no immunoglobulin was given.

She returned one week later with a necrotic and malodorous wound. She was unwell and complained of diffuse pains. She was admitted for debridement and split skin grafting.

Her condition worsened. Twenty four hours later she developed the signs and symptoms of tetanus, with increasing jaw stiffness, opisthotonos, and generalised limb spasticity. Cultures from the wound produced a heavy growth of Clostridium tetanii. She was transferred to intensive care but died 22 days later.

To access the complete article, go to: http://bmj.bmjjournals.com/cgi/content/full/324/7351/1442
10/31/03 • REPORT #60
Disclaimer: The Immunization Action Coalition (IAC) publishes Unprotected People Reports for the purpose of making them available for our readers' review. We have not verified the content of this report.
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