Tetanus, 2006

One case of fatal tetanus was reported during 2006. The case occurred in an 80-year-old white, non-Hispanic female with history of receiving tetanus and diphtheria toxoid (Td) in 2003. She had sustained numerous deep puncture wounds from falling in raspberry bushes. She sought medical attention 3 days later for cellulitis at the site of one of the puncture wounds. She received a Td booster and an antibiotic (levofloxacin). Four days subsequent to that (one week after the injury), she experienced cramping in her arm and neck. She was hospitalized and given tetanus immune globulin (TIG). One of the wounds was debrided, removing pieces of raspberry cane. Clostridium sordellii (and not Clostridium tetani) was isolated. C. sordellii is ubiquitous in the environment, and C. tetani is rarely isolated from tetanus cases. The clinical presentation was consistent with tetanus. The case-patient died 17 days after the wound incident.

Although this case-patient had received Td within the previous five years, it is unclear whether she had completed a primary series. If not, TIG would have been indicated at the time of her injury. A wound management algorithm for preventing tetanus is posted on the MDH website at Summary Guide to Tetanus Prophylaxis in Routine Wound Management. Wounds contaminated with soil present the greatest risk. Tetanus cases often result from minor wounds for which individuals did not seek immediate medical attention; therefore, all individuals should complete the primary series and receive Td boosters every 10 years.

• For up to date information see>> Tetanus
• Full issue>> Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2006