[Tetanus following an abrasion injury]

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.

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.

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.

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.