A case of tetanus infection in an adult with a protective tetanus antibody level
Tetanus is a bacterial infection caused by Clostridium tetani and most commonly presents as trismus or other muscle spasms. Despite the development of the tetanus toxoid vaccine, tetanus infection has not been eradicated. Additionally, while there are hypothesized protective levels of tetanus antibo...
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| Veröffentlicht in: | The American journal of emergency medicine 2014-04, Vol.32 (4), p.392.e3-392.e4 |
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| container_title | The American journal of emergency medicine |
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| creator | Vollman, Kristan E., PharmD Acquisto, Nicole M., PharmD Bodkin, Ryan P., MD, MBA |
| description | Tetanus is a bacterial infection caused by Clostridium tetani and most commonly presents as trismus or other muscle spasms. Despite the development of the tetanus toxoid vaccine, tetanus infection has not been eradicated. Additionally, while there are hypothesized protective levels of tetanus antibody, tetanus infection may still occur in properly vaccinated individuals. We report the case of a 31-year-old male that presented to the emergency department (ED) with a 2-day history of neck and jaw pain. He reports puncturing his hand with a rusty nail 10 days prior. His reported vaccination history was that he received his last booster vaccination 13 years prior to presentation. In the ED, tetanus vaccine, tetanus immune globulin, and metronidazole were administered. His symptoms improved over the next 2 days and resolved at day 6. Despite his presentation of tetanus infection and rule out of other causes for his symptoms, his tetanus antibody level was reported at 8.4 U/mL, which is considered to be protective.A tetanus antibody level that is adequate for protective immunity should not preclude a patient from treatment of tetanus infection. This case demonstrates that a thorough history, physical exam, and rule out of other causes should guide treatment when there is concern for a tetanus infection. |
| doi_str_mv | 10.1016/j.ajem.2013.10.025 |
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Despite the development of the tetanus toxoid vaccine, tetanus infection has not been eradicated. Additionally, while there are hypothesized protective levels of tetanus antibody, tetanus infection may still occur in properly vaccinated individuals. We report the case of a 31-year-old male that presented to the emergency department (ED) with a 2-day history of neck and jaw pain. He reports puncturing his hand with a rusty nail 10 days prior. His reported vaccination history was that he received his last booster vaccination 13 years prior to presentation. In the ED, tetanus vaccine, tetanus immune globulin, and metronidazole were administered. His symptoms improved over the next 2 days and resolved at day 6. Despite his presentation of tetanus infection and rule out of other causes for his symptoms, his tetanus antibody level was reported at 8.4 U/mL, which is considered to be protective.A tetanus antibody level that is adequate for protective immunity should not preclude a patient from treatment of tetanus infection. This case demonstrates that a thorough history, physical exam, and rule out of other causes should guide treatment when there is concern for a tetanus infection.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2013.10.025</identifier><identifier>PMID: 24211286</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Antibodies, Bacterial - blood ; Diagnosis, Differential ; Dysphagia ; Emergency ; Emergency medical care ; Humans ; Infections ; Male ; Muscle pain ; Rigidity ; Tetanus ; Tetanus - diagnosis ; Tetanus - immunology ; Tetanus Antitoxin - blood ; Tetanus Toxoid - immunology ; Vaccines</subject><ispartof>The American journal of emergency medicine, 2014-04, Vol.32 (4), p.392.e3-392.e4</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright Elsevier Limited 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c509t-1b2a64e6d80341d076e8eac6ed635f0f06ee7a0a98fbaebabc0840d5038b90053</citedby><cites>FETCH-LOGICAL-c509t-1b2a64e6d80341d076e8eac6ed635f0f06ee7a0a98fbaebabc0840d5038b90053</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1510807387?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24211286$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vollman, Kristan E., PharmD</creatorcontrib><creatorcontrib>Acquisto, Nicole M., PharmD</creatorcontrib><creatorcontrib>Bodkin, Ryan P., MD, MBA</creatorcontrib><title>A case of tetanus infection in an adult with a protective tetanus antibody level</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>Tetanus is a bacterial infection caused by Clostridium tetani and most commonly presents as trismus or other muscle spasms. Despite the development of the tetanus toxoid vaccine, tetanus infection has not been eradicated. Additionally, while there are hypothesized protective levels of tetanus antibody, tetanus infection may still occur in properly vaccinated individuals. We report the case of a 31-year-old male that presented to the emergency department (ED) with a 2-day history of neck and jaw pain. He reports puncturing his hand with a rusty nail 10 days prior. His reported vaccination history was that he received his last booster vaccination 13 years prior to presentation. In the ED, tetanus vaccine, tetanus immune globulin, and metronidazole were administered. His symptoms improved over the next 2 days and resolved at day 6. Despite his presentation of tetanus infection and rule out of other causes for his symptoms, his tetanus antibody level was reported at 8.4 U/mL, which is considered to be protective.A tetanus antibody level that is adequate for protective immunity should not preclude a patient from treatment of tetanus infection. This case demonstrates that a thorough history, physical exam, and rule out of other causes should guide treatment when there is concern for a tetanus infection.</description><subject>Adult</subject><subject>Antibodies, Bacterial - blood</subject><subject>Diagnosis, Differential</subject><subject>Dysphagia</subject><subject>Emergency</subject><subject>Emergency medical care</subject><subject>Humans</subject><subject>Infections</subject><subject>Male</subject><subject>Muscle pain</subject><subject>Rigidity</subject><subject>Tetanus</subject><subject>Tetanus - diagnosis</subject><subject>Tetanus - immunology</subject><subject>Tetanus Antitoxin - blood</subject><subject>Tetanus Toxoid - immunology</subject><subject>Vaccines</subject><issn>0735-6757</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kVGL1DAQgIMo3t7pH_BBAr740nUmadIsiHAcegoHCupzSJMppnbbs0lX9t-bsucJ9yAEEibfDDPfMPYCYYuA-k2_dT3ttwJQlsAWhHrENqikqAw2-JhtoJGq0o1qzth5Sj0AYq3qp-xM1AJRGL1hXy65d4n41PFM2Y1L4nHsyOc4jeXFXTlhGTL_HfMP7vjtPOX190D3vBtzbKdw5AMdaHjGnnRuSPT87r5g3z-8_3b1sbr5fP3p6vKm8gp2ucJWOF2TDgZkjQEaTYac1xS0VB10oIkaB25nutZR61oPpoagQJp2B6DkBXt9qls6-rVQynYfk6dhcCNNS7KoUAghFZiCvnqA9tMyj6W7lQJTNJmmUOJE-XlKaabO3s5x7-ajRbCrb9vb1bddfa-x4rskvbwrvbR7CvcpfwUX4O0JoOLiEGm2yUcaPYU4F482TPH_9d89SPdDHKN3w086Uvo3h03Cgv26bnxdOEoAvdON_AMqOaT0</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Vollman, Kristan E., PharmD</creator><creator>Acquisto, Nicole M., PharmD</creator><creator>Bodkin, Ryan P., MD, MBA</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20140401</creationdate><title>A case of tetanus infection in an adult with a protective tetanus antibody level</title><author>Vollman, Kristan E., PharmD ; Acquisto, Nicole M., PharmD ; Bodkin, Ryan P., MD, MBA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c509t-1b2a64e6d80341d076e8eac6ed635f0f06ee7a0a98fbaebabc0840d5038b90053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Antibodies, Bacterial - blood</topic><topic>Diagnosis, Differential</topic><topic>Dysphagia</topic><topic>Emergency</topic><topic>Emergency medical care</topic><topic>Humans</topic><topic>Infections</topic><topic>Male</topic><topic>Muscle pain</topic><topic>Rigidity</topic><topic>Tetanus</topic><topic>Tetanus - diagnosis</topic><topic>Tetanus - immunology</topic><topic>Tetanus Antitoxin - blood</topic><topic>Tetanus Toxoid - immunology</topic><topic>Vaccines</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vollman, Kristan E., PharmD</creatorcontrib><creatorcontrib>Acquisto, Nicole M., PharmD</creatorcontrib><creatorcontrib>Bodkin, Ryan P., MD, MBA</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vollman, Kristan E., PharmD</au><au>Acquisto, Nicole M., PharmD</au><au>Bodkin, Ryan P., MD, MBA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A case of tetanus infection in an adult with a protective tetanus antibody level</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>32</volume><issue>4</issue><spage>392.e3</spage><epage>392.e4</epage><pages>392.e3-392.e4</pages><issn>0735-6757</issn><eissn>1532-8171</eissn><abstract>Tetanus is a bacterial infection caused by Clostridium tetani and most commonly presents as trismus or other muscle spasms. Despite the development of the tetanus toxoid vaccine, tetanus infection has not been eradicated. Additionally, while there are hypothesized protective levels of tetanus antibody, tetanus infection may still occur in properly vaccinated individuals. We report the case of a 31-year-old male that presented to the emergency department (ED) with a 2-day history of neck and jaw pain. He reports puncturing his hand with a rusty nail 10 days prior. His reported vaccination history was that he received his last booster vaccination 13 years prior to presentation. In the ED, tetanus vaccine, tetanus immune globulin, and metronidazole were administered. His symptoms improved over the next 2 days and resolved at day 6. Despite his presentation of tetanus infection and rule out of other causes for his symptoms, his tetanus antibody level was reported at 8.4 U/mL, which is considered to be protective.A tetanus antibody level that is adequate for protective immunity should not preclude a patient from treatment of tetanus infection. This case demonstrates that a thorough history, physical exam, and rule out of other causes should guide treatment when there is concern for a tetanus infection.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24211286</pmid><doi>10.1016/j.ajem.2013.10.025</doi></addata></record> |
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| subjects | Adult Antibodies, Bacterial - blood Diagnosis, Differential Dysphagia Emergency Emergency medical care Humans Infections Male Muscle pain Rigidity Tetanus Tetanus - diagnosis Tetanus - immunology Tetanus Antitoxin - blood Tetanus Toxoid - immunology Vaccines |
| title | A case of tetanus infection in an adult with a protective tetanus antibody level |
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