Letter to the Editor

A Case of Clinical Tetanus in a Patient with Protective Antitetanus Antibody Level

Authors: Alvaro Beltran, MD, Eddie Go, MD, Mahenaaz Haq, MD, Hillary B. Clarke, MD, Muhammad Zaman, MD, Rose A. Recco, MD

Abstract

To the Editor:


Human tetanus is rare in the United States, with about 40 cases reported each year.1 We report a case of generalized tetanus in a patient with a generally accepted “protective level” of tetanus antibody (0.01 antitoxin units per milliliter (U/mL),2 and to stress the fact that tetanus remains a clinical diagnosis.

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References

1. Pascual FB, McGinley EL, Zanardi LR, et al. Tetanus surveillance–United States, 1998–2000. MMWR Surveill Summ 2003;52:1–8.
 
2. Sneath PAT, Kerslake EG, Scruby F. Tetanus immunity: the resistance of guinea pigs to lethal spore doses induced by active and passive immunization. Am J Hyg 1937;25:464–476.
 
3. Crone N, Reder A. Severe tetanus in immunized patients with high anti-tetanus titers. Neurology 1992;42:761–764.
 
4. Berger SA, Cherubin CE, Nelson S. Tetanus despite preexisting antitetanus antibody. JAMA 1978;240:769–770
 
5. Atkinson WL, Pickering LK, Schwartz B, et al. General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR 2002;51:1–35.