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Case Report

Tetanus in an Intravenous Drug User

Alok Arora* , Alok Arora* , Gaurav Jain* , Samiksha Fouzdar Jain**

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New Indian Journal of Surgery 7(3):p 323-327, Sept - Dec 2016. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.7316.21

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Abstract

 Tetanus is the only vaccine­preventable disease that is infectious but is not contagious. The diagnosis is based on the presentation of tetanus symptoms and does not depend upon isolation of the ubiquitous bacteria, which is recovered from the wound in only 30% of cases and can be isolated from patients who do not have tetanus. In the United Kingdom, 5 doses of tetanus toxoid– containing vaccine at appropriate intervals are considered to provide lifelong protection, as long as tetanus­prone wounds are treated with tetanus immunoglobulin but the immunity wanes over time particularly in elderly. Recent experience has pointed to Intravenous Drug Users (IVDUs) as being at significant risk of tetanus. Awareness of the risk and value of vaccination in this group, and awareness among those working with them, is extremely important. The reasons for emergence of Clostridium infections in IVDUs in the United Kingdom include an increase in contamination of heroin and an aging cohort of heroin users who are more likely to use “popping” as the mode of injection. Most patients with tetanus lack a history of receipt of a full series of tetanus toxoid immunization and receive inadequate prophylaxis following a wound. Approximately three­fourths of the patients who acquired tetanus recalled an acute injury prior to the onset of their symptoms, but approximately two­thirds of these individuals did not seek medical care. Tetanus is a clinical diagnosis and must be considered in patients with muscle spasms and an inadequate vaccination history. ‘Confirmed cases’ of tetanus need to meet the laboratory criterion.

Keywords: Magnesium and Tetanus; IVDUs and Tetanus; “Skin Popping” and Tetanus; Tetanus Immunoglobulin Vs Human Immunoglobulin.

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.7316.21

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