Laverse Etienne, Dhamija Kanchan, Meyers Marilyn, Grant Kathie
Southend Hospital, Southend, Essex, SS0 7DB, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.03.2009.1649. Epub 2009 Jun 11.
The case of a 79-year-old woman with neurotoxin producing Clostridium tetani identified in a lower limb laceration that was promptly treated is presented; the patient developed no symptoms of tetanus. Her antibody levels were measured as 0.01 U/ml (protective levels >0.01 U/ml) and were therefore not protective. The isolate of C tetani was identified by 16S sequencing. The potential to produce tetanus toxin was determined by detection of a fragment of the C tetani neurotoxin gene. She was given a week long course of oral flucloxacillin, 500 mg four times a day and metronidazole, 400 mg three times a day, for 5 days. The patient was subsequently given prophylactic immunoglobulin (500 IU) as per guidelines. The fact that the patient did not manifest any symptoms of localised or generalised tetanus could be attributed to prompt management when she presented to her primary care site.
本文报告了一例79岁女性病例，其在下肢撕裂伤中发现产神经毒素的破伤风梭菌，伤口得到及时处理；患者未出现破伤风症状。检测其抗体水平为0.01 U/ml（保护水平>0.01 U/ml），因此无保护作用。破伤风梭菌分离株通过16S测序鉴定。通过检测破伤风梭菌神经毒素基因片段确定产生破伤风毒素的可能性。给予她为期一周的口服氟氯西林疗程，每日4次，每次500 mg，以及甲硝唑，每日3次，每次400 mg，共5天。随后根据指南给予患者预防性免疫球蛋白（500 IU）。患者未表现出局部或全身破伤风的任何症状，这一事实可归因于她到初级保健机构就诊时得到的及时处理。
