Fica Alberto, Gaínza Daniela, Ortigosa Pablo
Servicio de Infectología, Hospital Militar de Santiago, Santiago, Chile.
Servicio de Medicina, Hospital Militar de Santiago, Santiago, Chile.
Rev Chilena Infectol. 2017 Apr;34(2):181-185. doi: 10.4067/S0716-10182017000200012.
Tetanus is declining due to vaccination, professional labor management and appropriate wound care. Tetanus cases have been reported despite immunization. We report the case of a previously healthy 21 years old female patient that presented a mild generalized tetanus requiring admission after mild and recurrent cat scratch and bites. She had received six vaccine shots during childhood, and a booster dose five years earlier after a rabbit bite. Symptoms appeared seven weeks after the last contact, and included headache, muscle spasms and mild opisthotonus. Laboratory evaluation, including CSF analysis and microbiological investigation, as well as imaging studies were all normal. The patient received 6,000 IU of human antitoxin immunoglobulin. No autonomic manifestations or respiratory compromise were registered. Symptoms resolved rapidly and she was discharge after seven days with an order to complete a tetanus toxoid immunization schedule with three doses.
Tetanus is possible in urban settings with a declining epidemiologic curve of disease in previously immunized patients. Severity of disease is modulated by previous vaccination.
由于接种疫苗、专业的劳动管理和适当的伤口护理，破伤风发病率正在下降。尽管进行了免疫接种，但仍有破伤风病例报告。我们报告一例既往健康的21岁女性患者，该患者因轻度且反复的猫抓和咬伤后出现轻度全身性破伤风而需要住院治疗。她在儿童时期接种过6剂疫苗，5年前被兔子咬伤后接种过一剂加强针。症状在最后一次接触后7周出现，包括头痛、肌肉痉挛和轻度角弓反张。实验室检查，包括脑脊液分析和微生物学调查，以及影像学检查均正常。患者接受了6000 IU的人抗毒素免疫球蛋白治疗。未出现自主神经表现或呼吸功能障碍。症状迅速缓解，7天后出院，并医嘱完成3剂破伤风类毒素免疫接种程序。
在疾病流行病学曲线呈下降趋势的城市环境中，既往接种过疫苗的患者仍有可能感染破伤风。疾病的严重程度受既往接种疫苗的影响。
