ELEVATED ANTITOXIN TITERS IN A MAN WITH GENERALIZED TETANUS

Vaccination programs have significantly reduced the incidence of tetan us in the United States. The disease develops almost exclusively in th ose who have been inadequately immunized. This report describes severe , generalized tetanus in a 29-year-old man who had received a primary series as a child and two booster injections. Serum obtained before ad ministration of tetanus immune globulin showed antibody titers to teta nus greater than 100 times the level considered protective. Aggressive supportive care can usually prevent serious consequences. Since most physicians have never seen a case of tetanus, however, the diagnosis c an be difficult. Many disorders that exhibit signs and symptoms simila r to tetanus must be carefully considered during the evaluation of the se patients. Tetanus is a preventable disease. Prevention, however, re quires both appropriate immunizations and prompt wound care. While con troversy exists regarding the most effective policy to adequately immu nize all individuals, this case shows that vaccination alone does not preclude the possibility of tetanus.