At risk for tetanus?
April 5, 2017 | 20,00 EUR | answered by Nadja Struß
Hello,
I injured myself on a glass pane on Sunday, 26.04.17. I was treated at the hospital (about 30 minutes later): wounds were washed, disinfected, and stitched. There was a wound on the elbow with 5 stitches and another with 2 stitches. A stitch was made on the forearm, and on the wrist and fingers, there was 1 stitch each at 3 different spots.
At that time, I thought I had an active tetanus protection. My last booster was done 2 years ago. However, it is unclear when the last booster was (at least 20 years ago) and whether a primary immunization was done, as I no longer have my old vaccination record and the previous pediatrician could not provide any information from that far back.
The wound healing looks very good, with no external signs of inflammation, and the stitches will be removed on 06.04. I change the bandages daily, and when changing them, I spray them with a wound disinfection spray.
However, I have been experiencing mild muscle pain (not only in the arm), so I went to the doctor on 03.04.17. I insisted on a titer test (results pending) and a passive immunization (Tetagam P), which was then done. Additionally, the CRP level was measured at 0.7 at that time.
I still feel weak and have fasciculations (not visible) on my face.
Now, my questions are:
a) How likely is a possible tetanus infection? (please provide reasoning for your answer)
b) Is the CRP value informative in this case, or should the immunoglobulin level have been checked instead?
c) Was the passive immunization with Tetagam P done too late, or does it provide sufficient protection?
d) What would be your further steps?
Thank you and best regards.
Dear inquirer,
The crucial factor for the approach to tetanus prophylaxis following an injury is initially whether the wound is externally clean or contaminated, whether there are contusions, how deep the wound is, etc.
It is certain that you received a single tetanus vaccination 2 years ago. The frequency of vaccinations prior to that and whether there is a basic immunization is unknown according to your information. In such a case, an active immunization should be carried out for clean wounds (as prophylaxis). If the surgeon classifies your injuries as contaminated, etc., a passive immunization must be carried out simultaneously, as there is an increased risk of infection and the passive vaccine can neutralize ingested pathogens (or the toxin).
Therefore, in response to your question c), based on the information provided by you, a sole passive immunization does not provide sufficient protection. Additionally, several days elapsed between the injury and the passive vaccination, so the effectiveness is greatly reduced.
Regarding question b): The CRP value (C-reactive protein) is determined to detect inflammation activity in the body, especially caused by bacteria. The value should be below 5 mg/l, but it is important to always consider the reference value of the laboratory that measured it. Please inquire again or check if you have a printout (pay attention to the units).
Regarding your first question:
I consider a tetanus infection to be quite unlikely. Typically, one injures oneself on contaminated objects outside, such as nails, thorns, etc. In addition, the symptoms worsen quickly after initial flu-like symptoms (stiff neck, tense abdominal muscles), with severe muscle cramps (initially in the face with lockjaw, cramping of the back muscles), deterioration of the general condition, and neurological deficits. Having only mild muscle pain for days without the symptoms progressing would be very atypical.
If the wound was clean, the probability of infection is already low, and you had at least one last vaccination 2 years ago.
If your symptoms unexpectedly worsen, you should immediately seek medical attention at the hospital.
The diagnosis of tetanus is made clinically, i.e., based on the symptoms. Without clear symptoms, therapy without a confirmed diagnosis is not advisable, and attempts are made only to confirm the presence of tetanus toxin.
Please contact your general practitioner again and discuss the matter, especially ensuring that your vaccination status - including other infectious diseases - is up to date.
I hope I could assist you further.
Best regards,
Nadja Struß
