Tetanus Despite Preexisting Antitetanus Antibody

Abstract

SINCE 1955, most cases of tetanus in New York City have occurred in heroin addicts. 1 Possible reasons for this include a relatively large population of addicts lacking detectable circulating antitoxin and the deep subcutaneous injection of irritating, possibly contaminated substances. With one exception in 1942, 2 there has been no instance of multiple tetanus cases from a common environmental source such as the drug or injection apparatus. Recently, a brother and sister were admitted to Metropolitan Hospital with tetanus following use of heroin from a single source. The disease was severe and protracted in one patient but mild in the second patient, who had preexisting serum antitoxin. Report of Cases Case 1.— A 29-year-old male heroin addict had trismus and painful cervical spasms over a 24-hour period. Physical examination showed a temperature of 37.3 °C, blood pressure of 120/70 mm Hg, and pulse rate of 112 beats per minute.