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August 25, 1978

Tetanus Despite Preexisting Antitetanus Antibody

Author Affiliations

From the Infectious Disease Service, New York Medical College, New York (Drs Berger and Nelson); the Jewish Hospital of Brooklyn, Brooklyn, NY (Dr Cherubin); and the State Laboratory Institute, Department of Public Health, Boston (Mr Levine).

JAMA. 1978;240(8):769-770. doi:10.1001/jama.1978.03290080059029

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.

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