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June 6, 1980

Otogenous Tetanus

JAMA. 1980;243(21):2156. doi:10.1001/jama.1980.03300470018009

To the Editor.—  We have recently had the opportunity to care for an 18-month-old male Hmong refugee who was hospitalized with tetanus one week after an otological examination in a health screening clinic. We believe that the manner in which he became infected is sufficiently unusual that it should be brought to the attention of the medical community in view of the escalating immigration of Indochinese refugees to this country.

Report of a Case.—  The patient was seen in the screening clinic within ten days of arrival in the United States from a northern Thailand refugee camp. Immunization history indicated that he had been given an injection in the refugee camp at 10 months of age, but it could not be determined that it was a dipropyltryptamine immunization. The patient's clinical examination findings were entirely normal except that the tympanic membranes were totally obscured by cerumen. An unsuccessful attempt was