Tetanus in patients with chronic wounds – are we aware?

Abstract

The incidence of tetanus in patients with wounds is unknown; however, recently concern has been raised over the proportion of tetanus cases in which a chronic wound is the portal of entry for Clostridium tetani. Varicose ulcers, dermatosis and necrosed tumours are estimated to be the point of entry for C. tetani spores in 11-14% of three cases. Of diabetic patients in the USA who contracted tetanus, a diabetic foot ulcer was responsible in 25% of cases despite this chronic wounds have yet to be considered as a risk factor for tetanus. An audit was undertaken and a survey devised to form the basis of the data collection to assess if patients with chronic wounds are up-to-date in accordance with the tetanus immunisation programme. Over a 5-day period, the data were prospectively collected and the tetanus status of a 100 patients retrospectively analysed. The status was then compared with general practitioner (GP) records via telephone follow-up. One hundred patients (n = 100) were available in the audit period, with the majority being male (n = 51). The age range was 22-91 years old (median 70 years). Nearly half of the samples (n = 48) were diabetic, with the majority of patients (n = 35) having venous leg ulcers. Only 15% had a biopsy of their wound. The duration of wounds varied from 1 to 480 months. Patients were asked to confirm their tetanus status. Almost half of the patients were unsure of their tetanus status 48% (n = 48), almost a third 30% (n = 30) thought they were not covered and 22% (n = 22) thought they were up-to-date. After confirming with the GP records, the results were as follows: almost half of the patients, 43% (n = 43) were not covered, 33% (n = 33) were up-to-date, 13% had no immunisation records available at the GPs, 10% had no GP contact details and 1% no contact was possible. Currently, tetanus prophylaxis is given based on the vaccination history of the patient but as identified that this can prove to be unreliable. With the burden of chronic wound and ageing population set to increase, levels of protection amplify the risk of tetanus faced by those suffering from chronic wounds. Strict caution should be taken in those patients who were born before the national childhood vaccination programme, implemented in 1961. Moreover, every effort should be made to ensure that such individuals complete their primary course. By ensuring each patient is actively immunised, protection against tetanus, a potential killer, is provided.

Tetanus after envenomations caused by freshwater stingrays

“…Lack of immunization is the greatest risk factor for contracting tetanus (Hsu and Groleau, 2001). With the burden of chronic wound and aging population set to increase, levels of protection amplify the risk of tetanus faced by those suffering from chronic wounds (Farnworth et al, 2012).…”

Diabetic Foot Wounds: Which Patients are More Prone to Tetanus?

“…In the present study, we found that sufficient protection rates in DFW patients decreased with increasing age, as in the aforementioned study. Another study conducted by Farnworth et al [25] included 100 patients with chronic leg ulcer, nearly half of whom had DM. When the patients were asked about their tetanus immunization status, 48% were unsure of their status, 30% believed that they were not covered, and 22% believed that they were covered.…”

Is there any difference in tetanus IgG levels of diabetic patientswith respect to the presence of foot ulcers?

“…According to Centers for Disease Control and Prevention (CDC) data, diabetic foot ulcers and gangrene are a major route for tetanus infections. Chronic wounds, which are more commonly observed in diabetic patients, were shown to be the etiologic factor in about 26% of tetanus cases (4,8,9).…”