Pre-emptive treatment for Clostridium tetani: Importance of early recognition and treatment in the community

The case of a 79-year-old woman with neurotoxin producing Clostridium tetani identified in a lower limb laceration that was promptly treated is presented; the patient developed no symptoms of tetanus. Her antibody levels were measured as 0.01 U/ml (protective levels >0.01 U/ml) and were theref ore not protective. The isolate of C tetani was identified by 16S sequencing. The potential to produce tetanus toxin was determined by detection of a fragment of the C tetani neurotoxin gene. She was given a week long course of oral flucloxacillin, 500 mg four times a day and metronidazole, 400 mg three times a day, for 5 days. The patient was subsequently given prophylactic immunoglobulin (500 IU) as per guidelines. The f act that the patient did not manifest any symptoms of localised or generalised tetanus could be attributed to prompt management when she presented to her primary care site.