An unusual case of evolving localized tetanus despite prior immunization and protective antibody titer
vaccination; immunization; persistence; decennial booster; evolving tetanus; localized tetanus; protective antibody titer; tetanus titer
Centers for Disease Control and Prevention has reported that tetanus infection in a fully immunized person with the last dose within 10 years is extremely rare. The prevalence of localized tetanus in such a scenario is unknown. Only two case reports of localized tetanus in previously immunized patients have been reported so far, making this the third one. Also, this is the first case of its kind to demonstrate evolving localized tetanus. Our patient is a 19-year-old man who presented with shortness of breath, pain in right upper extremity, shoulder, and neck. His chest X-ray and creatine kinase were normal. The patient was sent home. He presented again to our hospital two days later with difficulty swallowing and speaking as well as chest tightness. Routine blood tests, electrocardiogram, CT angiography of the chest, and transthoracic echocardiogram were normal. He gave a history of a cut in the right middle finger while removing the carpet a week before his presentation. His immunization history was complete with documented last tetanus shot nine years and two months ago. He was treated with tetanus vaccine and penicillin. His tetanus antitoxoid titer came out protective.
Tharu B; Ibrahim S; Shah M; Basnet S; Park T
Cureus
2020
2020-07-31
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.7759/cureus.9498" target="_blank" rel="noreferrer noopener">10.7759/cureus.9498</a>
A Rare Case of Pleural Empyema Caused by Clostridium Baratii
General & Internal Medicine; perfringens; Respiratory System
Talat A; Shah M
Chest
2016
2016-10
Journal Article
<a href="http://doi.org/10.1016/j.chest.2016.08.167" target="_blank" rel="noreferrer noopener">10.1016/j.chest.2016.08.167</a>
Summary Of Nih Medical-surgical Emergency Research Roundtable Held On April 30 To May 1, 2009
Emergency Medicine
Study objective: In 2003, the Institute of Medicine Committee on the Future of Emergency Care in the United States Health System convened and identified a crisis in emergency care in the United States, including a need to enhance the research base for emergency care. As a result, the National Institutes of Health (NIH) formed an NIH Task Force on Research in Emergency Medicine to enhance NIH support for emergency care research. Members of the NIH Task Force and academic leaders in emergency care participated in 3 roundtable discussions to prioritize current opportunities for enhancing and conducting emergency care research. The objectives of these discussions were to identify key research questions essential to advancing the scientific underpinnings of emergency care and to discuss the barriers and best means to advance research by exploring the role of research networks and collaboration between the NIH and the emergency care community. Methods: The Medical-Surgical Research Roundtable was convened on April 30 to May 1, 2009. Before the roundtable, the emergency care domains to be discussed were selected and experts in each of the fields were invited to participate in the roundtable. Domain experts were asked to identify research priorities and challenges and separate them into mechanistic, translational, and clinical categories. After the conference, the lists were circulated among the participants and revised to reach a consensus. Results: Emergency care research is characterized by focus on the timing, sequence, and time sensitivity of disease processes and treatment effects. Rapidly identifying the phenotype and genotype of patients manifesting a specific disease process and the mechanistic reasons for heterogeneity in outcome are important challenges in emergency care research. Other research priorities include the need to elucidate the timing, sequence, and duration of causal molecular and cellular events involved in time-critical illnesses and injuries, and the development of treatments capable of halting or reversing them; the need for novel animal models; and the need to understand why there are regional differences in outcome for the same disease processes. Important barriers to emergency care research include a limited number of trained investigators and experienced mentors, limited research infrastructure and support, and regulatory hurdles. The science of emergency care may be advanced by facilitating the following: (1) training emergency care investigators with research training programs; (2) developing emergency care clinical research networks; (3) integrating emergency care research into Clinical and Translational Science Awards; (4) developing emergency-care specific initiatives within the existing structure of NIH institutes and centers; (5) involving emergency specialists in grant review and research advisory processes; (6) supporting learn-phase or small, clinical trials; and (7) performing research to address ethical and regulatory issues. Conclusion: Enhancing the research base supporting the care of medical and surgical emergencies will require progress in specific mechanistic, translational, and clinical domains; effective collaboration of academic investigators across traditional clinical and scientific boundaries; federal support of research in high-priority areas; and overcoming limitations in available infrastructure, research training, and access to patient populations. [Ann Emerg Med. 2010;56:522-537.]
Kaji A H; Lewis R J; Beavers-May T; Berg R; Bulger E; Cairns C; Callaway C; Camargo C A; Carcillo J; DeBiasi R; Diaz T; Ducharme F; Glickman S; Heilpern K; Hickey R; Vanden Hoek T; Hollander J; Janson S; Jurkovich G; Kellermann A; Kingsmore S; Kline J; Kuppermann N; Lowe R; McLario D; Nathanson L; Nichol G; Peitzman A; Richardson L; Sanders A; Shah M; Shapiro N; Silverman R; Than M; Wilber S; Yealy D M; Roundtable External Participants; Roundtable Steering Comm; Fed Participants
Annals of Emergency Medicine
2010
2010-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.annemergmed.2010.03.014" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2010.03.014</a>
Impact Of Pharmacy Contribution To Interprofessional Transitions Intervention On Patient Outcomes
Pharmacology & Pharmacy
Fosnight S; King P; Dittmer A; Grzybowski G; Shah M; Worthington J
Pharmacotherapy
2017
2017-12
Journal Article or Conference Abstract Publication
n/a
Pneumonia Due To Pan-resistant Acinetobactor Baumannii &
General & Internal Medicine; Respiratory System
Elahee M; Talat A; Khalid M; Shah M; Bailey R S
American Journal of Respiratory and Critical Care Medicine
2018
2018
Journal Article or Conference Abstract Publication
n/a