Fatal Tetanus in a Boy after Prophylactic Tetanus Antitoxin

Tetanus Eight Days After Administration of Anti-tetanus Serum

“…Similarities to a Previous Report.-A report similar in two respects to that above was made by Littlewood, Mant, and Wright (1954). They reported the case of a schoolboy who injured his hand while experimenting with a home-made bomb.…”

“…-Littlewood et al (1954) urged that anyone who has received horse serum should be actively immunized not only against tetanus but also against diphtheria. Diphtheria antitoxin, like tetanus antitoxin, is produced in horses, and a second injection of this animal's protein may result in its very rapid elimination from the body, thus running the risk of greatly shortening the duration of passive immunity (Wright, 1958).…”

Tetanus Prophylaxis

“…Several workers have studied this subject since the classical experiments of Glenny andHopkins (1922, 1923). Reviewing the literature, Littlewood, Mant, and Wright (1954) agreed with other authorities that after the first injection of serum the effectiveness of subsequent injections was minimized because of their accelerated elimination. This would apply to one-third of the patients in the sample of a casualty population recently studied, since that number had previously received prophylactic tetanus antitoxin.…”

“…In the present study of tetanus cases four such reactions occurred, and in one of these cases the reaction was fatal. Littlewood et al (1954) reported a similar case of anaphylaxis following therapeutic serum.…”

Antivenene Reaction Following Accidental Sea-snake Bite

“…Payling Wright and his colleagues (Littlewood et al, 1954) have shown that, once injection of horse serum has been given, with second or subsequent injections the serum is likely to be removed so rapidly from the circulation by the liver that prophylactic effectiveness is curtailed. Therapeutic effectiveness would presumably be nil.…”