Surviving a rare bout of tetanus

Infection: The disease has nearly vanished in this country, but it was lurking among the berries in a 71-year-old Halethorpe woman's garden.

October 24, 2004|By Jonathan Bor | Jonathan Bor,SUN STAFF

Though it remains a common killer in poor regions of the world, tetanus has all but disappeared in the United States, thanks to vaccines and booster shots that doctors urge everyone to get.

But somehow, 71-year-old Estelle Driver of Halethorpe managed to go decades - perhaps all her life - without a tetanus shot. This summer, she faced the consequences after she fell on a garden stake and developed a raging tetanus infection that nearly took her life.

The symptoms didn't occur right away. But 10 days after the accident opened a large V-shaped wound on her leg, Driver, known as Stella, lay hooked to machines in the intensive care unit at St. Agnes HealthCare, while doctors tried to quell violent muscle contractions that caused her back to snap repeatedly off the bed in a frozen arch.

"Me scared?" asked her husband, Clayton O. Driver, 76, affectionately known as the "Candy Man" at St. Agnes, where he doles out sweets to those caring for his wife of 54 years. "I'm not scared of anything - only bees - but I could have easily lost her. If there is any way to get people to please get those tetanus shots."

Because tetanus seizures can crack vertebrae and cause neurologic damage, doctors were forced to administer drugs to paralyze her muscles and put her to sleep - a type of medically induced coma in which she remained for six weeks.

Six weeks ago, she opened her eyes for the first time since the ordeal began. Since then, she has become more alert and has begun to speak and sip liquids through a straw.

Doctors say the tetanus toxin has been cleared from her system, though it could be months before she can move freely and take care of herself.

"She has a long recovery period ahead of her," said Dr. Uday Nanavaty, an intensive care specialist at St. Agnes.

Within a week or two, St. Agnes might transfer her to a rehabilitation hospital. There, physical therapists will help her regain motion in her arms, which are weak and stiff from lack of use.

Mrs. Driver speaks quietly, timing quick bursts of words with the rhythms of a ventilator that pumps air into an opening in her throat. She receives food through an opening in her abdomen and has her blood filtered by a dialysis machine that does the work of her kidneys.

Recently, she admitted that she has become aggravated by her confinement and can't wait to return home.

"Want to spread out and exercise," she said.

Danger to elderly

Stopping outside her room one afternoon, her doctors - Nanavaty; Dr. Anthony Martinez, chief of intensive care; and Dr. Viney Setya, a surgeon - reflected on dangers facing elderly Americans who might have never kept current on their tetanus shots.

It's an odd thought, given the current fixation with the shortage of flu vaccine.

The physicians noted that today's elderly grew up in an era when authorities were less vigilant about vaccines. And today, while schools are not allowed to accept children unless their inoculations are up to date, doctors treating older patients might be too focused on the flu and diseases of aging to push something as humdrum as a tetanus shot.

"As older patients become more active, they really need protection," said Setya, pointing out that people need to get boosters every 10 years to maintain their immunity.

Mr. Driver guesses that he has received one tetanus shot in his life, when he served in the Marine Corps. He said he has been too preoccupied with his wife's illness to correct the problem, but he vows to do so.

Tetanus shots weren't made a part of routine childhood immunizations until the 1940s. Before that, about 400 cases occurred annually, and about a third of the victims died, according to the federal Centers for Disease Control and Prevention.

Since then, cases have dropped steadily, reaching an all-time low of 25 in 2002.

About one case every two years turns up in Maryland, according to the state health department. Death is rare because of modern intensive care units, such as the one at St. Agnes, where patients can be stabilized until the infection plays itself out.

Dormant in soil

Tetanus bacteria live in the soil inside spores, where they remain dormant until they find a hospitable environment such as the human body. Inside deep wounds lacking oxygen, they break out of their shells and release a toxin that disrupts the orderly transmission of signals from one nerve cell to another.

What results are spasms in which every muscle in the body contracts at once. Some pull while others push, producing the arched-back spasms that last several seconds and recur repeatedly.

The disease is sometimes called lockjaw after the pain and stiffness that many patients experience in the face and throat.

Doctors can spend a career treating an encyclopedia's worth of illnesses without encountering tetanus. Dr. John Bartlett, chief of the infectious diseases division at the Johns Hopkins School of Medicine, said he has never seen a case in the United States.

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