Tetanus Prophylaxis for Diabetic Foot Ulcers

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Diabetes as a risk factor for tetanus

Several factors place the diabetic patient at risk for developing tetanus. First, the diabetic patient is at high risk for the development of a lower extremity wound. It is estimated that approximately 15% of diabetics suffer a foot ulceration during their lifetime [12]. The diabetic foot with macro- or microvascular disease can favor anaerobic conditions with lower oxygen tensions and affect the delivery of immune cells to the extremity. Gangrene, which occurs frequently in diabetic wounds, is

The vaccine

To harvest tetanus toxoid, C tetani is fermented, and the toxin is filtrated, purified, and detoxified with 40% formaldehyde. In the United States, several preparations of toxoid are available including tetanus toxoid, diphtheria and tetanus toxoid (DT or Td), and diphtheria and tetanus toxoid plus pertussis (DTP) or with acellular pertussis (DTaP) [8]. In the United States, DTP is generally used for the primary series in infancy. DT is used for pediatric patients younger than 7 years because

Recommendations

The recommendations of the ACIP for tetanus vaccination are presented in Table 1. Note that TIG is indicated only for those who have had fewer than three previous toxoid doses or whose vaccine history is unknown. Each dose during a primary series should be counted, so patients who have completed only a primary series have already had three immunizations. Hence, most infants born in the United States complete a primary series. All adults who have never completed a primary series or who have an

Summary

Because of better immunization practices in the United States, tetanus is becoming proportionally less frequent in the classic farming or soil-contaminated wounds and more common in the atypical wounds like diabetic foot ulcers that have exposure only to indoor environments. Tetanus is a rare but serious and potentially fatal complication of diabetic foot ulcers and infections. Because diabetics are at greater risk for tetanus intoxication and have a higher case-fatality ratio, updating the

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References (23)

  • D.B. Thordarson et al.

    Tetanus complicating a polymicrobial diabetic foot infection: case presentation and review of current treatment

    Foot Ankle Int

    (1995)

    • Cited by (0)

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    Published by Elsevier Inc.