DRUGS ALERT
On 22 April 2007 a Doctor at Russell’s Hall Hospital, Dudley, treated a 50-year old male who presented with a 2-day progressive history of back spasms, trismus, spasticity and sweating (mild grade). He did not experience any dysphagia or respiratory difficulty. The patient is a heroin injecting drug user (IDU), but significantly he injects IM (lateral thigh and deltoid areas) – the veins being no longer accessible and does not utilise the femorals in the groin areas. In 2003, he was similarly admitted with tetanus, at that time of a moderate/severe grade. He was then successfully treated with tetanus immunoglobulin, but there is no evidence from the notes of a course of tetanus toxoid prior/following hospital discharge. Initially he was admitted to the ITU, given tetanus immunoglobulin and penicillin. On 24 April, he was moved to the general wards. He now has some residual jaw stiffness and mild back spasms. The potential for injecting heroin users, especially ‘skin-poppers’ – those injecting into muscles or below skin, to contract tetanus and there was an outbreak of tetanus among injecting users in 2003-4. The risk of tetanus increases with the prevalence of contaminated heroin. This circulation seeks to raise the awareness of Drug Action Teams/CJITs and to alert drug users to the possible presence of contaminated heroin and the potential for users to contract tetanus. Common symptoms of tetanus (including those described above) are: The most common symptoms of tetanus are muscle spasms, usually starting in the jaw (known as ‘lock jaw’, by which name tetanus is also known). Lock jaw makes it difficult to open and close the mouth, causing difficulty in chewing and swallowing food. Spasms of the facial muscles may follow, then as the poison spreads, muscle spasms in the arms, stomach, legs and back.
The length of time between becoming infected with tetanus and the development of symptoms can range from 2 days to 1 month. As tetanus affects the muscles in the jaw it can cause breathing difficulties, which if not treated can lead to suffocation and death.
