Ocorrência de eventos adversos após o uso da vacina adsorvida difteria, tétano e pertussis (acelular) - dTpa -, São Paulo, SP, 2015-2016 / Aparecimiento de eventos adversos después del uso de la vacuna adsorbida difteria, tétanos y tosferina (acelular) - dTpa -, São Paulo, SP, Brasil, 2015-2016 / Adverse event occurrence following use of tetanus, diphtheria and acellular pertussis adsorbed vaccine - Tdap -, São Paulo, SP, Brazil, 2015-2016

Objetivo: descrever a ocorrência de eventos adversos pós-vacinação (EAPV) com a vacina dTpa durante a gestação. Métodos: estudo descritivo, com dados de relatos das participantes de estudo de efetividade e imunogenicidade realizado em dois hospitais de São Paulo, SP, Brasil, entre 2015 e 2016. Resultados: das 201 mães incluídas no estudo, 48 (23,9%) apresentaram pelo menos um EAPV; foram identificados 60 sintomas relacionados ao uso da dTpa - dor (22,4%), inchaço (2,5%), febre (1,5%), sono (1,0%), vermelhidão (0,5%), vômito (0,5%), dor de cabeça (0,5%), reação local (0,5%) e cansaço (0,5%); não foram registrados eventos adversos raros, muito raros ou extremamente raros; todos os eventos foram considerados esperados e estão descritos em bula; todos tiveram desfecho para cura sem sequelas. Conclusão: a dTpa, na forma adotada pelo Programa Nacional de Imunizações (PNI), é segura; não foram identificados eventos adversos inesperados entre as gestantes imunizadas com a vacina.

Objetivo: describir el aparecimiento de eventos adversos posvacunación (EAPV) con la vacuna dTpa durante el embarazo. Métodos: estudio descriptivo con datos de relatos de las participantes del estudio de efectividad e inmunogenicidad realizado en dos hospitales de São Paulo, SP, Brasil, entre 2015 y 2106. Resultados: de las 201 madres del estudio, 48 (23,9%) tuvieron al menos un EAPV; se identificaron 60 síntomas relacionados al uso de dTpa - dolor (22.4%), hinchazón (2.5%), fiebre (1.5%), somnolencia (1.0%), enrojecimiento (0.5%), vómitos (0.5 %), dolor de cabeza (0.5%), reacción local (0.5%) y cansancio (0.5%) -; no se informaron eventos adversos raros, muy raros o extremadamente raros; todos los eventos se consideraron esperados y se describen en el prospecto; todos tuvieron resultados curativos sin secuelas. Conclusión: el estudio mostró que la vacuna dTpa utilizada por el Programa Nacional de Inmunización (PNI) es segura y no se identificaron eventos adversos inesperados entre las mujeres embarazadas vacunadas.

Objective: to describe occurrence of adverse events following immunization (AEFI) with Tdap vaccine during pregnancy. Methods: this was a descriptive study using data from reports by participants in an effectiveness and immunogenicity study conducted in two hospitals in São Paulo, SP, Brazil, from 2015 to 2016. Results: of the 201 mothers included in the study, 48 (23.9%) had at least one AEFI; 60 symptoms related to Tdap use were identified - pain (22.4%), swelling (2.5%), fever (1.5%), somnolence (1.0%), redness (0.5%), vomiting (0.5%), headache (0.5%), local reaction (0.5%), and fatigue (0.5%); no rare, very rare, or extremely rare adverse events were reported; all events were considered to be expected, as they are described in the vaccine package insert; outcome of all events was recovery without sequelae. Conclusion: Tdap vaccine in the form adopted by the National Immunization Program is safe; no unexpected adverse events were identified among vaccinated pregnant women.

Inmunidad humoral a tétanos, sarampión y rubéola en niños con leucemia linfoblástica aguda luego del tratamiento quimioterápico / Humoral immunity to tetanus, measles and rubella in children with acute lymphoblastic leukemia after chemotherapy

Los regímenes de quimioterapia y los avances en el soporte clínico han mejorado la supervivencia de los niños con leucemia linfoblástica aguda. Son temas de preocupación las secuelas del tratamiento, entre ellas, el daño inmunológico inducido por la terapia inmunosupresora, que se refleja en la pérdida de niveles protectores de anticuerpos provistos por inmunizaciones previas. Nuestro objetivo fue evaluar la presencia de títulos protectores de anticuerpos para sarampión, rubéola y tétanos en pacientes con leucemia linfoblástica aguda luego de haber finalizado el tratamiento quimioterápico. Se incluyeron 61 niños con leucemia linfoblástica aguda asistidos en el Hospital Garrahan, que habían finalizado el tratamiento, como mínimo, 6 meses antes y con vacunación completa previa al diagnóstico. Las tasas de anticuerpos protectores fueron sarampión: 46% (IC 32-59); tétanos: 53% (IC 40-67); rubéola: 60% (IC 47-63). Estos resultados refuerzan la necesidad de reconsiderar la revacunación en este grupo de pacientes.

Chemotherapy regimens and clinical support advances have improved survival in children with acute lymphoblastic leukemia. The after-effects of treatment are a reason for concern, including damage to the immune system induced by immunosuppressive therapy which is reflected in the loss of antibody protection provided by prior immunizations. Our goal was to assess the presence of measles, rubella, and tetanus protective antibody titers among patients with acute lymphoblastic leukemia after completing chemotherapy. Sixty-one children with acute lymphoblastic leukemia seen at the Hospital Garrahan were included; patients had finished their chemotherapy at least 6 months earlier and had a complete immunization schedule before diagnosis. The rates of protective antibodies were 46% (CI: 32-59) for measles, 53% (CI 40-67) for tetanus, and 60% (CI 47-63) for rubella. These results strengthen the need to reconsider revaccination in this group of patients.

Influences on Formation of Tetanus Antibody after Simultaneous Injection of Tetanus Immunoglobulin with Tetanus Vaccine

The goal of this study was to determine how much the formation of tetanus antibody is influenced after a single injection of tetanus vaccine (Td) and the simultaneous injection of tetanus vaccine with tetanus immunoglobulin (TIG). All of the healthy adult volunteers were divided into two groups: group 1 (Td only) and group 2 (Td plus TIG). Two hundred thirty seven volunteers were enrolled. When the baseline antibody titer, gender and age were adjusted, the geometric mean titers (GMTs) of the tetanus antibody (group 1 vs group 2) was 0.8438 IU/mL vs 0.5684 IU/mL at 4 weeks (P = 0.002), 0.4074 IU/mL vs 0.3217 IU/mL at 6 months (P = 0.072) and 0.3398 IU/mL vs 0.2761 IU/mL at 12 months (P = 0.140) after injection, respectively. The formation of tetanus antibody after tetanus vaccination is not influenced by TIG at the late period and in adults below the age of 50 yr, but there are significant differences between the two groups at the early period of 4 weeks after vaccination and for the patients over 60 yr.

Assessment of Serologic Immunity to Diphtheria-Tetanus-Pertussis After Treatment of Korean Pediatric Hematology and Oncology Patients

The aim of this study was to investigate the diphtheria-tetanus-pertussis antibody titers after antineoplastic treatment and to suggest an appropriate vaccination approach for pediatric hemato-oncologic patients. A total of 146 children with either malignancy in remission after cessation of therapy or bone marrow failure were recruited. All children had received routine immunization including diphtheria-tetanus-acellular pertussis vaccination before diagnosis of cancer. The serologic immunity to diphtheria, tetanus and pertussis was classified as: completely protective, partially protective, or non-protective. Non-protective serum antibody titer for diphtheria, tetanus and pertussis was detected in 6.2%, 11.6%, and 62.3% of patients, respectively, and partial protective serum antibody titer for diphtheria, tetanus and pertussis was seen in 37%, 28.1%, and 8.9% of patients. There was no significant correlation between the severity of immune defect and age, gender or underlying disease. Revaccination after antineoplastic therapy showed significantly higher levels of antibody for each vaccine antigen. Our data indicates that a large proportion of children lacked protective serum concentrations of antibodies against diphtheria, tetanus, and pertussis. This suggests that reimmunization of these patients is necessary after completion of antineoplastic treatment. Also, prospective studies should be undertaken with the aim of devising a common strategy of revaccination.

Clinico-epidemiological study of tetanus at district headquarter hospital, Faisalabad

To study age, sex and regional frequency of tetanus. To define the status of immunization against tetanus. To find the outcome of the treatment provided. All the consecutive patients above 10 years of age with the clinical evidence of tetanus presenting at DHQ Hospital, Faisalabad were included in the study. Detailed history of the illness was obtained from the relatives. Physical examination carried out specifically looking for any evidence of injury. Associated co-morbid factors were noted and managed accordingly. Careful management of the tetanus was done in a separate unit with limited facilities. A total of 40 patients presented during one year of study with the clinical evidence of Tetanus. 28 patients were in between 10-30 years of age, 12 were of more than 40 years of age. There were 29 [72,5%] males and 11 [27.5%] females. Most of the patients [87.5%] belonged to rural areas and only 12.5% were from the urban areas. 25 patients had no knowledge about their tetanus immunization status. 15 patients gave history of tetanus immunization in the past but none of them had a booster dose within last 10 years. Male population belonging to rural areas is the commonest victims of tetanus. Most of them are affected during the 2[nd] and 3[rd] decades of life. There is a complete lack of knowledge about the tetanus immunization. Standard management of tetanus at dedicated centers with facilities for artificial ventilation can save many lives

Prevalence of diphtheria and tetanus antibodies and circulation of Corynebacterium diphtheriae in São Paulo, Brazil

The introduction of routine vaccination against tetanus and diphtheria in Brazil has decreased the incidence and changed the epidemiology of both diseases. We then investigated the prevalence of Corynebacterium diphtheriae carrier status and diphtheria and tetanus immunity in São Paulo, Brazil. From November 2001 to March 2003, 374 individuals were tested for the presence of C. diphtheriae in the naso-oropharynx and of serum diphtheria and tetanus antibodies. Participants were all healthy individuals without acute or chronic pathologies and they were stratified by age as follows: 0-12 months and 1-4, 5-9, 10-14, 15-24, 25-39, 40-59, and ³60 years. Antibodies were assessed using a double-antigen ELISA. C. diphtheriae species were identified by biochemical analysis and toxigenicity was assessed by the Elek test. For diphtheria, full protection (antibodies ³0.1 IU/mL) was present in 84 percent of the individuals, 15 percent had basic protection (antibodies ³0.01 and <0.1 IU/mL) and 1 percent were susceptible (antibodies <0.01 IU/mL). Full tetanus protection (antibodies ³0.1 IU/mL) was present in 79 percent of the participants, 18 percent had basic protection (antibodies ³0.01 and <0.1 IU/mL) and 3 percent were susceptible (antibodies <0.01 IU/mL). The geometric mean of diphtheria and tetanus antibodies reached the highest values at 5-9 years and decreased until the 40-59-year age range, increasing again in individuals over 60 years. Three participants (0.8 percent) were carriers of C. diphtheriae, all non-toxigenic strains. The present results demonstrate the clear need of periodic booster for tetanus and diphtheria vaccine in adolescents and adults after primary immunization in childhood.

Tetanus and diphtheria immunity in adolescents from São Paulo, Brazil

Tetanus and diphtheria vaccines are of special concern in adolescents because boosters are necessary for adequate maintenance of protection and are often omitted. We assessed serum levels of tetanus and diphtheria antibodies in adolescents and their association with vaccination status. From May to October 2001, we evaluated the vaccination records of 208 adolescents aged 10 to 20 years in São Paulo, Brazil. Antibodies to tetanus and diphtheria were detected using double-antigen ELISA and vaccination records were analyzed according to the guidelines of the Brazilian National Immunization Program. All adolescents had received complete primary vaccinations against tetanus and diphtheria, but 23.1 percent of them had not received a booster dose in the last 10 years. All adolescents were immune to tetanus and 88.9 percent were fully protected (antibodies ³0.1 IU/mL). One individual (0.5 percent) was non-immune to diphtheria and 86 percent were fully protected against the disease. Adolescents with up-to-date vaccination records had higher antibody levels than those with not up-to-date records for tetanus (0.763 vs 0.239 IU/mL, t-test: P < 0.0001) and diphtheria (0.366 vs 0.233 IU/mL, t-test: P = 0.014). Full immunity against tetanus (antibodies ³0.1 IU/mL) was higher among individuals with up-to-date vaccination (93.1 percent) when compared to those with not up-to-date records (75 percent, Fisher's exact test: P = 0.001). All adolescents had received basic immunization in childhood and were protected against tetanus and diphtheria. However, these data indicate that more emphasis should be placed on the tetanus-diphtheria booster in order to avoid a decay in antibody levels.

Effect of a single tetanus-diphtheria vaccine dose on the immunity of elderly people in São Paulo, Brazil

Epidemiological data regarding tetanus and diphtheria immunity in elderly people in Brazil are scarce. During the First National Immunization Campaign for the Elderly in Brazil in April 1999, 98 individuals (median age: 84 years) received one tetanus-dyphtheria (Td) vaccine dose (Butantan Institute, lot number 9808079/G). Inclusion criteria were elderly individuals without a history of severe immunosuppressive disease, acute infectious disease or use of immunomodulators. Blood samples were collected immediately before the vaccine and 30 days later. Serum was separated and stored at -20°C until analysis. Tetanus and diphtheria antibodies were measured by the double-antigen ELISA test. Tetanus and diphtheria antibody concentrations lower than 0.01 IU/mL were considered to indicate the absence of protection, between 0.01 and 0.09 IU/mL were considered to indicate basic immunity, and values of 0.1 IU/mL or higher were considered to indicate full protection. Before vaccination, 18 percent of the individuals were susceptible to diphtheria and 94 percent were susceptible to tetanus. After one Td dose, 78 percent became fully immune to diphtheria, 13 percent attained basic immunity, and 9 percent were still susceptible to the disease. In contrast, 79 percent remained susceptible to tetanus, 4 percent had basic immunity and 17 percent were fully immune. Although one Td dose increases immunity to diphtheria in many elderly people who live in Brazil, a complete vaccination series appears to be necessary for the prevention of tetanus.

Tetanus antitoxin levels and cutaneous anergy in hemodialysis patients in two University Hospitals in Iran

The global incidence of tetanus is about I million cases annually. Tetanus antibody values decrease with age. Some patients with humoral immune deficiencies may not respond adequately to tetanus toxoid vaccination. The incidence of infectious disease is increased in patients with chronic renal failure. The purpose of this study was to determine tetanus antitoxin level and cutaneous anergy test in hemodiaksis patients. A cross sectional study was performed on 44 hemodialysis patients who had been on dialysis thrice a week for at least 2 months. Quantitation of tetanus-specific antibodies was achieved by ELISA technique. Then, for Manteaux test 0.1 ml of 1/10 saline diluted solution of tetanus and diphtheria toxoid was injected intradermally to the volar surface of the shunt-free arm. Induration was recorded 48 - 72h and 7 - 9 days after the injection. Twenty-eight [64%] patients had induration /= 0.1 IU/ml. There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis history of tetanus-diphtheria vaccination, and tetanus antitoxin levels. There was a significant difference between induration size of anergy test results recorded on two separate observations [48 - 72h and 7 - 9 days after the test] [p < 0.05]. Our results indicate that immunization history was not consistent with protective antibody level, so monitoring immunization status and administering the tetanus vaccine in hemodialysis patients are required. Keywords: Anergy test, Anti-tetanus antibody, Hemodialysis

Evaluation of tetanus vacination status of pregnant mothers referring to delivery wards, Yazd

Tetanus is a serious infectious disease and the most common cause of neonatal mortality in developing countries. Although neonatal tetanus [NT] can be prevented by immunization of expectant mothers, good hygiene and asepsis during delivery, total eradication of organism is not possible. The cross-sectional study was done on 480 pregnant women after delivery. Data was collected by a questionnaire and analysed using SPSS windows software program. Prenatal immunization rate [complete and partial] was 65/2% and 34/8%, respectively. There was a significant relationship between the vaccination status and age, education of mother, parity and length of time between pregnancy and previous pregnancy. The reasons reported by non immunized mothers [not receiving the two dose vaccine] included complete tetanus vaccination coverage before pregnancy, lack of awareness about the needs for vaccination, improper counseling by persons responsible for antenatal care, e.t.c. Considering the results of the study, it is proposed that a complete history of the pregnant woman recorded at the first antenatal visit should be the basis of counseling and education of the woman and prenatal care staff should be also be fully educated

Influence of placental malaria infection and maternal hypergammaglobulinaemia on materno-foetal transfer of measles and tetanus antibodies in a rural west African population.

Placental malaria infection jeopardizes pregnancy outcome, and its influence may also impair the transplacental transfer of some antibodies. Two hundred and thirteen Gambian mother-baby pairs were studied to determine the influence of placental malaria infection and maternal hypergammaglobulinaemia on transplacental transfer of measles and tetanus antibodies in Gambian population. Placental blood and tissue were collected for placental malaria diagnosis. Cord and maternal sera were tested for total IgG concentration by laser nephelometry and for IgG antibody to tetanus toxoid and measles by ELISA. The prevalence of placental malaria infection was 51.1%. Mothers whose placentae were parasitized had a significantly higher mean total serum IgG (22.0 g/L vs 11.3 g/L, p < 0.001) and measles antibody level (4.02 IU/mL vs 1.21 IU/mL, p < 0.01), but not tetanus antibody, than mothers with non-parasitized placentae. Results of multiple regression analysis showed that placental malaria infection and maternal hypergammaglobulinaemia were associated with the reduction of 72% (95% CI 67.84) and 86% (95% CI 76.91) in transplacental transfer of measles antibody respectively but did not influence the transfer of tetanus antibody. It is concluded that the combined influence of placental malaria infection and maternal hypergammaglobulinaemia is significantly associated with the transfer of impaired measles antibody in this population.

Cobertura de inmunización con antitetánica y antihepatitis B en estudiantes del primer y cuarto curso del Instituto Dr. Andrés Barbero de la Carrera de Enfermería del año 2001

Estudio descriptivo con un universo de 128 estudiantes y una muestra de 86, para analizar la inmunización con antitetánica y antihepatitis en las estudiantes del primero y cuarto curso del Instituto Dr. Andrés Barbero-Carrera de Enfermería. Determina el porcentaje de alumnos inmunizados y las causas de la no inmunización

Contrainmunoelectroforesis: una técnica simple y adecuada para la selección de plasmas con alto título de anticuerpos antitetánicos / Couterelectrophoresis: a simple and suitable test for plasma screening with high antibody antitetanus titer

La elaboración de inmunoglobulina G antitetánica humana requiere partir de una materia prima (plasma) enriquecida en AcAT, la que puede provenir de donantes voluntarios de sangre, inmunizados previamente con toxoide tetánico, o no inmunizados, seleccionada mediante la aplicación de una técnica de screening. Para ello se diseñó un método inmunoquímico la CIEF, capaz de detectar plasmas con niveles de AcAT en el orden de 10 UI/ml. Esta técnica resultó óptima para aplicarla como método de screening debido a ventajas tales como: capacidad de procesar gran número de muestras sin dilución previa, alta reproducibilidad y especificidad, y ser simple de realizar y de bajo costo. Aplicando esta técnica sobre un total de 4.535 muestras de plasma, provenientes de donantes voluntarios no inmunizados analizados de manera randomizada, se pudo establecer que el 9,88 por ciento de las muestras contenía AcAT en el orden de 10 UI/ml. Además se establecieron distintas categorías de proveedores de materia prima teniendo en cuenta el porcentaje de unidades con niveles de AcAT en el orden de 10 UI/ml. Esta categorización permitió establecer un mecanismo de elección de proveedores para la recolección de "plasma antitetánico" en el menor tiempo posible.

Immunogenicity and tolerance of H. influenzae type b, tetanus toxoid conjugate vaccine given concurrently or in combination.

The present prospective, open, controlled, randomised comparative trial was undertaken to evaluate the sero response and side effects of PRP-T Conjugate Vaccine (ACT-HIB) in infants and children aged 2 months and 16-24 months. Fifty four babies aged 2 months formed group A, 56 children aged 16-24 months formed group B. Groups A and B were further subdivided into two sub groups each destined to receive either PRP-T vaccine in association with DPT vaccine at different sites (I) or PRP-T and DPT both vaccines at the same site mixed in the same syringe (II). Group A received 3 doses at 2, 3 and 4 months of age and group B received one dose between 16-24 months. The Geometric mean titres of Anti PRP antibodies observed in primary immunisation schedule (A) and single dose vaccination schedule (B) were comparable and significantly higher to prevaccination titres. A serum anti PRP level of > 1.0 mcg/ml after immunisation is believed to correlate with long term protection. Ninety-six percent of infants in Group A and 98% in Group B achieved titres > 1.0 mcg/ml. The side effects were minimal, local and were comparable between the study and control groups, suggesting that PRP-T vaccine is highly immunogenic and well tolerated in Indian infants and children.

Experience of combined tetravalent diphtheria, tetanus, whole-cell pertussis and hepatitis B vaccine in Thailand.

In 1992, hepatitis B (HB) vaccination of all newborns was officially included in the national expanded program on immunization (EPI), since satisfactory levels of immunity had been attained among the target populations of Chiang Mai and Chon Buri Province during the trial period, 1989 and 1992. In order to facilitate this process and to reduce the administrative costs created by integration of the additional vaccine, the option of combining HB vaccine with the DTP vaccine was investigated. Thus, in 1991 our group performed a clinical study of Smith Kline Beecham Biological's DTP-HB vaccine, administering it to 160 infants of HBsAg negative mothers at the age of 2, 4 and 6 months, respectively. We found the evoked immune responses to be at least equal to, if not higher, than those achieved with the monovalent vaccine. Likewise, any adverse reactions were comparable to those observed after administering either DTP or HB vaccine separately. According to our additional data, we consider HB vaccination at birth, followed by the combined DTP-HB vaccine at the ages of 2, 4, 6 and 18 months, respectively, most advantageous and we would recommend integrating this regimen into the basic immunization service. Thus, the possibility of eradicating hepatitis B infection altogether might eventually be provided.

Tétanos en pediatría: actualización y presentación de casos

El tétanos es una enfermedad infectocontagiosa de gran impacto, no solo para el paciente sino tambien para la comunidad y para los servicios de salud. Por ser inmunoprevenible, su presencia en una región determinada es un reto para estos últimos y es un indicador de la calidad de los mismos. Su erradicación es un propósito que debe cumplirse en los albores del próximo milenio; en los años recientes se ha avanzado en la comprensión de sus aspectos fisiopatológicos y se han refinado las medidas terapéuticas. En este artículo se presenta una actualización suscinta y general de este importante problema de salud pública, especialmente en lo que se refiere a sus aspectos patogénicos y terapéuticos. Al mismo tiempo se presentan los casos de esta enfermedad atendidos durante un período de diez años en un hospital pediátrico de tercer nivel de la ciudad de Medellíin, como una contribución a la comprensión del problema

Programa de inmunización para adultos / Program of immunization for adults

Mediante estudios epidemiológicos realizados por la Dirección General de Epidemiología SSA México, se ha detectado el resurgimiento de enfermedades virales o bacterianas en poblaciones fuera de la edad pediátrica, las cuales considerábamos superadas con la edad adulta, identificándose la necesidad de planterar un esquema de inmunizaciones para el adulto, desafortunadamente por nuestras propias limitantes no es posible llevar a cabo planteamientos más ambiciosos que obviamente originarían una cobertura más amplia en padecimientos susceptibles a prevención por medio de inmunización activa. La sugerencia de un programa básico de inmunización ofrece prevención a los siete padecimientos más frecuentes en nuestro medio (tétanos, difteria, sarampión, rubéola, parotiditis, neumonía neumocócica, hepatitis B), además presenta la ventaja de modificar o ampliar la aplicación de inmunógenos de acuerdo a las necesidades especifícas del individuo a tratar, la obtención de estos inmunógenos es posible ya sea por medio de las autoridades sanitarias o bien por su compra en laboratorios de productos médicos. En el presente trabajo se incluye: información general de cada padecimiento, datos epidemiológicos actualizados, indicaciones de inmunización, tipos de inmunógenos, vía de administración y dosis recomendadas, finalmente se propone en un esquema básico de inmunización para adultos y un formato que puede ser aplicado a la población en general con fines preventivos. Diseño del programa: basado en información bibliográfica y programas establecidos en las Instituciones de Salud. Estrategia: Inmunizaciones específicas a la población adulta en general con el fin de reactivar el programa vacunal efectuado en la etapa pediátrica

Tétano: comprometimento ORL como sintomatologia inicial, relato de caso / Tetanus: initial clinical signs in otorhinolaringoloy, case report

O tétano é uma doença infecciosa, nao contagiosa, causada pelo Clostridium tetani, bacilo gram-positivo, anaeróbio que através de uma fraçao cutâneo-mucosa no hospedeiro se torna um bacilo ativo produtor de duas exotoxinas: tetanolisina e a tetanospasmina, esta última responsável pela sintomatologia. Relata-se um caso de um paciente branco, sexo masculino, 62 anos, pecuarista, que duas semanas após cauterizaçao elétrica de cornetos inferiores sob anestesia local em consultório, apresentou quadro de disfagia, trismo e parotidite bilateral de etiologia tetânica. Esta forma de apresentaçao inicial da patologia é discutida, assim como, a importância de lembrar-se desta doença em indivíduos com maior risco no pré-operatório de qualquer abordagem cirúrgica.