to TIG or not to TIG (tetanus immune globulin)

[firstmate]

My unvax'd 7yo child was bitten in face by dog in back yard (city, not farm). The wounds bled extensively. There was one laceration, and it was irrigated in ER before sutures. My fam doc is pushing for TIG, the shot that contains human antibodies to tetanus and provides protection for ~23 days (not the vaccine). 72-hour window for receiving TIG is closing in ten hours.

Even after reading threads on rarity of tetanus poisoning in kids, I'm still somewhat undecided about TIG. Can anyone supply links to medical literature that spells out blood flow as defense mechanism against tetanus infection?

[luminesce]

My first thought was, 'Are dog bites more likely to impart tetanus than some other kind of wound?'

Remarkably, I found this:
http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0

Although the risk of tetanus must be taken into consideration in all wounds, it is of no greater significance in dog bites. So ultimately, the question is just about the wound itself... I would imagine it is deep with punctures from teeth and contaminated due to the nature of the injury. These risk factors would worry me. That said, it did bleed well and receive proper wound care. This would be a tough one for me. I don't know -- I'd probably seriously consider TIG but then likely decline because of the risk incurred with receiving a blood product.

I'd definitely be worried about bacterial infections and/or rabies though.

Let us know what you decide. The risk of tetanus always nags me a little. My son currently has a severely bruised toenail and it even crossed my mind with that.

[firstmate]

Thanks for the reference. I feel better seeing it in writing:

"Although the risk of tetanus must be taken into consideration in all wounds, it is of no greater significance in dog bites."

I agree that it comes down to the wound itself. Actually, there were no puncture wounds; just surface scratches and one laceration. The length of the laceration began above the lip and ended at the base of the lip. Regarding depth, it didn't go all the way through to the inside of the lip. When irrigated, the wound opened up in a V shape making for good access, I think. The ER doc felt confident in not prescribing antibiotics. The dog is up-to-date on rabies vax so no worries there.

Still would like to see references to bleeding defense mechanism for tetanus in medical literature. No doctor has ever told me this!

[firstmate]

We decided to give the TIG. I had a slight concern that it was medically necessary, and my family doc was unsupportive of not doing so. From all she said to me, I wasn't confident that she wouldn't take legal action. Much to grieve there.

BTW, it took many, many phone calls to find a hospital pharmacy with the TIG wthat was preservative/mercury-free. Plus it cost $307.

Still would love more info on natural defense mechanisms against tetanus, like blood supply.

[Otto]

Originally Posted by firstmate

Still would like to see references to bleeding defense mechanism for tetanus in medical literature. No doctor has ever told me this!

C. tetani is an obligate anaerobe, which is why puncture wounds are particularly risky, since they can allow the spores to lodge deep and also provide a localized region of necrotic tissue to grow in. Bleeding helps to wash out wounds and temporarily provides an oxygenated environment (which can't hurt, although the pathogen has defenses). Some of the folk wisdom may also stem from the fact that minor, non-tetanus-prone, wounds can bleed like crazy out the capillaries, making blood a routine proxy for shallow injury.

[newmum35]

Originally Posted by firstmate

BTW, it took many, many phone calls to find a hospital pharmacy with the TIG wthat was preservative/mercury-free. Plus it cost $307.

Can you please go into detail about which brand you used, and which brands have the mercury. This would be SOOOOO Good to know in the event we are ever faced with the same situation. The high mercury was one of my worries and I thought all the tig had it.