Reference no: EM132612689

On August 15, 1993 a 57-year-old man with non insulin-dependent diabetes sought treatment at an emergency diabetes sought treatment at an emergency for a puncture wound to his foot that occurred when he stepped on a rusty nail earlier that day. Treatment in the emergency department included wound cleaning and administration of the appropriate toxoid (0.5cc).

On August 19, the man returned to the emergency department, reporting onset on August 18 of severe pain in the affected foot, fever, chills and vomiting. He was hospitalized and treated for cellulitis. On August 20, he complained stiffness in his neck and had difficulty chewing and swallowing. Examination noted lockjaw. He subsequently had a cardiopulmonary arrest, was resuscited and placed on mechanical ventilation. He remained on mechanical ventilation and died following a cardiac arrest on September 16.

a) Name the toxin responsible.

b) List the toxin properties.

c) Why did the administration of a toxoid on first presentation not prevent the disease? Identify the reason and explain clearly.