Tetanus
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pathogen
- Clostridium tetani
- gram positive terminal round shape (drumstick like) bacilli
- spore-forming
- drumstick looking is from spore
- means long term sustainability in soil
- strict anaerobe
- incubation 3-21 days (average 10 days)
- AB toxin
- blockade of releasing GABA in synapus
- convulsive contraction of voluntary muscles
- toxin binding is irreversible
epidmiology
clinical picture
- opisthotonus
- muscle spasm in opisthotonus is very painful
- trismus (lockjaw)
- difficulty opening mouth
- respiratory difficulties
- cardiovascular instability
- sympathetic nervous system
- drastic rise and fall of blood pressure
- localized (not generalized) tetanus also may occur
- increased muscle tones lasts more than 2 months
- muscle spasm emerges after increased muscle tones and lasts > 1 month
- needs long term ventilator support
diagnosis
- culture
- difficult and tricky
- PCR - toxin gene
treatment
- tetanus immunoglobulin 500 - 1000 IU intramuscular
- only once is needed, to neutralize residual toxins
- penicillin or metronidazole
- spasm management
- diazepam, midazolam, paraldehyde
- sedatives
- muscle relaxants
- tracheostomy and respiratory support
- just to wait washing out of toxin effects
- death occurs due to:
- secondary infection by long-term ventilator support
- overwhelming autonomic instability, i.e., cardiovascular death
prevention
- wound debridement is crucial
- C. tetani is anaerobe which grows in closed wound area
