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

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