Clostridium tetani

Tetanus is infection of the nervous system with the potentially deadly

bacteria Clostridium tetani (C. tetani)

Tetanus

• Tetanus infection can be acquired through surgery, drug abuse, bites, burns, body piercing, puncture wounds, and ear infections.

• The organism can enter through any break in the integrity of the body.

• Result of widespread vaccination, tetanus is relatively rare in the United States.

• 325 cases of tetanus reported between 1991 and 1997• Most cases of tetanus in the United States occur in those

who have not been properly vaccinated against the disease.

• Spores of the bacteria C. tetani live in the soil and are found around the world. In the spore form, C. tetani may remain inactive in the soil, but it can remain infectious for more than 40 years.

• This poison blocks nerve signals from the spinal cord to the muscles, causing severe muscle spasms.

• The spasms can be so powerful that they tear the muscles or cause fractures of the spine.

• The time between infection and the first sign of symptoms is typically 7 to 21 days.

Symptoms

• Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affect the chest, neck, back, and abdominal muscles.

• Sometimes the spasms affect muscles that help with breathing, which can lead to breathing problems.

• Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups.

Exam and Test

• Your doctor will perform a physical exam and ask questions about your medical history. No specific lab test is available to determine the diagnosis of tetanus.

Staphylococcal or Streptococcal bacteriumGram(+)

• A 38 year old man came to office with a complaint of jaw discomfort and inability to open his mouth fully for 3 days. He had struck his right shin with a hammer 10 days earlier while fixing his lawn mower. The hammer penetrated deeply through the skin and although the wound hurt and bled he did not seek medical attention.

• Seven days after the accident he started noticing jaw discomfort and the inability to open his mouth completely. On the 3rd day his wife urged him to go to the hospital.

• The patient had no history of medical or surgical procedures, had no known allergies, and was not taking medications.

• He received his primary tetanus series in childhood, and his last booster was more than 10 years ago.

• His blood pressure was 125/70 and his temperature was 98.5F.

• When examined he was unable to open his jaw wider than 1 inch.

• He had a 2.5X1-cm puncture wound just lateral to the mid aspect of his right leg.

• His leg was draped in sterile fashion.• Hydrogen peroxide was applied to the area and

3ml of 1% lidocaine was injected around the lesion.

• The wound was cut with No.15 scalpel and a wick was inserted for drainage, and the wound was allowed to drain and to close by secondary intention.

• The patient was counseled about the diagnosis of tetanus with secondary wound infection and the need for hospital admission.

• The patient refused admission.

• The patient requested to be treated as an outpatient with admission only if symptoms worsened.

• Two does of human antitetanus immunoglobulin was given into the upper outer quadrant of each buttock.

• He was then given 0.5mg tetanus booster into left deltoid muscle.

• Metronidazole 500 mg orally four times per day for 10 days.

• During a follow up visit the next day he was totally asymptomatic. His wound stopped draining but his temperature was now 99.5F.

• The wick was removed and once again wound was clean with normal saline and left open to heal by secondary intention.

• Directed to still take his meds he was also giving Ciprofloxacin 250mg orally two times a day was added for any secondary infection of the wound from streptococcus organisms.

• He was instructed to return for a follow up in 4 days.

• The patient returned and he was asymptomatic and the wound was clean and dry.

• Patient was sent home and told to finish his 10 day supply of meds.

• C.Tetani releases a toxin that interferes with the neurotransmitters.

• Antibiotic penicillin was giving every 4 hours for 10 days. Could have increased the spams cause by tetanus toxin and should not be considered first choice.

• There is no laboratory finding characteristic of tetanus.

• The diagnosis is entirely clinical and does not depend on bateriologic confirmation.