Clostridium tetani

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Introduction

Tetanus is an illness resulting from the systemic effects of the exotoxin, tetanospasmin, produced locally in a wound infected by Clostridium tetani. The incubation period is typically ~ two weeks. The disease is characterized by generalized tetanic muscular contractions often including the laryngeal and respiratory musculature. Mortality approaches 50 %. It is common in some third world countries although relatively rare in areas where the general population is immunized.

 

 

 

The Case of...

A brief case (1-2 sentences) with 2-3 questions (no answers) to prompt thinking by students.

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Epidemiology

 

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Classification and Characteristics

C. tetani is a gram-positive obligate anaerobic bacterium.

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Transmission and Infection

For 50% of people, the source of tetanus is never identified.

 

A picogram of tetanus toxoid is enough to kill someone.

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Clinical Manifesations

Incubation from several days to several weeks.

 

Lockjaw

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Diagnosis

 

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Prophylaxis

All accidental injuries in which the skin is broken, including burns, should be considered for Tetanus prophylaxis.

 

Immunizations are normally given as a primary course, with three immunizations of Tetanus toxoid, followed by boosters of immunization every 10 years. Passive immunization with Tetanus Immune Globulin (TIG) may given for patients who have not received a full primary series.

 

 


All Wounds



Immunization History


Td 0.5 ml IM


TIG 250 IU IM


Fully Immunized - < 10 years since booster


NO


NO


Fully Immunized - > 10 years since booster


YES


NO, or possibly if wound is grossly contaminated


Incomplete Series - ( < 3 injections)**


YES


YES


A patient’s recollection of immune status may be unreliable; If uncertain it is generally best to err on the side of caution and immunize.


 

 

Treatment

Touch and stimulation send people into spasms; feed via NG and take blood from a line so that they are not touched.

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Resources and References

Public Health Agency of Canada tetanus information

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