Clostridium tetani
last authored:
last reviewed:
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.
Epidemiology
Classification and Characteristics
C. tetani is a gram-positive obligate anaerobic bacterium.
Transmission and Infection
For 50% of people, the source of tetanus is never identified.
A picogram of tetanus toxoid is enough to kill someone.
Clinical Manifesations
Incubation from several days to several weeks.
Lockjaw
Diagnosis
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.
Resources and References
Public Health Agency of Canada tetanus information
 |