Clostridium tetani

C. tetani is the cause of tetanus, a disease of increased muscular tone.

 

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.

 

Epidemiology

 

 

 

Classification and Characteristics

 

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

 

Virulence Factors

 

Transmission and Infection

 

 

 

Clinical Manifesations

Incubation from several days to several weeks.

 

Lockjaw

 

 

Diagnosis

 

 

Prophylaxis

All accidental injuries in which the skin is broken- including lacerations, abrasions, puncture wounds and burns - should be considered for Tetanus prophylaxis. Although some wounds are particularly ‘tetanus prone’ (i.e. those contaminated with dirt or fecal matter), tetanus may occur following trivial or apparently ‘clean’ wounds. For this reason, many physicians advocate treating all wounds as equal regardless of how dirty they appear.


A primary course of three immunizations with Tetanus toxoid (typically administered as Tetanus/Diphtheria - Td) are required to provide assurance of immunity for most patients. Booster immunizations are then required every 10 years to maintain active immunity. Passive immunization with Tetanus Immune Globulin (TIG) may be indicated for patients who have never received a full primary series of three Tetanus Immunizations.


The following are the generally accepted guidelines for Tetanus Prophylaxis.


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***


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.


* Consider more frequent immunization in the elderly.


** These patients should complete their primary series through their family doctor.


***Some would advocate the use of TIG in this patient if the wound were grossly contaminated

with soil or feces.



 

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