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Unformatted text preview: Tetanus
By: Omar Ramirez What is Tetanus?
Tetanus is an illness characterized by an acute
onset of hypertonia, painful muscular
contractions (usually of the muscles of the jaw
and neck), and generalized muscle spasms
without other apparent medical causes.
Despite widespread immunization of infants and
children in the United States since the 1940s,
tetanus still occurs in the United States.
Tetanus has declined significantly since the mid1940’s due to increased use of Tetanus
Overall, mortality is approximately 45%. The
mortality rate in the United States is 6% for those
who previously had received 1-2 doses of tetanus
toxoid and 15% for unvaccinated individuals.
Mortality rate is highest for those older than 60
In the United States, African Americans from the
rural south have a greater risk of tetanus than
individuals of other races. Statistics (cont.)
Men are better protected from Tetanus
because of the higher vaccinations
received during military service or other
Incidence of tetanus increases with
advancing age. 54% of the patients with
tetanus in the United States are older than
59 years old. How it forms…
The nonencapsulated spore-forming bacterium
Clostridium tetani causes Tetanus.
Spores that gain entry can survive for months to
years. Under anaerobic conditions, these spores
geminate and produce tetanospasmin.
Tetanospasmin that is released by the maturing
bacilli is distributed via the lymphatic and vascular
circulations to the end plates of all nerves.
Tetanospasmin then enters the nervous system
peripherally at the myoneural junction and is
transported centripetally into neurons of the
central nervous system (CNS). How it forms… (cont.)
These neurons become unable of
neurotransmitter release. The neurons, which
release gamma-aminobutyric acid (GABA) and
glycine, the major inhibitory neurotransmitters, are
sensitive to tetanospasmin, leading to failure of
inhibition of motor reflex responses to sensory
stimulation. This results in generalized
contractions of the agonist and antagonist
musculature characteristic of a tetanic spasm. The
shortest peripheral nerves are the first to deliver
the toxin to the CNS, which leads to the early
symptoms of facial distortion and back and neck
In 77% of patients with tetanus in the United States,
tetanus occurred after an acute injury, including puncture
wounds (49%), lacerations (22%), abrasions (12%), and
animal bites (2.6%).
Stepping on a nail accounted for 39% of the puncture
Tetanus can occur in burn victims, patients receiving
intramuscular injections, and with frostbite, dental infections
(such as periodontal abscesses), penetrating eye injuries,
and umbilical stump infections.
Tetanus has been reported after tooth extractions, root
canal therapy, and intraoral soft tissue trauma. Causes (cont.)
Neonatal tetanus is caused by:
Unvaccinated mothers, home delivery, and
unhygienic cutting of the umbilical cord.
History of neonatal tetanus in a previous
child is a risk factor for subsequent
neonatal tetanus. The Spatula Test
This simple test involves touching the
oropharynx with a spatula or tongue blade.
Usually, this test causes a gag reflex with
the patient, and the patient tries to expel
the spatula. (This means they have tested
In tetanus, patients develop a reflex
spasm of the masseters and bite the
spatula (a positive test). Medications Used for Treatment
Diazepam (Valium) -- Most commonly used drug
for treatment of tetanic spasms and tetanic
seizures. Depresses all levels of CNS, including
limbic and reticular formation, possibly by
increasing activity of GABA, a major inhibitory
Tetanus immune globulins (Hyper-Tet) -- Used
to induce active immunity against tetanus in
selected patients. Medications (cont.)
Metronidazole (Flagyl) -- Active against various
anaerobic bacteria and protozoa. Appears to be
absorbed into cells, and intermediateabsorbed
metabolized compounds that are formed bind
DNA and inhibit protein synthesis, causing cell
Penicillin G (Pfizerpen) -- Interferes with
synthesis of cell wall mucopeptide during active
multiplication, resulting in bactericidal activity
against susceptible microorganisms.
Long bone fractures
Glenohumeral and temporomandibular
Adverse effects of autonomic instability,
such as cardiac dysrhythmias and
Coma, neuropathies, and psychological
Prognosis is dependent on incubation period, time from
spore inoculation to first symptom, and time from first
symptom to first tetanic spasm.
In general, shorter intervals indicate more severe tetanus
and a poorer prognosis.
Patients usually survive tetanus and return to their
predisease state of health.
Recovery is slow and usually occurs over 2-4 months.
Clinical tetanus does not produce a state of immunity;
therefore, patients who survive the disease require
active immunization with tetanus toxoid to prevent a
recurrence. Works Cited
www.emedicine.com – Tetanus article by
Daniel J. Dire, MD, FACEP, FAAEM
www.emedicinehealth.com – Tetanus
article by Robert N Bilkovski, MD ...
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- Fall '11