Caused by Clostridium tetani, a gram-positive anaerobic organism found in areas with warm climates that are rich in inorganic soil.
Life threatening, but preventable disease caused by the toxin of Clostridium tetani.
Clostridium tetani are spore forming, gram-positive bacillus found in high concentrations in soil and animal excrement.
Spores are ubiquitous, highly resistant to destruction and can survive on almost any surface for long periods of time.
Spores enter the body form any break in the skin and become vegetative and produce the neurotoxin tetanospasmin.
Spores require low oxygen tension, as occurs in necrotic tissue and poorly vascularized areas, to become vegetative.
Approximately 50 deaths per year in the U.S.
Between 2001-2008 233 cases were reported in the case fatality rate was 13.2%, and 31.3% among persons older than 65 years.
During 2001-2008 average annual incidence 0.10 cases per 1 million population and 0.23 among persons 65 years or older.
Reported cases in the United States have declined greater than 95% and deaths have declined greatly 99% since 1947.
Approximately 1 million cases of tetanus annually worldwide.
More than a half a million children in developing countries die of tetanus every year.
Incidence of neonatal tetanus worldwide is approximately 6 per 1000 live births.
Death rate for all cases about 50%, with neonatal mortality above 85%.
In the U.S. the population primarily at risk are the young, the elderly, intravenous drug abusers and immigrants.
In the United States, two times more common in Hispanics, 15% of patients have diabetes and approximately 15% are injection drug users.
Up to date tetanus toxoid vaccinations should be insured, especially among individuals greater than 65 years of age, persons with diabetes and intravenous drug abusers.
No diagnostic laboratory test.
Diagnosis based on clinical judgement.
Patients present with muscle rigidity, with early involvement of the masseter and facial muscles.
Patients may have laryngospasm causing difficulty swallowing.
Trismus and spasms of the deglutination muscles may result indifficulty with swallowing and verbal expression.
Patients commonly have autonomic instability and hyperadrenergic state.
A case consists on the acute onset of hypertonia and/or painful muscular contractions, usually of the jaw and neck, and generalized muscular spasms without other apparent cause.
In cephalic tetanus, in addition to lockjaw, weakness of at least one other facial muscle occurs.
The sardonic smile, risus sardonicus, is a characteristic feature that results from facial muscle spasms.
Muscle spasms are progressive and may include arching of the back known as opisthotonus.
Muscle spasms may be so intense that bones may break and joints dislocate.
Severe spasms of the vocal cords or muscles may result in death.
In localized tetanus, muscle spasms occur at the site of the injury, and can progress to generalized tetanus.
Neonatal tetanus is identical to generalized tetanus.
It’s essential to clean the wound to prevent the growth of tetanus spores.
All dirt, foreign objects and dead tissue from the wound must be removed.
Antibiotics for tetanus infection should be given.
Tetanus anti-toxin-such as tetanus immune globulin can be administered, but the anti-toxin neutralizes only toxin that has not yet been bound to nerve tissue.
All patients should receive tetanus vaccine.
Magnesium sulfate and certain beta blockers, might be used to regulate involuntary muscle activity, such as your heartbeat and breathing.