TETANUS
 

Etiology:

  1. Clostridium tetani produces tetanospasmin.
     
  2. G(+) rod, anaerobe, lives as spore in contaminated soil, decubiti ulcer, intestine (has been reported after intestinal operation).
     
  3. The exotoxin travels along the axon and at neuromuscular junction causes weakness while at CNS inhibits GABA and causes stimulation.

S & S / DX:

  1. Trismus, sardonic smile, opisthotonus,
     
  2. Labile vital signs, intact mental status
     
  3. Spasm can cause rhabdomyolysis or respiratory failure 2ry to spasm.

Differential:

  1. Dystonia
     
  2. Strychnine poisoning
     
  3. Hypocalcemia

Treatment:

  1. Treatment of acute tetanus:
    • Intubate prn
       
    • Benzodiazepines
       
    • Labetalol for autonomic instability.
       
    • Antitoxin TIG 5000-10000 U IM.  This will neutralize circulating but not already bound toxin.
       
    • Active immunization with Td (at different site from TIG), repeated 6 weeks and 6 months later.
       
    • Antbx: PCN or Metronidazole
       
  2. Prophylaxis of tetani:
    1. Td must be given to every one after 5-10 years of last immunization.
       
    2. If tetanus immunization is unknown one should give TIG 250 U IM and Td 0.5mg IM. The latter is given again after 6 wks. and 6 mo.
       
    3. Td and TIG is safe in pregnancy.  No contraindication to administer Td to immunocompromised pt, but must be instructed to check the levels.
       
    4. Many healthcare providers think that administering Td in ED after injury  prevents patient from tetanus from that injury.  In reality, it only protects them  from tetanus in the future.  To prevent the disease from current injury, TIG should also be administered if there is a concern about immunization.

 

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