TETANUS

First described by Hippocrates
Etiology discovered in 1884 by Carle and Rattone
Passive immunization used for treatment and prophylaxis during World War I
Tetanus toxoid first widely used during World War II
Clostridium tetani
Anaerobic gram-positive, spore-forming bacteria
Spores found in soil, animal feces; may persist for months to years
Multiple toxins produced with growth of bacteria
Pathogenesis
Anaerobic conditions allow germination of spores and production of toxins
Toxin binds in central nervous system
Interferes with neurotransmitter release to block inhibitor impulses
Leads to unopposed muscle contraction and spasm
Clinical features
Incubation period; 8 days (range, 3-21 days)
Generalized tetanus: descending symptoms of trismus (lockjaw), difficulty swallowing, muscle rigidity, spasms
Spasms continue for 3-4 weeks; complete recovery may take months
Fatality rate ~90% w/o treatment
~30% w/ treatment
Neonatal tetanus
Generalized tetanus in newborn infant
Infant born without protective passive immunity
Tetanus complication
Laryngospasm
Fractures
Hypertension
Nosocomial infections
Pulmonary embolism
Aspiration pneumonia
Death
Tetanus toxoid
Formalin-inactivated tetanus toxin
Schedule Three or four doses + booster Booster every 10 years
Efficacy Approximately 100%
Duration Approximately 10 years
Should be administered with diphtheria toxoid as DTaP, DT, Td, or Tdap