Question

For tetanus, what is:

The causative agent

The tissue that is affected

How it is transmitted

Common places it may be encountered

Treatment options

Answer 1

The causative organism of tetanus is Clostridium tetani. It is a gram-positive, anaerobic, rod-shaped bacterium that is seen widely in the soil as spores. The spores are present in soil, dust, and animal waste etc. It can survive in any medium for many years and are resistant to extremes of temperature. The bacteria enter the body through breaks in the skin like punctures or cuts.

The toxins produced by the Clostridium tetani binds to the CNS and interferes with the release of the neurotransmitter and block the inhibitory impulses. This will lead to uncontrollable muscle contraction and spasm. It can be presented clinically as local (uncommon), cephalic (rare) or generalized (most common). In generalized tetanus, the pattern of affecting muscles is descending pattern. It begins with lockjaw, difficulty in swallowing, neck stiffness, the rigidity of abdominal muscles. The muscle spasm continues for 3-4 weeks and recovery may take months.

Tetanus cannot be transmitted from person to person. It is transmitted by tetanus-prone injuries like:

Surgery, Frostbite, burns, Crush wound, Childbirth, Abscesses, IV drug users, Foreign bodies,

People who are not immunized against tetanus or failed to take adequate active booster doses of vaccine may be affected.

Treatment

Tetanus is considered as a medical emergency needs immediate hospitalization, emergency treatment with human tetanus immune globulin (TIG), drugs to control muscle spasm, proper wound care, antibiotics, and a booster dose of tetanus toxoid. Immune Globulin Intravenous (IGIV) can be used in the absence of tetanus immune globulin. Recommend dose of tetanus immune globulin (TIG) is 500 international units (IU) administered intramuscularly.

Supportive management:

Maintain patent airway (endotracheal intubation, tracheostomy and mechanically assisted respiration can be used)

Sedation

Muscle relaxants

control autonomic nervous system instability

Active immunization

Patients with HIV infection or immunocompromised with contaminated wounds should receive TIG, irrespective of the of tetanus immunizations.

Antibiotics are used when signs of infection are detected.