Tetanus Presentation

Editor's Notes

• #4: The bacterium was first isolated in 1899 by Kitasato while he was working with R. Koch in Germany. Kitasato also found the toxin responsible for tetanus and developed the first protective vaccine against the disease
• #15: Tetanospasmin binds to motor nerves that control muscles, enters the axons (filaments that extend from nerve cells), and travels in the axon until it reaches the body of the motor nerve in the spinal cord or brainstem (a process termed retrograde intraneuronal transport). Tetanospasmin that is released by the maturing bacilli is distributed via the lymphatic and vascular circulations to the end plates of all nerves.
• #18: Usually a puncture wound or laceration, nails Dead tissue Extremely potent neurotoxin Only creates small immune response so not enough antibodies for immunity and not usually any inflamation of the wound
• #48: DIFFERENTIAL DIAGNOSIS — The diagnosis of tetanus is usually obvious and can generally be made based upon typical clinical findings outlined above. Tetanus should especially be suspected when there is a history of an antecedent tetanus prone injury and a history of inadequate immunization for tetanus. However, tetanus can sometimes be confused with the following mimics: Drug-induced dystonias such as those due to phenothiazines — Drug-induced dystonias often produce pronounced deviation of the eyes, writhing movements of the head and neck and an absence of tonic muscular contraction between spasms. By contrast, tetanus does not produce eye deviations and the muscles are characteristic tonically contracted between spasms. Finally, administration of an anticholinergic agent such as benztropine mesylate will usually immediately reverse the spasms seen in drug-induced dystonias. Such therapy has no effect on patients with tetanus. Trismus due to dental infection — Dental infections may produce striking trismus that may rarely be confused with cephalic forms of tetanus. However, the presence of an obvious dental abscess and the lack of progression or superimposed spasms usually make the distinction between the two diseases apparent after initial evaluation and/or a period of observation. (See "Deep neck space infections" and "Complications, diagnosis, and treatment of odontogenic infections".) Strychnine poisoning due to ingestion of rat poison — Accidental or intentional strychnine poisoning may produce a clinical syndrome similar to tetanus. Supportive care for both conditions is critical; thus, the initial treatment of both conditions is identical. Assays of blood, urine, and tissue for strychnine can be performed in Tetanus special reference laboratories. Such tests should be obtained when there is any suspicion of accidental or intentional poisoning or when a typical history of an antecedent injury or infection for tetanus is lacking or the patient has been adequately immunized for tetanus. (See "Strychnine poisoning".) Malignant neuroleptic syndrome — Patients with malignant neuroleptic syndrome can present with striking symptoms of autonomic instability and muscular rigidity. However the presence of fever, altered mental status, and recent receipt of an agent with a propensity to cause this complication usually makes the distinction from tetanus relatively easy. (See "Neuroleptic malignant syndrome".) Stiff-person syndrome — Stiff-person syndrome (SPS) is a rare neurologic disorder characterized by severe muscle rigidity. Spasms of the trunk and limbs may be precipitated by voluntary movements, or auditory, tactile or emotional stimulation, all of which can also occur in tetanus. The absence of trismus or facial spasms and rapid response to diazepam distinguish SPS from true tetanic spasms [24]. In addition, SPS is associated with autoantibodies against glutamic acid decarboxylase. (See "Stiff-person syndrome".)
• #53: Penicillin G : I nterferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms. GABA antagonist effect of penicillins and third-generation cephalosporins,which may lead to CNS excitability. Metronidazole : Active against various anaerobic bacteria and protozoa. Appears to be absorbed into cells, and intermediate-metabolized compounds that are formed bind DNA and inhibit protein synthesis, causing cell death.
• #69: Can be achieved by active immunization by tetanus toxoid (5 doses – 0 day, 1 month, 6 month, 1 year, 10 year).