Clostridium tetani - Revision history

Aidan: /* Generalized Tetanus */

2026-01-06T22:33:48Z

Generalized Tetanus

← Older revision		Revision as of 22:33, 6 January 2026
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	*Disease is characterized by tonic spasms		*Disease is characterized by tonic spasms
			*Classically descending rigid paralysis
	*Classically starts with muscles of the jaw, causing trismus, lockjaw, and risus sardonicus, and sometimes abdominal rigidity		*Classically starts with muscles of the jaw, causing trismus, lockjaw, and risus sardonicus, and sometimes abdominal rigidity
	*Progresses to generalized spasm, which involves decorticate posturing with opisthotonus, arm flexion, and leg extension		*Progresses to generalized spasm, which involves decorticate posturing with opisthotonus, arm flexion, and leg extension

Aidan: /* Diagnosis */

2020-10-15T13:49:00Z

Diagnosis

← Older revision		Revision as of 13:49, 15 October 2020
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	*Acquired either by direct inoculation or via umbilical stump in neonates		*Acquired either by direct inoculation or via umbilical stump in neonates

	=== Microbiology ===		===Microbiology===

	*Thin [[Stain::Gram-positive]] [[Shape::bacillus]], with terminal spore (drumstick appearance), with numerous spores		*Thin [[Stain::Gram-positive]] [[Shape::bacillus]], with terminal spore (drumstick appearance), with numerous spores
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	==Diagnosis==		==Diagnosis==

			*Almost entirely a clinical diagnosis, due to low yield of organism and toxin from clinical samples
	*Baseline IgG serology; if positive, then they are tetanus-immune and it rules out the diagnosis		*Baseline IgG serology; if positive, then they are tetanus-immune and it rules out the diagnosis
	*Send wound swab or tissue for culture or PCR		*Send wound swab or tissue for culture or PCR

Aidan at 13:47, 15 October 2020

2020-10-15T13:47:21Z

← Older revision		Revision as of 13:47, 15 October 2020
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	*Ubiquitous soil organism		*Ubiquitous soil organism
	*Acquired either by direct inoculation or via umbilical stump in neonates		*Acquired either by direct inoculation or via umbilical stump in neonates

			=== Microbiology ===

			*Thin [[Stain::Gram-positive]] [[Shape::bacillus]], with terminal spore (drumstick appearance), with numerous spores

	===Pathophysiology===		===Pathophysiology===

Aidan at 00:54, 15 October 2020

2020-10-15T00:54:39Z

← Older revision		Revision as of 00:54, 15 October 2020
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	*The toxin, tetanospasmin, is a zinc-dependent matrix metalloproteinase that blocks inhibitory interneurons in the spinal cord and autonomic nervous system		*The toxin, tetanospasmin, is a zinc-dependent matrix metalloproteinase that blocks inhibitory interneurons in the spinal cord and autonomic nervous system

	=== Epidemiology ===		===Epidemiology===

	* Rare in developed countries (0.1 to 0.2 cases per million people in the US)		*Rare in developed countries (0.1 to 0.2 cases per million people in the US)
	* Cases and deaths have decreased substantially after introduction of vaccination		*Cases and deaths have decreased substantially after introduction of vaccination

	==Clinical Manifestations==		==Clinical Manifestations==

	*Incubation period of [[Usual incubation period::3 to 21 days]], which is followed by a period of onset to the first generalized spasm		*Incubation period of [[Usual incubation period::3 to 21 days]], which is followed by a period of onset to the first generalized spasm
			**Shorter incubation period and period of onset are both associated with poorer prognosis

	=== Generalized Tetanus ===		===Generalized Tetanus===

	*Disease is characterized by tonic spasms		*Disease is characterized by tonic spasms
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	*Disease progresses over two weeks, with complete recovery taking another month		*Disease progresses over two weeks, with complete recovery taking another month

	=== Localized Tetanus ===		===Localized Tetanus===

	* Rigidity of muscles near the site of inoculation		*Rigidity of muscles near the site of inoculation
	* May be mild and often resolves spontaneously over time		*May be mild and often resolves spontaneously over time
	* May progress to generalized tetanus		*May progress to generalized tetanus

	=== Cephalic Tetanus ===		===Cephalic Tetanus===

	* Localized tetanus involving the cranial nerves following a head injury		*Localized tetanus involving the cranial nerves following a head injury

	=== Neonatal Tetanus ===		===Neonatal Tetanus===

	* Caused by infection of the umbilical stump, due to contamination in the context of unimmunized mothers		*Caused by infection of the umbilical stump, due to contamination in the context of unimmunized mothers
	* Presents with generalized weakness and failure to nurse, followed eventually by rigidity and spasms		*Presents with generalized weakness and failure to nurse, followed eventually by rigidity and spasms
	* Very high mortality (90%)		*Very high mortality (90%)

	===Prognosis and Complications===		===Prognosis and Complications===

Aidan at 00:54, 15 October 2020

2020-10-15T00:54:11Z

← Older revision		Revision as of 00:54, 15 October 2020
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	===Pathophysiology===		===Pathophysiology===

	*~~Toxin~~ blocks inhibitory interneurons in the spinal cord and autonomic nervous system		*The toxin, tetanospasmin, is a zinc-dependent matrix metalloproteinase that blocks inhibitory interneurons in the spinal cord and autonomic nervous system

			=== Epidemiology ===

			* Rare in developed countries (0.1 to 0.2 cases per million people in the US)
			* Cases and deaths have decreased substantially after introduction of vaccination

	==Clinical Manifestations==		==Clinical Manifestations==

	*Incubation period of [[Usual incubation period::3 to 21 days]]		*Incubation period of [[Usual incubation period::3 to 21 days]], which is followed by a period of onset to the first generalized spasm

	*Followed by generalized tetanus, with tetanic spasms with even minimal external stimulus
			=== Generalized Tetanus ===
	*Lockjaw, risus sardonicus, opisthotonus, abdominal rigidity, and eventually apnea

			*Disease is characterized by tonic spasms
			*Classically starts with muscles of the jaw, causing trismus, lockjaw, and risus sardonicus, and sometimes abdominal rigidity
			*Progresses to generalized spasm, which involves decorticate posturing with opisthotonus, arm flexion, and leg extension
			**Spasms may be triggered by sensory stimuli
			**May cause airway obstruction, and may involve diaphragm, both of which can be fatal
			*Disease progresses over two weeks, with complete recovery taking another month

			=== Localized Tetanus ===

			* Rigidity of muscles near the site of inoculation
			* May be mild and often resolves spontaneously over time
			* May progress to generalized tetanus

			=== Cephalic Tetanus ===

			* Localized tetanus involving the cranial nerves following a head injury

			=== Neonatal Tetanus ===

			* Caused by infection of the umbilical stump, due to contamination in the context of unimmunized mothers
			* Presents with generalized weakness and failure to nurse, followed eventually by rigidity and spasms
			* Very high mortality (90%)

	===Prognosis and Complications===		===Prognosis and Complications===
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	*Wound care with debridement as indicated, though it does not alter the course of the disease		*Wound care with debridement as indicated, though it does not alter the course of the disease

	== Prevention ==		==Prevention==

	=== Vaccination ===		===Vaccination===

	* The tetanus toxoid vaccine is part of the routine childhood immunization		*The tetanus toxoid vaccine is part of the routine childhood immunization

	=== Postexposure Prophylaxis ===		===Postexposure Prophylaxis===

	* Postexposure prophylaxis involves either tetanus vaccination, tetanus immunoglobulin (TIg), or both		*Postexposure prophylaxis involves either tetanus vaccination, tetanus immunoglobulin (TIg), or both

	{\| class="wikitable"		{\| class="wikitable"
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	\|}		\|}
	{{DISPLAYTITLE:''Clostridium tetani''}}		{{DISPLAYTITLE:''Clostridium tetani''}}
	[[Category:Infectious diseases]]
	[[Category:Gram-positive bacilli]]		[[Category:Gram-positive bacilli]]

Aidan at 22:11, 20 September 2020

2020-09-20T22:11:37Z

@@ Line 39: / Line 39: @@
 *Wound care with debridement as indicated, though it does not alter the course of the disease
 {{DISPLAYTITLE:''Clostridium tetani''}}
 [[Category:Infectious diseases]]

Aidan: /* Management */

2020-09-15T14:32:34Z

Management

← Older revision		Revision as of 14:32, 15 September 2020
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	== Background ==		==Background==

	* Ubiquitous soil organism		*Ubiquitous soil organism
	* Acquired either by direct inoculation or via umbilical stump in neonates		*Acquired either by direct inoculation or via umbilical stump in neonates

	=== Pathophysiology ===		===Pathophysiology===

	* Toxin blocks inhibitory interneurons in the spinal cord and autonomic nervous system		*Toxin blocks inhibitory interneurons in the spinal cord and autonomic nervous system

	== Clinical Manifestations ==		==Clinical Manifestations==

	* Incubation period of [[Usual incubation period::3 to 21 days]]		*Incubation period of [[Usual incubation period::3 to 21 days]]
	* Followed by generalized tetanus, with tetanic spasms with even minimal external stimulus		*Followed by generalized tetanus, with tetanic spasms with even minimal external stimulus
	* Lockjaw, risus sardonicus, opisthotonus, abdominal rigidity, and eventually apnea		*Lockjaw, risus sardonicus, opisthotonus, abdominal rigidity, and eventually apnea

	=== Prognosis and Complications ===		===Prognosis and Complications===

	* 30% mortality		*30% mortality
	* Can cause bony fractures, asphyxia, hematomas, and rhabdomyolysis		*Can cause bony fractures, asphyxia, hematomas, and rhabdomyolysis

	== Diagnosis ==		==Diagnosis==

	* Baseline IgG serology; if positive, then they are tetanus-immune and it rules out the diagnosis		*Baseline IgG serology; if positive, then they are tetanus-immune and it rules out the diagnosis
	* Send wound swab or tissue for culture or PCR		*Send wound swab or tissue for culture or PCR

	== Management ==		==Management==

			*Supportive care
	* Tetanus antitoxin or IVIg
			**Early intubation for airway protection
	* Wound care with debridement
			**[[Benzodiazepines]] to manage muscle spasms
	* Antibiotics
			***Rarely, need to escalate to neuromuscular blockage
	* Vaccination on recovery
			**May need α- or β-adrenergic blockade with [[labetalol]] to manage autonomic dysfunction
			***Avoid unopposed α effect, which can cause severe hypertension
			**Increased nutritional support, given the high metabolic demands of the illness
			*Immunization
			**Tetanus antitoxin, tetanus immune globulin (TIg), or [[IVIg]] can shorten the duration of illness. Administer as early as possible and within 24 hours.
			**Vaccination with toxoid vaccine, within 24 hours, into a different limb.
			*[[Metronidazole]] may improve outcomes compared to [[penicillin]]
			*Wound care with debridement as indicated, though it does not alter the course of the disease

	{{DISPLAYTITLE:''Clostridium tetani''}}		{{DISPLAYTITLE:''Clostridium tetani''}}

Aidan: Created page with "== Background == * Ubiquitous soil organism * Acquired either by direct inoculation or via umbilical stump in neonates === Pathophysiology === * Toxin blocks inhibitory int..."

2020-08-18T12:14:40Z

Created page with "== Background == * Ubiquitous soil organism * Acquired either by direct inoculation or via umbilical stump in neonates === Pathophysiology === * Toxin blocks inhibitory int..."

New page

== Background ==

* Ubiquitous soil organism
* Acquired either by direct inoculation or via umbilical stump in neonates

=== Pathophysiology ===

* Toxin blocks inhibitory interneurons in the spinal cord and autonomic nervous system

== Clinical Manifestations ==

* Incubation period of [[Usual incubation period::3 to 21 days]]
* Followed by generalized tetanus, with tetanic spasms with even minimal external stimulus
* Lockjaw, risus sardonicus, opisthotonus, abdominal rigidity, and eventually apnea

=== Prognosis and Complications ===

* 30% mortality
* Can cause bony fractures, asphyxia, hematomas, and rhabdomyolysis

== Diagnosis ==

* Baseline IgG serology; if positive, then they are tetanus-immune and it rules out the diagnosis
* Send wound swab or tissue for culture or PCR

== Management ==

* Tetanus antitoxin or IVIg
* Wound care with debridement
* Antibiotics
* Vaccination on recovery

{{DISPLAYTITLE:''Clostridium tetani''}}
[[Category:Infectious diseases]]
[[Category:Gram-positive bacilli]]