Clostridium tetani

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 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