Clostridium tetani: Difference between revisions
From IDWiki
Clostridium tetani
(Created page with "== Background == * Ubiquitous soil organism * Acquired either by direct inoculation or via umbilical stump in neonates === Pathophysiology === * Toxin blocks inhibitory int...") Â |
(→â€) |
||
| Line 1: | Line 1: | ||
| − | == |
+ | ==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== |
| + | *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''}} |
||
Revision as of 10:32, 15 September 2020
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
- Supportive care
- Early intubation for airway protection
- Benzodiazepines to manage muscle spasms
- Rarely, need to escalate to neuromuscular blockage
- 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
