Clostridium tetani: Difference between revisions
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Clostridium tetani
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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 |
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== Prevention == |
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=== Vaccination === |
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* The tetanus toxoid vaccine is part of the routine childhood immunization |
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=== Postexposure Prophylaxis === |
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* Postexposure prophylaxis involves either tetanus vaccination, tetanus immunoglobulin (TIg), or both |
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{| class="wikitable" |
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!Immunization Status |
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!Wound |
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!Vaccine |
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!Immunoglobulin |
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|- |
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| rowspan="2" |did not complete childhood series, |
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or unknown |
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|clean, minor injury |
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|yes |
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|no |
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|- |
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|all others |
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|yes |
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|yes |
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|- |
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| rowspan="2" |completed childhood series |
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|clean, minor injury |
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|only if last was given ≥10 years ago |
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|no |
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|- |
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|all others |
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|only if last was given ≥5 years ago |
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|no |
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|} |
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{{DISPLAYTITLE:''Clostridium tetani''}} |
{{DISPLAYTITLE:''Clostridium tetani''}} |
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[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
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Revision as of 22:11, 20 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
Prevention
Vaccination
- The tetanus toxoid vaccine is part of the routine childhood immunization
Postexposure Prophylaxis
- Postexposure prophylaxis involves either tetanus vaccination, tetanus immunoglobulin (TIg), or both
| Immunization Status | Wound | Vaccine | Immunoglobulin |
|---|---|---|---|
| did not complete childhood series,
or unknown |
clean, minor injury | yes | no |
| all others | yes | yes | |
| completed childhood series | clean, minor injury | only if last was given ≥10 years ago | no |
| all others | only if last was given ≥5 years ago | no |
