Tetanus is a topic covered in the 5-Minute Emergency Consult.

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  • Rare disease in US but still prevalent in 3rd-world countries
  • About 30 cases per year in US
  • One-half of the cases involve people >50 yr of age
  • Majority of cases in US occur in the unvaccinated, >10 yr since last booster or IVDUs
  • 500,000–1,000,000 cases worldwide
  • High mortality rates even with treatment
  • Incubation period:
    • Inoculation to the appearance of the 1st symptoms:
      • 48 hr to 3 wk or more
    • Period of onset:
      • <7 days—poor prognosis
      • Very poor prognosis if <48 hr from 1st symptom to initial reflex spasm
  • Neonatal tetanus:
    • Due to infected umbilical stump
    • Symptom onset in 2nd week of life when maternal antibodies decrease
    • Rare in US but common in 3rd-world countries
    • Worldwide, accounts for over one-half of all tetanus infections


  • Clostridium tetani:
    • Slender, motile, heat-sensitive, anaerobic gram-positive rod with a terminal spherical spore
    • Spore characteristics
    • Resistant to oxygen, moisture, temperature extremes
    • Can survive indefinitely until it germinates
    • Ubiquitous in soil and feces
  • When inoculated into a wound or devitalized tissue or injected IV as a contaminant of street drugs, the spores germinate under anaerobic conditions and produce 2 toxins.
  • Toxins:
    • Tetanolysin:
      • Damages tissue
      • Does not cause clinical manifestations of tetanus infection
    • Tetanospasmin:
      • Powerful neurotoxin
      • Disrupts the release of neurotransmitters such as γ-aminobutyric acid (GABA)
      • Responsible for the clinical manifestations
  • Muscle spasms
  • Autonomic instability
  • Uncontrolled motor activity

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