Tetanus
Basics
Description
Description
- Commonly referred to as “lockjaw”
- Rare in developed countries due to widespread vaccination, but still prevalent in developing countries
- About 30 cases per year in U.S.
- Incidence is higher in individuals >65 yr of age due to loss of immunity
- Majority of cases in U.S. occur in the unvaccinated, >10 yr since last booster or IVDUs
- ∼1,000,000 cases worldwide, >300,000 deaths
- High mortality rates even with treatment
- Associated with an acute injury but patients often do not remember incident that caused inoculation
- Increased rates of infection after natural disasters (earthquakes and tsunamis)
- Incubation period:
- Inoculation to the appearance of the first symptoms:
- 3 d to 3 wk or more
- Period of onset:
- <7 d – poor prognosis
- Very poor prognosis if <48 hr from first symptom to initial reflex spasm
- Inoculation to the appearance of the first symptoms:
Etiology
Etiology
- 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
- Tetanolysin:
- Muscle spasms
- Autonomic instability
- Uncontrolled motor activity
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Citation
Schaider, Jeffrey J., et al., editors. "Tetanus." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307627/all/Tetanus.
Tetanus. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307627/all/Tetanus. Accessed December 3, 2024.
Tetanus. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307627/all/Tetanus
Tetanus [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307627/all/Tetanus.
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