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Tetanus
ByAmberGoods
Tetanus(Lockjaw);Etiologicalagent-Clostridiumtetani.
Transmission:
Tetanusisnotspreadfrompersontoperson.Itisusuallyfoundinsoilandmanureandenters
thebodythroughbreaksintheskin,usuallycausedbycontaminatedobjects3.
Reservoirs:
TetanuscanbecausedbysoilcontaminatedwithC.tetani.Manuretreatedsoilmaycontain
largenumbersofspores.C.tetanicanbefoundintheintestinesofanimals,meaningtetanus
canalsobecausedbyanimalfeces.Thesporescanalsobefoundonskinsurfaces;adultsmay
harbortheorganism.
GeneralCharacteristicsofMicroorganism:
Tetanusisanacute,sometimesfatal,diseaseofthecentralnervoussystem,causedby
Clostridiumtetani6.Itisaslender,gram-positive,anaerobicrodthatmaydevelopaterminal
spore,whichgivesitadrumstickappearance3.Somestrainsalsohaveflagella,makingthem
motile8.C.tetaniissensitivetoheatandcannotsurvivewithoxygen.Thesporesarevery
resistanttoheatandnormalantiseptics.Thesporescanalsosurviveautoclavingat249.8°Ffor
10-15minutes3.
Keytestsforidentification:
Doctorscandiagnosetetanusbyexaminingthepatientandlookingforcertainsignsand
symptoms.Ifnecessary,someteststohelpidentifytetanusare,indoleandglucosetests.
Tetanusresultsinapositiveindoletest,andnegativeforacidinaglucosetest8.
Signsandsymptoms:
Whenapersonisinfectedwithtetanus,symptomscanappearwithin3to14daysofinfection5.
Itbeginswithmusclespasmsinthejawandface,whichcanleadto“locking”ofthejaw.This
makesithardtoopenthemouthorswallow4.Stiffnessorpaininmusclesoftheneck,shoulder,
orbackcanalsooccur.Musclespasmscanbesoseverethattheyspreadtotheabdomen,
upperarms,andthighs5.Patientsmayalsoexperiencefever,fastpulse,andsweating.
Historicalinformation:
Evidenceoftetanusdatesbackto5thcenturyBCE.CarleandRottonewerethefirsttoproduce
tetanusinanimalsbyinjectingthemwithpusfromahumantetanuscase.Soonafter,Nicolaier
producedtetanusinanimalsbyinjectingthemwithsamplesofsoil.In1889,Kitasatoisolated
theorganismfromahuman,revealedthatitwasabletoproducediseasewheninjectedinto
animals,healsodeclaredthatthetoxincouldbeneutralizedbycertainantibodies3.In1897,
Nocarddemonstratedtheprotectiveeffectofpassivelytransferredantitoxin,andpassive
immunizationinhumanswasusedfortreatmentandprophylaxisduringWorldWarI3.
Formaldehyde,amethodusedtoinactivatethetetanustoxinwasdiscoveredbyRamoninthe
1920’s.ThisledtothedevelopmentifthetetanustoxoidbyDescombeyin1924,whichwasfirst
generallyusedduringWorldWarII.
Virulencefactors:
OnceC.tetaniinvadeshosttissuesitsecretestwoexotoxinstetanolysinandtetanospasmin.
Notmuchisknownabouttetranolysin.Tetranospasminisaneurotoxinandcausestheclinical
manifestationsoftetanus3.Basedonweight,tetanospasminisoneofthemostpotenttoxins
known.Theestimatedminimumhumanlethaldoseis2.5nanogramsperkilogramofbody
weight3.Thetoxinsaredispersedviabloodandlymphatics.Thesestoxinseffectsitesinthe
bodysuchasperipheralmotorendplates,spinalcord,thebrain,andthesympatheticnervous
system.Tetanustoxinsmayalsointerferewiththereleaseofneurotransmitters,blocking
inhibitorimpulses3.
Control/Treatment:
Peopleinfectedwithtetanusaretreatedwithlargedosesofantibioticssuchasmetronidazole
orpenicillintokillthetetanusbacteria,andmustundergolocalwounddebridement.Also,
tetanusimmuneglobulin(TIG)isusedtoremoveunboundtetanustoxin.Intravenousimmune
globulin(IVIG)containstetanusantitoxinandcanbeusedifTIGinunavailable3.
Prevention/Vaccineinfo
Gettingthevaccinecanhelppreventtetanus.TheCDCrecommendsthatchildrenreceive5
DTapshots6.ADTapshotisonethatprotectsagainstdiphtheria,tetanus,andpertussis.After
thisseriesofvaccines,itisimportanttofollowupwithaboosterevery10years.Therearefour
combinationsofvaccinesusedtopreventtetanus:DTaP,TdaP,DT,andTd.Otherwaysto
preventtetanusinclude,protectingthebottomsofyourfeetagainstdeepordirtywoundsby
wearingshoeswiththicksoles,andwearingshoesatalltimeswhenyou’reoutside.Ifyougeta
woundmakesureitiskeptclean,applyanantibacterialmedicinetokeepbacteriafrom
growing.
Localcasesoroutbreaks:
TetanusisaveryrarediseaseintheUnitedStates,duetowidespreadimmunization.During
2001–2008atotalof233casesoftetanuswerereportedintheUnitedStates,withonly12
beinginthestateofTexas7.ThegraphbelowshowszeroincidencesofTetanusinHarris
County,Texas,nottoofarfromAustin.
Table2:NumberofReportedVaccine-PreventableDiseaseCasesand(Rateper100,000Population)HarrisCounty,
7
Texas,ExcludingCityofHouston,2007-2012
TheimagebelowillustratestetanuscasesintheUSfrom1947-20123.
Globalcasesoroutbreaks:
Themorbidityandmortalityoftetanushasdeclinedworldwidesincethemidtolate1940s,as
showninthefigurebelow.In2009,theCDCreportedatotalof19tetanuscasesand2deaths
tothenationaltetanussurveillancesystem.
References:
1. "DepartmentofHealth."Tetanus(lockjaw).Web.7May2016.
http://www.health.ny.gov/diseases/communicable/tetanus/fact_sheet.htm
2. "Home-HarrisCountyPublicHealth."Home-HarrisCountyPublicHealth.Web.9May
2016.http://www.hcphes.org/
3. "Tetanus."CentersforDiseaseControlandPrevention.CentersforDiseaseControland
Prevention,2015.Web.7May2016.
http://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html
4. "Tetanus:MedlinePlus."U.SNationalLibraryofMedicine.U.S.NationalLibraryofMedicine.
Web.8May2016.
https://www.nlm.nih.gov/medlineplus/tetanus.html
5. "Tetanus."KidsHealth-theWeb'sMostVisitedSiteaboutChildren'sHealth.TheNemours
Foundation.Web.8May2016.
http://kidshealth.org/en/teens/tetanus.html
6. “Tetanus”JohnHopkinsMedicineHealthLibrary.Web.7May2016
http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/infectious_diseases/tetan
us_85,p00652/
7. "TetanusSurveillance---UnitedStates,2001--2008."CentersforDiseaseControland
Prevention.CentersforDiseaseControlandPrevention,2011.Web.9May2016.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm#tab1
8. Wells,CarolL.,andTracyD.Wilkins.MedicalMicrobiology.4thed.Galveston:Universityof
TexasMedicalBranchatGalveston,1996.Clostridia:SporeformingAnaerobicBacilli.U.S.
NationalLibraryofMedicine,17Jan.1996.Web.7May2016.
http://www.ncbi.nlm.nih.gov/books/NBK8219/