Tetanus

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Tetanus is a serious bacterial infection caused by Clostridium tetani. The bacteria produce a toxin that affects the nervous system, leading to severe muscle spasms and stiffness.

Aetiology

Tetanus is caused by the bacterium Clostridium tetani. The bacteria can enter the body through:

• Puncture wounds (e.g., from nails, needles)
• Burns
• Crushed injuries
• Wounds contaminated with dirt, faeces, or saliva
• Surgical procedures

Pathophysiology

The pathophysiology of tetanus involves:

• Clostridium tetani spores enter the body through a wound.
• Under anaerobic conditions, the spores germinate into bacteria that produce tetanospasmin toxin.
• The toxin binds to nerve endings and travels along the nerves to the spinal cord and brainstem.
• The toxin blocks the release of neurotransmitters, leading to uncontrolled muscle contractions and spasms.

Risk Factors

• Lack of vaccination against tetanus
• Deep or contaminated wounds
• Inadequate wound care
• Intravenous drug use
• Living in areas with poor sanitation

Signs and Symptoms

The signs and symptoms of tetanus include:

• Muscle stiffness, particularly in the jaw (lockjaw) and neck
• Difficulty swallowing
• Muscle spasms and rigidity, often triggered by sensory stimuli
• Fever and sweating
• Restlessness and irritability
• Elevated blood pressure and heart rate

Investigations

Specific investigations to diagnose tetanus include:

• Clinical diagnosis: Based primarily on history and physical examination, as there are no specific laboratory tests for tetanus.
• Wound culture: To identify Clostridium tetani, although this is not always reliable.
• Full blood count (FBC): To check for elevated white blood cell count and other markers of infection.

Management

Primary Care Management

• Wound cleaning: Thorough cleaning of wounds to remove foreign material and reduce bacterial load.
• Antibiotics: Metronidazole or penicillin to eradicate Clostridium tetani.
• Tetanus immunoglobulin: Administered to neutralise the toxin.
• Tetanus vaccination: If the patient is not up-to-date with their tetanus vaccinations, they should receive a booster.

Specialist Management

• Hospitalisation: For all cases of suspected tetanus, due to the risk of severe complications.
• Intensive care: Management in an ICU for severe cases, including mechanical ventilation if necessary.
• Muscle relaxants: Such as diazepam or baclofen to control muscle spasms.
• Management of autonomic dysfunction: Medications to control heart rate and blood pressure.
• Supportive care: Including hydration, nutrition, and pain management.

References

1. NHS (2024) Tetanus. Available at: https://www.nhs.uk/conditions/tetanus/ (Accessed: 24 June 2024).
2. Centers for Disease Control and Prevention (2024) Tetanus. Available at: https://www.cdc.gov/tetanus/index.html (Accessed: 24 June 2024).
3. World Health Organization (2024) Tetanus. Available at: https://www.who.int/news-room/fact-sheets/detail/tetanus (Accessed: 24 June 2024).
4. British Medical Journal (2024) Tetanus: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h1735 (Accessed: 24 June 2024).

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