Title: Tetanus--How to Catch a Killer<br/>Author: Andrea Tenner<br/><a href='http://umem.org/profiles/faculty/1069/'>[Click to email author]</a><hr/><p>
<strong><em>General Information: </em></strong>Tetanus is caused by the toxin of <em>Clostridium tetani--</em>a gram-positive bacillus found in soil and animal excrement. It is a life-threatening but preventable disease. Cases have declined by > 95% in the past 65 years, but dozens of cases still occur annually in the US and it is still frequently seen in developing countries.</p>
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<strong><em>Clinical Presentation:</em></strong></p>
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Generalized increased rigidity</li>
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Convulsive spasms of skeletal muscles</li>
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<em>Risus sardonicus</em> (severe facial spasms with a “sardonic” smile)</li>
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autonomic instability (fever, sweating, tachycardia, salivation, hyper- or hypo prefusion)</li>
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Lucid mental state</li>
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<strong><em>Diagnosis:</em></strong></p>
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Clinical Case Definition: In the absence of a more likely diagnosis, an acute illness with muscle spasms or hypertonia. There is no diagnostic laboratory test for tetanus.</p>
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<strong><em>Treatment:</em></strong></p>
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Supportive care (including ventilator support as needed)</li>
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Control symptoms with muscle relaxants and anticonvulsants as needed</li>
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Wound debridement and antibiotics (metronidazole, e.g. 0.5 gm every 6 hours) to decrease <em>C tetani</em></li>
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Passive immunization with human tetanus immune globulin (TIG) (may shorten course and decrease severity--Dose: TIG 3,000-6,000 units IM)</li>
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Tetanus toxoid vaccine (clinical disease does not produce immunity!)</li>
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<strong><em>Bottom Line:</em></strong></p>
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Tetanus is not as rare as we would like to think. Acute diagnostic acumen and assertive clinical management can help save the life of someone with this potentially deadly disease</p>
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<strong>University of Maryland Section for Global Emergency Health</strong></p>
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<strong>Author: Jon Mark Hirshon, MD, MPH, PhD</strong></p>
<fieldset><legend>References</legend>
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<a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm">http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm</a></p>
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<a href="http://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html">http://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html</a></p>
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http://emedicine.medscape.com/article/229594-treatment</p>
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