UMEM Educational Pearls

Title: Tetanus--How to Catch a Killer

Keywords: tetanus, global, international, infectious disease (PubMed Search)

Posted: 6/25/2014 by Andrea Tenner, MD (Updated: 4/20/2024)
Click here to contact Andrea Tenner, MD

General Information: Tetanus is caused by the toxin of Clostridium tetani--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.

Clinical Presentation:

Generalized increased rigidity
Convulsive spasms of skeletal muscles
Risus sardonicus (severe facial spasms with a “sardonic” smile)
autonomic instability (fever, sweating, tachycardia, salivation, hyper- or hypo prefusion)
Lucid mental state

Diagnosis:

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.

Treatment:

Supportive care (including ventilator support as needed)
Control symptoms with muscle relaxants and anticonvulsants as needed
Wound debridement and antibiotics (metronidazole, e.g. 0.5 gm every 6 hours) to decrease C tetani
Passive immunization with human tetanus immune globulin (TIG) (may shorten course and decrease severity--Dose: TIG 3,000-6,000 units IM)
Tetanus toxoid vaccine (clinical disease does not produce immunity!)

Bottom Line:

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

University of Maryland Section for Global Emergency Health

Author: Jon Mark Hirshon, MD, MPH, PhD

References

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6012a1.htm

http://www.cdc.gov/vaccines/pubs/surv-manual/chpt16-tetanus.html

http://emedicine.medscape.com/article/229594-treatment