Tetanus is an acute and often fatal disease caused by clostridium tetani and is characterized by

• Muscle rigidity
• Autonomic instability
• Convulsions

Higher incidence in third world countries (less immunized)

Pathogenesis

Clostridium tetani

• Obligate anaerobic spore-bearing gram positive bacillus
• Produces toxins (tetanospasmin, tetanolysin)
• Infection via wound, puncture etc.
• Infection remains local but toxin is spread via bloodstream

Toxin affects

• Peripheral nerve ends (decreased Ach release) 
• Spinal chord (polysynaptic reflexes)
• Brain (seizure, autonomic dysfunction, inhibition of cortical activity)
• Mainly bound to inhibitory neurons (therefore inhibition of neuronal action is decreased)

Symptoms

Presentation within 14days from infection

Main symptoms: stiffness and pain, trismus and lockjaw

Stiffness descending (facial stiffness > teeth clenching, “risus sardonicus”)

Severe muscle spasm (life threatening when affecting diaphragm or larynx

Autonomic dysfunction and instability (tachy-/bradycardia, hypo-/hypertension, pyrexia, sweating

Diagnosis

• Clinically
• Clostridium culture only in 30%

Management

• Passive immunization (human antitetanus toxin, 3000-6000 IU iv)
• wound care/surgery
• antibiotics (Metronidazole 500mg 8/24 OR penicillin G 1-3mio 6/24)
• Controlling muscle spasm (intubate, sedate, paralyze)
• Treat autonomic dysfunction
• general support