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Essential Features


  • • Anaerobic infection mediated by a neurotoxin that causes nervous irritability and tetanic muscular contraction

    • Causative organism, Clostridium tetani

    • Wounds contaminated with soil or feces (eg, deep puncture from stepping on a nail)

    • Tetanus-prone wound is usually a puncture wound or one containing devitalized tissue or a foreign body

    • Tetanus-prone wounds are characterized by:

    • –Elapsed time from injury (more than 6 hrs)

      –Deeper than 1 cm

      –Contaminated by soil, feces, rust

      –Stellate configuration

      –Caused by missile, crush, burn, or frostbite

      –Characterized by devitalized or denervated tissue

      –Cause by animal or human bite




  • • Occurrence of tetanus in United States has dropped over the last 5 decades

    • Improvement is attributed to the increasingly widespread use of tetanus toxoid and improved wound management

    • Tetanus continues to be a severe disease primarily of older adults who are unvaccinated or inadequately vaccinated

    • Disproportionately high number of cases (35%) was reported in persons aged 60 or older


Clinical Findings


Symptoms and Signs


  • • Tetanus is a clinical diagnosis, as confirmatory laboratory tests are not routinely available

    • Symptoms of tetanus may occur as soon as 1 day following exposure or as long as several months later

    • First symptoms are usually pain or tingling in the area of injury

    • "Lockjaw" (limitation of movements of the jaw)

    • Spasms of the facial muscles (risus sardonicus)

    • Neck stiffness

    • Dysphagia

    • Laryngospasm

    • Chest and diaphragm spasms occur, longer and longer periods of apnea follow

    • Temperature is normal or slightly elevated


Laboratory Findings


  • • Wound isolation of the organism is neither sensitive nor specific


Diagnostic Considerations


Rule Out


  • • Associated animal bites

    • Associated injuries




  • • History and physical exam

    • Careful exam of wound

    • Determine tetanus prophylaxis status


When to Admit


  • • Complications of tetanus: Paralysis, respiratory compromise


Treatment and Management


  • • Imperative that all patients with traumatic wounds be asked about previous tetanus prophylaxis

    • Neutralization of the toxin with tetanus immune globulin (TIG)

    • IV high-dose penicillin

    • Ventilator support if indicated

    • Surgical wound debridement




  • • If tetanus is suspected, perform excision and debridement of the wound




  • • IV high-dose penicillin

    • Tetanus-diphtheria (Td) booster (active immunization for clean wounds)

    • • TIG (passive immunization for contaminated wounds)


Treatment Monitoring


  • • An attack of tetanus does not confer lasting immunity, and patients who have recovered from the disease require active immunization according to the usual recommended schedules




  • • Respiratory ...

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