• 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
–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
• 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
• Chest and diaphragm spasms occur, longer and longer periods of apnea follow
• Temperature is normal or slightly elevated
• 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
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