Tetanus (Clostridium tetani Infection)

Excerpt

Clostridium tetani is the causative organism for the disease known as tetanus. This bacillus and its spores are ubiquitous in the environment, and infection by plasmid-containing neurotoxin-producing strains has been a scourge since antiquity. Fortunately, the advent of highly protective vaccines has nearly eliminated tetanus worldwide. However, tetanus remains a significant infectious disease in resource-poor areas where public health outreach may be lacking. Conversely, in resource-rich areas with easily accessible vaccines, tetanus is a rare occurrence for most clinicians. Its rarity in the latter setting can lead to delays in diagnosis and optimal therapy when patients with tetanus seek medical attention.

Thus, it is important to identify risk factors, recognize typical clinical presentations, and understand the immediate management and treatment of C tetani infection. Tetanus is a life-threatening disorder characterized by painful muscular spasms, hypertonia, and autonomic nervous system dysfunction. Despite widespread vaccination efforts in the US, the disorder still arises.

Tetanus is classified into 4 categories:

1. Generalized

2. Localized

3. Cephalic

4. Neonatal

Mortality rates are highest at the extremes of age, where a combination of diminished immunity and the presence of comorbidities is common. Ideally, individuals with tetanus should receive care from a multispecialty team within a critical care setting. Unfortunately, this optimal care environment is frequently unavailable in regions where it is most urgently needed for treating patients with tetanus. Furthermore, in resource-poor areas, neonatal tetanus is associated with high mortality.

The management of tetanus relies on experience gained and reported in many case studies. Due to the relatively low incidence of infection and the potentially lethal nature of tetanus, there are no large randomized, placebo-controlled studies for a comprehensive comparison of best practices. Nevertheless, the management approach has been well established through anecdotal reports, case series, and small-scale randomized clinical studies.