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Microbiological characteristics C. tetani is an anaerobic gram-positive bacillus that forms spores.

The bacteria have been described to look like a drumstick, racket or club. This organism is sensitive to heat and cannot survive in the presence of oxygen. However, the spores are very resistant to heat and usual antiseptics.
Tetanus facts

Tetanus is frequently a fatal infectious disease. Tetanus is caused by a type of bacteria (Clostridium tetani). The tetanus bacteria often enter the body through a puncture wound, which can be caused by nails, splinters, insect bites, burns, any skin break, and injection-drug sites. All children and adults should be immunized against tetanus by receiving vaccinations. A tetanus booster is needed every 10 years after primary immunization or after a puncture or other skin wound which could provide the tetanus bacteria an opportunity to enter the body.

What is tetanus?
Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacteriumClostridium tetani. This bacterium is found throughout the world in the soil and in animal and human intestines. Tetanus Symptoms and Signs
The hallmark feature of tetanus is muscle rigidity and spasms. In generalized tetanus, the initial complaints may include any of the following: Irritability, muscle cramps, sore muscles, weakness, or difficulty swallowing are commonly seen. Facial muscles are often affected first.Trismus or lockjaw is most common. This condition results from spasms of the jaw muscles that are responsible for chewing. A sardonicsmile -medically termed risussardonicus -- is a characteristic feature that results from facial muscle spasms. o Muscle spasms are progressive and may include a characteristic arching of the back known as opisthotonus (Figure 2). Muscle spasms may be intense enough to cause bones to break and joints to dislocate. o Severe cases can involve spasms of the vocal cords or muscles involved in breathing. If this happens, death is likely, unless medical help (mechanical ventilation with a respirator) is readily available. In cephalic tetanus, in addition to lockjaw, weakness of at least one other facial muscle occurs. In two-thirds of these cases, generalized tetanus will develop. In localized tetanus, muscle spasms occur at or near the site of the injury. This condition can progress to generalized tetanus. Neonatal tetanus is identical to generalized tetanus except that it affects the newborn infant. Neonates may be irritable and have poor sucking ability or difficulty swallowing. o o

How does the tetanus toxin cause damage to the body?


The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates. This region is called the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate. Of note, because of tetanus vaccination programs, there have only be a few cases of neonatal tetanus reported in the U.S. since 1990, and in each of these cases, the mothers were incompletely immunized. Worldwide, however, neonatal tetanus is still, unfortunately, common.

What is the incubation period for tetanus?


The incubation period between exposure to the bacteria in a contaminated wound and development of the initial symptoms of tetanus ranges from two days to two months, but it's commonly within 14 days of injury.

What is the course of the tetanus disease? What are the symptoms and signs of tetanus?
During a one- to seven-day period, progressive muscle spasms caused by the tetanus toxin in the immediate wound area may progress to involve the entire body in a set of continuous muscle contractions. Restlessness,headache, and irritability are common. The tetanus neurotoxin causes the muscles to tighten up into a continuous ("tetanic" or "tonic") contraction or spasm. The jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called "trismus"). Muscles throughout the body are affected, including the vital muscles necessary for normal breathing. When the breathing muscles lose their power, breathing becomes difficult or impossible and death can occur without life-support measures. Even with breathing support, infections of the airways within the lungs can lead to death.

What is the treatment for tetanus?


General measures to treat the sources of the bacterial infection with antibiotics and drainage are carried out in the hospital while the patient is monitored for any signs of compromised breathing muscles. Treatment is directed toward stopping toxin production, neutralizing its effects, and controlling muscle spasms. Sedation is often given for muscle spasm, which can lead to lifethreatening breathing difficulty.

In more severe cases, breathing assistance with an artificial respirator machine may be needed. The toxin already circulating in the body is neutralized with antitoxin drugs. The tetanus toxin causes no permanent damage to the nervous system after the patient recovers. After recovery, patients still require active immunization because having the tetanus disease does not provide natural immunization against a repeat episode.

How is tetanus prevented?


Active immunization ("tetanus shots") plays an essential role in preventing tetanus. Preventative measures to protect the skin from being penetrated by the tetanus bacteria are also important. For instance, precautions should be taken to avoid stepping on nails by wearing shoes. If a penetrating wound should occur, it should be thoroughly cleansed with soap and water and medical attention should be sought. Finally, passive immunization can be administered in selected cases (with specialized immunoglobulin).

What is the schedule for active immunization (tetanus shots)?


All children should be immunized against tetanus by receiving a series of five DTaP vaccinations which generally are started at 2 months of age and completed at approximately 5 years of age. Booster vaccination is recommended at 11 years of age with Tdap. Follow-up booster vaccination is recommended every 10 years thereafter. While a 10-year period of protection exists after the basic childhood series is completed, should a potentially contaminated wound occur, an "early" booster may be given in selected cases and the 10 years "clock" reset.

What are the side effects of tetanus immunization?


Side effects of tetanus immunization occur in approximately 25% of vaccine recipients. The most frequent side effects are usually quite mild (and familiar) and include soreness, swelling, and/or redness at the site of the injection. More significant reactions are extraordinarily rare. The incidence of this particular reaction increases with decreasing interval between boosters.

What is passive immunization (by way of specialized immunoglobulin)?


In individuals who exhibit the early symptoms of tetanus or in those whose immunization status is unknown or significantly out of date, the tetanus immunoglobulin (TIG) is given into the muscle surrounding the wound with the remainder of the dose given into the buttocks.

Tetanus Diagnosis
The diagnosis of generalized tetanus is usually made by observing the clinical presentation and a combination of the following: History of a recent injury resulting in skin breakage (but this is not universal; only 70% of cases have an identified injury) Incomplete tetanus immunizations Progressive muscle spasms (starting in the facial region, especially lockjaw and progressing outward from the face to include all muscles of the body) Fever Changes in blood pressure (especially high blood pressure) Irregular heartbeat In localized tetanus, pain, cramps, or muscle spasms occur at or near a recent skin injury. Neonates show signs of being generally irritable, muscle spasms, and poor ability to take in liquids (poor sucking response), usually seen in neonates about 7-10 days old. Laboratory tests are rarely used to diagnose tetanus. However, some reference labs can determine if the patient has serum antitoxin levels that are protective, and thus a positive test detecting these levels suggests that the diagnosis of tetanus is unlikely.

Self-Care at Home
Any wound that results in a break in the skin should be cleaned with soap and running water. All open wounds are at risk to develop tetanus. Wounds from objects outdoors or crush injuries are at higher risk for gettingC. tetani spores into a wound. Apply a clean and dry cloth to stop or minimize bleeding. Apply direct pressure to the site of bleeding to help minimize blood loss. Do not take chances; if the injured person is unsure of their tetanus vaccine status or if the injury may have "dirt" in it, they should visit the nearest emergency care center.

TRISMUS- spasm of jaw: a sustained spasm of the jaw muscles, characteristic of the early stages of tetanus OPISTHOTONUS- extreme backward arching of the spine: a powerful spasm of the muscles that straighten the vertebral column, causing the body to arch backward until the heels nearly touch the head. Opisthotonus occurs in untreated tetanus, strychnine poisoning, and some cases of severe meningitis. RISUS SARDONICUS- contorted facial expression: a distorted grinning expression caused by involuntary prolonged contraction of the facial muscles, especially as a result of tetanus