Clostridium tetani

Description,
Microbiology

Motile, Gram positive, Spore-forming

(terminally located) Obligate Anaerobe
Spores can survive boiling but not
autoclaving
Not a tissue-invasive organism but it
produces toxin: tetanospasmin or tetanus
toxin

Epidemiology

Occurs worldwide
Natural habitat: soil, dust, and the
alimentary tracts of various animals
MC form: Neonatal (or Umbilicus
Tetanus-kills approx. 300, 000 infants each
year
It occurs in infants whose mothers are not
immunized.
Nonneonatal cases: assoc with traumatic
injury- penetrating wound, illicit drug
injection, use of contaminated suture
material , animal bite etc

Clostridium tetani
Pathogene
sis

Introduced spores germinate, multiply, and produre

tetanus toxin in the low oxidation-reduction potential
of an infected injury site.
Toxin binds at the neuromuscular junction and
prevents the release of glycine and -aminobutyric
acid.
Blocks the normal inhibition of antagonistic muscles
on which voluntary coordinated movement depends;
muscles sustain maximal contraction and cannot relax.

Clinical
Incubation period: 2-14 days but may be months
Manifestati Generalized Tetanus:
ons
a. Trismus (masseter muscle spasm, or lockjaw),
stiffness, difficulty chewing, dysphagia, and neck
muscle spasm.
b. Sardonic smile of tetanus (Risus Sardonicus):
intractable spasms of facial and buccal muscles
c. Opisthotonos: arched posture of extreme
hyperextension of the body
Neonatal Tetanus: infantile form, manifests within
3-12 days of birth, difficulty in feeding , associated
hunger and crying, paralysis, spasms, with or without

Clostridium tetani
Clinical
Localized Tetanus: painful spasms of the muscles
Manifestati adjacent to the wound site and may precede
ons
generalized tetanus.
Cephalic Tetanus: rare form, occurs with wounds
foreign bodies in the head, nostrils, or face; retracted
eyelids, trismus, risus sardonicus, and spastic paralysis
(tongue and pharynx)
Diagnosis

Leukocytosis, CSF is normal (intens e muscle

contraction may raise ICP)
No characteristic pattern on EEG nor EMG
Not always visible on Gram stain of wound material

Treatment

Surgical wound excision and debridement

Human tetanus immunoglobulin (TIG)- single IM, 500
units
Antibiotic of choice: Penicillin G (100, 000
units/kg/day divided every 4-6 hr IV for 10-14 days)
Metronidazole (500 mg every 8 hr IV for adults)
Erythromycin and Tetracycline(>8 yrs old):penicillinallergic patients

Clostridium tetani
Preventio Serum Ab titer of 0.01 units/mL is considered
n
protective.
Combined DTaP vaccine at 2,4,6 and 15-18 mo of age,
with boosters at 4-6 yr (DTaP) and 11-12 yr (Tdap) of age
and at 10 yr intervals thereafter throughout adult life
Pregnant women: 1 dose of reduced diphtheria and
pertussis toxoids (Tdap) during each pregnancy, at 27-36
wk gestation