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Clostridium tetani: Clinical manifestations

Transmission

Not transmitted from person to person, i.e. herd immunity is not protective
A minimum lethal human dose of exotoxin is 2.5 ng/kg.
The spores or bacteria enter the body through abrasions, wounds, or (in the case of neonates) the umbilical stump.
Seen more often in the summer season and in hot, damp climates with soil rich in organic matter.
Wounds contaminated with fecal matter and soil are most prone

May develop in chronic conditions:

skin ulcer
abscesses
gangrene
burns
frost bite
middle ear infection.

Also associated with :

surgery
abortion
childbirth
body piercing
drug abuse notably skin popping
open fracture etc.

Symptoms

Symptoms are due to the effect of toxin.
Tetanospasmin (neurotoxin) is responsible for tetanus.
Tetanus is characterized by increased muscle tone (muscle spasm) and rigidity.
Median time of onset after injury is 7 days.
Period of onset in tetanus refers to the time between first symptom to spasm
First symptom –
- Pain and tingling at the site of inoculation
Early signs –Headache restlessness and irritability
- Increased tone in masseter muscles called as trismus/lock jaw.
Dysphagia neck muscle spasm

Followed by Descending tetanus:

Sequential involvement of nerves of head, trunk and extremities
Short nerves affected first.
Hand and feets relatively spared

Sinus sardonius:

Spasms of facial and buccal muscles.
Unimpaired mentation.
Increased deep tendon reflex.
Opisthotonos (Arched posture)
Seizures
Respiratory muscle spasm
Autonomic dysfunction (sympathetic increase)
Sudden cardiac death may occur
Neonatal tetanus
- usually occurs as generalized form.
Local tetanus
- only the nerves supplying the affected muscles are involved.

Cephalic tetanus:

Rare form with high mortality
May occur after head injury or ear infection.

Exam Important

Infection is acquired by

Not transmitted from person to person , i.e. herd immunity is not protective
Minimum lethal human dose of exotoxin is 2.5 ng/kg.
Seen more often in the summer season and in hot, damp climates with soil rich in organic matter.
Wounds contaminated with fecal matter and soil are most prone

Symptoms

Symptoms are due to the effect of toxin.
Tetanospasmin (neurotoxin) is responsible for tetanus.
Median time of onset after injury is 7 days.
Period of onset in tetanus refers to the time between first symptom to spasm

Sinus sardonius:

Spasms of facial and buccal muscles.

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Clostridium tetani: Clinical manifestations