Clostridium tetani: Clinical manifestations

Clostridium tetani: Clinical manifestations

Q. 1 Which system is primarily affected by tetanus?
 A Hematological
 B Nervous
 C Skeletal
 D

All

Q. 1 Which system is primarily affected by tetanus?
 A Hematological
 B Nervous
 C Skeletal
 D

All

Ans. B

Explanation:

Nervous REF: Harrison’s Internal Medicine 17th edition chapter 133

“Tetanus is a neurologic disorder, characterized by increased muscle tone and spasms that is caused by tetanospasmin, a powerful protein toxin elaborated by Clostridium tetani”


Q. 2

Which of the following is a dead end infection?

 A

Tetanus

 B

Vibrio

 C

Staphylococcus

 D

Hemophilus

Q. 2

Which of the following is a dead end infection?

 A

Tetanus

 B

Vibrio

 C

Staphylococcus

 D

Hemophilus

Ans. A

Explanation:

When a pathogen infects a species that it does not normally infect, it is often unable to spread effectively from that host, this situation is known as dead end infection or dead end transmission. 

Dead end infections are,

  • Leptospirosis
  • Legionella
  • Endemic typhus
  • Tetanus
  • Human rabies
  • Japanese Encephalitis
  • T.solium
  • Echinococcus granulosus and Trichinella spiralis

Q. 3

True about tetanus –

 A

Gram -ve spore forming organism

 B

Produces tetanolysin and tetanospasmin

 C

Trismus and neck stiffness are early sign

 D

Generalized tonic-clonic seizure occurs on hyperstimulation

Q. 3

True about tetanus –

 A

Gram -ve spore forming organism

 B

Produces tetanolysin and tetanospasmin

 C

Trismus and neck stiffness are early sign

 D

Generalized tonic-clonic seizure occurs on hyperstimulation

Ans. B

Explanation:

Ans. is ‘b’ i.e., Produces tetanolysin and


Q. 4

Which of the following are true about tetanus ‑

 A

Gram –ye spore forming aerobe 

 B

Because of tetanospasmin

 C

Muscle enzymes are normal

 D

Vegetative cell will die with tetracycline

Q. 4

Which of the following are true about tetanus ‑

 A

Gram –ye spore forming aerobe 

 B

Because of tetanospasmin

 C

Muscle enzymes are normal

 D

Vegetative cell will die with tetracycline

Ans. B

Explanation:

Ans. is ‘b’ i.e., Because of tetanospasmin 

  • Clostridium tetani is a gram (+)ve, spore forming, anaerobic bacillus.
  • Tetanospasmin (neurotoxin) is responsible for tetanus.
  • Tetanus is characterized by increased muscle tone (muscle spasm) and rigidity.

Diagnosis of tetanus

  • The diagnosis of tetanus is based entirely on clinical findings. The diagnosis is established on the basis of

history of an injury, (particularly one in which either soil or fecal material has been introduced) 6-12 days before the

onset of typical clinical findings.

  • Wound should be cultured in suspected cases. However, C. tetani can be isolated from wounds of patients

without tetanus and frequently cannot be recovered from wounds of those with tetanus.

  • Other laboratory findings may be –

i)        There may be leukocytosis

ii)      Muscle enzyme levels may be raised

iii)    Electromyogram may show continuous discharge of motor units and shortening or absence of the silent

interval normally seen after an action potential. 

Treatment of tetanus

  • Treatment of tetanus includes :‑

1)       Antimicrobial therapy :- Antibiotic therapy is administered to eradicate vegetative cells, i.e. to eliminate the

source of toxins. Penicillin and metronidazole are first line drugs. Clindamycin and erythromycin are alternatives for penicillin – allergic patients. (Tetracycline is not used).

2)       Antitoxin :- is given to neutralize circulating toxin. Human tetanus immune globuline (TIG) is the

preparation of choice.

3)       Control of muscle spasms :- Many agents, alone or in combination, have been used to treat the muscle spasms

of tetanus, which are painful and can threaten ventilation by causing laryngospasm or sustained contraction of ventilatory muscles. Benzodiazepines (Diazepam, larazepam, midazolam) are used most commonly. Alternatives are Barbiturates and chlorpromazine. Mechanical ventilation with a nondepolarizing neuromuscular blocking agent may be used for spasms unresponsive to medications. Other agents include propofol, dantrolene, intrathecal beclofen, succinylcholine and magnesium sulfate.

4)         Respiratory care :- Intubation or tracheostomy, with or without mechanical ventilation may be required.

5)       Autonomic dysfunction :- For sympathetic overactivity labetalol, esmolol or clonidine may be used.

Vaccine :- Patient recovering from tetanus should be actively immunized


Q. 5

Which of the following is not true about transmission –

 A

Legionella may be transmitted through water aerosols

 B

Listeria may be transmitted through refrigerated food

 C

Leptospirosis may be transmitted through water contaminated with rat urine

 D

Tetanus may be transmitted through dust and droplets

Q. 5

Which of the following is not true about transmission –

 A

Legionella may be transmitted through water aerosols

 B

Listeria may be transmitted through refrigerated food

 C

Leptospirosis may be transmitted through water contaminated with rat urine

 D

Tetanus may be transmitted through dust and droplets

Ans. D

Explanation:

Ans. is. ‘d’i.e., Tetanus may be transmitted through dust and droplets

Transmission of tetanus

.   Tetanus is acquired by contamination of wounds with tetanus spores.

.   It is transmitted through contamination of wounds by tetanus spores in the dust.

.   Transmission may occur through a range of injuries from trivial pin pricks to unsterile surgery and compound fractures.

.   It is not transmitted by droplets.

Transmission of Legionella, listeria and leptospirosis has been explained.


Q. 6

Man is the terminal end for –

 A

Gonococcus

 B

Treponema

 C

Tetanus

 D

Ankylostomiasis

Q. 6

Man is the terminal end for –

 A

Gonococcus

 B

Treponema

 C

Tetanus

 D

Ankylostomiasis

Ans. C

Explanation:

Ans. is ‘c i.e., Tetanus 


Q. 7

Tetanus is noticed usually in

 A

Burn cases

 B

Wounds contaminated with faecal matter

 C

Open fractures

 D

Gunshot wounds

Q. 7

Tetanus is noticed usually in

 A

Burn cases

 B

Wounds contaminated with faecal matter

 C

Open fractures

 D

Gunshot wounds

Ans. B

Explanation:

B i.e. Wounds contaminated with faecal matter

• Wounds containated with fecal matter & soil are most prone for tetanus developmentQ
• Tetanus may develop in chronic conditions, such as skin ulcers, abscesses, and gangrene, burn, frost bite, middle ear infections. It is also associated with surgery, abortion, child birth, body
piercing, and drug abuse notably skin popping”, and open fractures etc


Q. 8

Soil acts as a source as well reservoir for – 

 A

Rabies

 B

Tetanus

 C

Typhoid

 D

Measles

Q. 8

Soil acts as a source as well reservoir for – 

 A

Rabies

 B

Tetanus

 C

Typhoid

 D

Measles

Ans. B

Explanation:

Ans. is ‘b’ i.e., Tetanus 

Source Vs Reservoir

Source

o The source of infection is defined as “the person, animal, object or substance from which an infectious agent passes or is disseminated to the host”.

          In other words, Anything from which a man acquires infection is the source of infection.

Reservoir

o Any person, animal, arthropod, plant, soil or substance in which an infectious agent lives and multiplies & metabolizes.

o Infectious agent is dependent on reservoir for survival.

o It reproduces in reservoir in such manner that it can be transmitted to susceptible host.

A reservoir acts as a source of infection when a person acquire infection directly from reservoir.

So, a resrvoir may sometimes act as a source, i.e., source may be a part of reservoir sometime (not always). Example

o Source & reservoir are same —› Tetanus spores survive in soil (reservoir) and a person acquires infection directly from soil (source). So, soil acts as reservoir as well as source.

o Source & reservoir different —> In typhoid, bacillus survives and multiplies inside human cases or carriers (act as reservoir), but immediate source of infection is feces or urine of patients, or contaminated food, water or milk (act as source).

o So, source may or may not be a part of reservoir. In other words reservoir may or may not act as a source. In simple words : ‑

o Man acquires infection from source.

o Infectious agent metabolizes and replicates in reservoir


Q. 9

The following disease require isolation to break transmission except –

 A

Measles

 B

Mumps

 C

Chicken pox

 D

Tetanus

Q. 9

The following disease require isolation to break transmission except –

 A

Measles

 B

Mumps

 C

Chicken pox

 D

Tetanus

Ans. D

Explanation:

Ans. is “`d’ i.e., Tetanus 


Q. 10

All are true regarding tetanus except –

 A

Transmission through contaminated wounds and injuries

 B

More common in winters and dry weather

 C

Reservoir in soil and intestines of humans and animals

 D

No herd immunity or life long immunity

Q. 10

All are true regarding tetanus except –

 A

Transmission through contaminated wounds and injuries

 B

More common in winters and dry weather

 C

Reservoir in soil and intestines of humans and animals

 D

No herd immunity or life long immunity

Ans. B

Explanation:

Ans. is ‘b’ i.e., More common in winters and dry weather

o Tetanus is common in areas where soil is cultivated, in rural areas, in warm climates, during summer months, and among males.

o Infection is acquired by contamination of wounds with tetanus spores.

o Reservoir of infection :- The natural habitat of organism is soil and dust. The bacilli may be found in the intestine of many herbivorous animals, e.g. cattle, horses, goat and sheep and are excreted in their feces. The bacilli may be found in the intestine of man without causing ill effects.

o Tetanus is one disease in which herd immunity does not protect the individual.


Q. 11

Sardonic grin is associated with –

 A

Rabies

 B

Tetanus

 C

Bell’s palsy

 D

Hemiplegia

Q. 11

Sardonic grin is associated with –

 A

Rabies

 B

Tetanus

 C

Bell’s palsy

 D

Hemiplegia

Ans. B

Explanation:

Ans. is ‘b’ i.e., Tetanus 


Q. 12

Tetanus is caused by

 A

Cl. Tetani

 B

Cl. Welchii

 C

Cl. edematiens

 D

CI. Septicum

Q. 12

Tetanus is caused by

 A

Cl. Tetani

 B

Cl. Welchii

 C

Cl. edematiens

 D

CI. Septicum

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cl. Tetani 


Q. 13

Period of onset in tetanus refers to the time between‑

 A

First injury to spasm

 B

First symptom to spasm

 C

First spasm to death

 D

Trismus to laryngeal spasm

Q. 13

Period of onset in tetanus refers to the time between‑

 A

First injury to spasm

 B

First symptom to spasm

 C

First spasm to death

 D

Trismus to laryngeal spasm

Ans. B

Explanation:

Ans. is ‘b’ i.e., First symptom to spasm


Q. 14

A Patient Presented with the following Typical Grin. Most Probable diagnosis ?

 A

Rabies

 B

Tetanus

 C

Bell’s palsy

 D

Opium Poisoning 

Q. 14

A Patient Presented with the following Typical Grin. Most Probable diagnosis ?

 A

Rabies

 B

Tetanus

 C

Bell’s palsy

 D

Opium Poisoning 

Ans. B

Explanation:

Ans:B.)Tetanus.

The Image Shows Sardonic Grin.

Clinical Manifestations of Tetanus

  • Refusal of feeds, apathy and excessive unexplained cry are the common initial symptoms.
  • “Trismus (spasm of masseter muscle) is the most common symptom of tetanus. It is seen in about 50% of patients with tetanus”.
  • Headache restlessness and irritability                                                       
  • Dysphagia neck muscle spasm.
  • Risus Sardonicus due to spasms of facial and buccal muscles.       
  • Opisthotonos (Arched posture)
  • Seizures                                                                                                                 
  • Respiratory muscle spasm 

Q. 15

 All of the following are true regarding tetanus except:

 A

It is transmitted from person to person

 B

Herd immunity is not of much value

 C

The main reservoir is soil and intestine of animals and humans

 D

Incubation period is 6-10 days

Q. 15

 All of the following are true regarding tetanus except:

 A

It is transmitted from person to person

 B

Herd immunity is not of much value

 C

The main reservoir is soil and intestine of animals and humans

 D

Incubation period is 6-10 days

Ans. A

Explanation:

Ans. a. It is transmitted



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