Tetanus

Question 1

What causes tetanus?

Answer 1

tetanospasmin exotoxin released from Clostridium tetani

Question 2

How is tetanus transmitted

Answer 2

• Tetanus spores are present in soil
• may be introduced into the body via a wound

Question 3

Tetanus prevents the release of which neurotransmitter

Answer 3

GABA

Question 4

Clinical features of tetanus

Answer 4

• fever, lethargy, headache
• trismus (lockjaw)
• risus sardonicus: facial spasms
• opisthotonus (arched back, hyperextended neck)
• spasms

Question 5

Management of tetanus

Answer 5

• ventilatory support
• muscle relaxants
• IM human tetanus immunoglobulin for high-risk wounds
• ABX: metronidazole

Question 6

When are tetanus vaccines routinely delivered in the UK vaccination schedule

Answer 6

2 months
3 months
4 months
3-5 years
13-18 years

Question 7

What wounds are considered tetanus prone?

Answer 7

• puncture injuries in contaminated environment e.g. gardening
• wounds containing foreign bodies
• compound fractures
• wounds/burns with systemic sepsis
• certain animal bites and scratches

Question 8

High risk tetanus prone wounds

Answer 8

heavy contamination with soil/manure

wounds or burns that show extensive devitalised tissue

Question 9

Patient has a tetanus prone wound and has had a full course of tetanus vaccines, with the last dose < 10 years ago.

How should this be managed?

Answer 9

no vaccine nor tetanus immunoglobulin is required,

regardless of the wound severity

Question 10

Patient has a tetanus prone wound and has had a full course of tetanus vaccines, with the last dose >10 years ago.

How should they be managed?

Answer 10

• Further dose of vaccine

If high-risk wound:
- dose of vaccine + tetanus immunoglobulin

Question 11

Patient has a tetanus prone wound and their vaccination history is incomplete or unknown.

Answer 11

For both tetanus prone and high-risk wounds:

• dose of vaccine + tetanus immunoglobulin