TETANUS Flashcards
The definition of probable tetanus according to CDC
CDC defines probable tetanus as “an acute illness with muscle spasms or hypertonia in the absence of a more likely diagnosis”
TRUE OR FALSE: C. tetani is an anaerobic, gram-positive, spore-forming rod whose spores are highly resilient
TRUE
The most common infection sites of tetanus in adults
Superficial abrasions to the LIMBS are the most common infection sites in adults.
- Very low concentrations of this highly potent toxin can result in tetanus (minimal lethal human dose, 2.5 ng/kg)
Risk factors for increased tetanus risk
- Persons >60 years of age
- Diabetes
- People who inject drugs—particularly those injecting heroin subcutaneously (“skin-popping”)
TRUE OR FALSE: Tetanus toxin undergoes retrograde transport into the central nervous system (CNS)
TRUE
- Tetanus toxin is intra-axonally transported to motor nuclei of the cranial nerves or ventral horns of the spinal cord
- Once inside the neuron, the toxin enters a retrograde transport pathway, whereby it is carried proximally to the motor neuron body.
*Following retrograde transport in the motor neuron, the tetanus toxin undergoes translocation across the synapse to the GABA-ergic presynaptic inhibitory interneuron terminals
Muscles of the ______ are affected first, presumably because of the shorter distances toxin must travel up motor nerves to reach presynaptic terminals
Muscles of the face and jaw
- In the typical progression of generalized tetanus, muscles of the face and jaw often are affected first, presumably because of the shorter distances toxin must travel up motor nerves to reach presynaptic terminals.
The most common cause of death in tetanus?
Respiratory Failure
- Without ventilatory support, respiratory failure is the most common cause of death in tetanus.
Autonomic disturbance is maximal during what week of severe tetanus?
Autonomic disturbance is maximal during the SECOND WEEK of severe tetanus
*Autonomic involvement is evidenced by gastrointestinal stasis, sweating, increased tracheal secretions, and acute (often high-output) renal failure
TRUE OR FALSE: The diagnosis of tetanus is based on clinical findings
TRUE
- The diagnosis of tetanus is based on clinical findings
- Treatment should not be delayed while laboratory tests are conducted.
- Culture of C. tetani from a wound provides supportive evidence.
What level of serum anti-tetanus IgG is deemed protective and do not support the diagnosis of tetanus?
Levels >0.1 IU/mL (measured by standard ELISA) are deemed protective and do not support the diagnosis of tetanus.
What is the preferred antibiotic therapy for severe tetanus?
Metronidazole (400 mg rectally or 500 mg IV every 6 h for 7 days)
What is the alternative antibiotic for severe tetanus?
Penicillin (100,000–200,000 IU/ kg per day)
The usual method of securing the airway in severe tetanus
Tracheostomy
Recovery from tetanus may take how many weeks?
4-6 weeks
TRUE OR FALSE: Patients must be given a full primary course of immunization as tetanus toxin is poorly immunogenic and the immune response following natural infection is inadequate
TRUE
