Tetanus

Question 1

What is the bacterium responsible for tetanus?

Answer 1

Clostridium tetani (anaerobic gram positive bacillus)

Question 2

What is the toxin responsible for tetanus

Answer 2

tetanospasmin toxin produced by clostridium tetani spores

Question 3

What is the normal duration of clinical tetanus

Answer 3

4-6 weeks

Question 4

What are 4 types of clinical tetanus

Answer 4

Cephalic Generalized Local Neonatal

Question 5

What are the treatment guidelines for tetanus prophylaxis

Answer 5

For patients with incomplete immunization (<3 doses)

Clean wound: Td vaccine

Dirty wound: Td vaccine + human tetanus Ig

For patients with complete immunizatio (=/>3 doses)

Clean wound: no intervention unless >10 years since last tetanus, then give Td vaccine

Dirty wound: Td vaccine if >5 years since last tetanus

Question 6

What is the normal incubation period for tetanus

Answer 6

7-10 days (can range from 2-38)

Question 7

What are 5 clinical features of classic tetanus

Answer 7

trismus

stiff neck

opisthotonus

risus sardonicus

board rigid abdomen

periods of apneas/upper airway obstruction

dysphagia

Question 8

What are 4 differential diagnoses considerations in tetanus toxicity

Answer 8

strychnine poisoning

drug induced dystonias

neuroleptic malignant syndrome

trismus from facial/dental infections

stiff person syndrome

Question 9

What are 5 management priorities in acute tetanus toxicity

Answer 9

1. Stop toxin production - wound debridement, antibiotics (metronidazole)
2. Neutralize unbound toxin - human tetanus immunoglobulin
3. Active immunization
4. Control muscle spasms - sedation, benzodiazepines, neuromuscular blockade
5. Manage autonomic instability (supportive)

Question 10

What are high risk features of a wound that suggest the need for tetanus vaccination

Answer 10

wounds contaminated with: dirt, soil, saliva, feces, saliva

puncture wounds

avulsions

crush wounds

wounds from missiles

burns

frostbite