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Section 3. Summaries of Infectious Diseases

Tetanus

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Generalized tetanus (lockjaw) is a neurologic disease manifesting as trismus and severe muscular spasms. Tetanus is caused by neurotoxin produced by the anaerobic bacterium Clostridium tetani in a contaminated wound. Onset is gradual, occurring over 1 to 7 days, and symptoms progress to severe generalized muscle spasms, which often are aggravated by any external stimulus. Severe spasms persist for 1 week or more and subside over several weeks in people who recover.

Localized tetanus manifests as local muscle spasms in areas contiguous to a wound. Cephalic tetanus is a dysfunction of cranial nerves associated with infected wounds on the head and neck. Both conditions may precede generalized tetanus.

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ETIOLOGY: Clostridium tetani is a spore-forming, anaerobic, gram-positive bacillus. This organism is a wound contaminant that causes neither tissue destruction nor an inflammatory response. The vegetative form of C tetani produces a potent plasmid-encoded exotoxin (tetanospasmin), which binds to gangliosides at the myoneural junction of skeletal muscle and on neuronal membranes in the spinal cord, blocking inhibitory pulses to motor neurons. The action of tetanus toxin on the brain and sympathetic nervous system is less well documented.

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EPIDEMIOLOGY: Tetanus occurs worldwide and is more common in warmer climates and during warmer months, in part because of the higher frequency of contaminated wounds associated with those locations and seasons. The organism, a normal inhabitant of soil and animal and human intestines, is ubiquitous in the environment, especially where contamination by excreta is common. Wounds, recognized or unrecognized, are the sites at which the organism multiplies and elaborates toxin. Contaminated wounds, especially wounds with devitalized tissue and deep-puncture trauma, are at greatest risk. Neonatal tetanus is common in many developing . . . [Go to Full Text]

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