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Appendices

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Section 3. Summaries of Infectious Diseases

Tetanus

(Lockjaw)

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.

Neonatal tetanus is a form of generalized tetanus occurring in newborn infants lacking protective passive immunity because their mothers are not immune. 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 of the latter conditions may precede generalized tetanus.


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ETIOLOGY

C 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 impulses 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. Organisms multiply in wounds, recognized or unrecognized, and elaborate toxins in . . . [Go to Full Text]


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