Tetanus
Tetanus is an acute neurotoxic illness caused by in‑vivo production of tetanospasmin by Clostridium tetani. In the emergency department the priorities are early recognition, neutralisation of circulating toxin, eradication of the organism, aggressive supportive care (airway/ventilation and spasm control) and early liaison with critical care, microbiology and public health.
Microbiology and pathogenesis
- Clostridium tetani: gram‑positive, spore‑forming anaerobe (classic “tennis‑racket” appearance). Spores are ubiquitous in soil, manure and the environment.
- Transmission: spores enter via breaches in skin integrity (puncture wounds, burns, bites, contaminated needles). Tetanus is not spread person‑to‑person.
- Toxins:
- Tetanospasmin (tetanus toxin): a potent zinc‑dependent protease. It is taken up at peripheral nerve terminals, transported retrograde to the CNS and blocks release of inhibitory neurotransmitters (GABA, glycine), producing disinhibited motor neurons, painful spasms and increased muscle tone.
- Tetanolysin: contributes to local tissue damage but is not responsible for the neurological syndrome.
- Clinical correlation: the closer the wound to the CNS (for example head/neck), the shorter the incubation period and the earlier cephalic involvement tends to occur.
Epidemiology and prognosis
- Incubation period: commonly ~10 days (typical range 3-21 days, sometimes longer).
- Mortality: roughly 10-20% in high‑income settings and higher in older adults and neonates; substantially greater in low‑income settings (30-50%+). Neonatal tetanus mortality remains very high without appropriate care.
- Major causes of death: respiratory failure and, in severe disease, sudden...