Acute tetanus

Background

1. C. tetani spores enter skin through wound, make tetanospasmin toxin
2. Spores found in soil and human feces
3. 2001-2008 in US, 233 cases, 26 deaths
4. as high as 45% mortality
5. 2 to 56d incubation period
6. if pt survives, no residual sequealae

Types

Neonatal

1. from umbilical stump infection. Usually protected by passive maternal Abs
2. sx- poor suck, irritability, crying, grimacing
3. usually with in 10 d of birth

Local

1. rigidity of muscles near wound- may progress to generalized

Generalized

1. most common form
2. pts are conscious and alert
3. hypersympathetic state c sweating, HTN, tachycardia, fever

Cephalic

1. follow injuries to head or otitis media
2. get CN dysfunction- usually CN 7

Diagnosis

1. sxs for 2 wks- pain & stiffness of jaw, abd, back, diff swallowing, hyperactive DTRs, labile HTN,
2. DX = clinical

Differential Diagnosis

• Dystonic reaction
• strychnine
• hypocalcemic tetany
• PTA
• teritonitis. SAN
• Meningitis
• Rabies
• TMJ

Treatment

• wound debridement
• TIG- 3000- 10K IM- prevents additional dz but does not reverse toxin already fixed to CNS. Binds circulating toxin
• IVF/ hyperal
• quiet room
• sedation with phenobarb, valium or paralytics

Antibiotics

Metronidizole

• 500 mg IV every 6 hours

(<1200g)

• 7.5 mg/kg PO/IV q48h
• First Dose: 7.5 mg/kg PO/IV x 1

(>1200g AND <1 Month Old)

• <7 days old
  • 7.5-15 mg/kg/day PO/IV q12-24h
  • First Dose: 7.5-15 mg/kg PO/IV x 1
• >7 days old
  • 15-30 mg/kg/day PO/IV q12h
  • First Dose: 7.5-15 mg/kg PO/IV x 1

(>1 Month Old)

• 30 mg/kg/day PO/IV q6h
• First Dose: 7.5 mg/kg PO/IV x 1
• Max: 4 g/day

Penicillin

• Although once the drug of choice it is now no longer recommended since it may potentiate the effect of tetanus toxin by inhibiting the GABA receptors

See Also

• Tetanus (Prophylaxis)
• Clostridium